| Dear Sir, | | | | "First, ADD is not a precisely circumscribed set of |
| It was with some interest that I read the article What | | | | symptoms. The ever-present "often" in the diagnostic |
| You Should Know About Attention Deficit Disorder by | | | | criteria betrays the loose boundaries of ADD, and it |
| Edward W. after having it handed to me by a member | | | | explains why Americans use the diagnosis so |
| of our church. There were elements of the article that | | | | frequently. Almost anyone can squeeze into the |
| were insightful, helpful, and needed to be said in a public | | | | parameters - at least on certain days." - p 59 |
| forum, especially the discussion of the moral and | | | | This statement is also potentially misleading to the |
| spiritual dimensions of behavior. For this part of the | | | | readers. "The ever-present 'often' in the diagnostic |
| article I applaud Mr. W. | | | | criteria..." is very similar to the "ever present" "nearly |
| However, Mr. W's discussion on the physiological | | | | every day" in the diagnostic criteria for Depression. |
| biological aspects of ADD ADHD was lacking to the | | | | The "often" is simply a realistic description of life for |
| point of being misleading to the readers. I am sure that | | | | individuals with ADD. It is not "always" as with a |
| Mr. Welch had no intention of misleading any readers, | | | | structural head injury. It is "often" because it is the result |
| as that would hardly reflect the "biblical guidelines with | | | | of neurological mechanisms being "often" |
| which to understand ADD" that he seeks to | | | | under-aroused and "often" under-performing. |
| communicate. Therefore, for the sake of clarifying | | | | ". . . and it explains why Americans use the diagnosis |
| some details, may I present the following evidence. | | | | so frequently." |
| Perhaps in the near future you would run an article | | | | Studies show that 3% to 5% of the population has |
| that would present some of this information to your | | | | ADHD. Over-diagnosis, if there is any, is not due to the |
| readers, so that they have an accurate understanding | | | | diagnostic criteria, but rather to a lack of a |
| of the disorder. | | | | comprehensive diagnostic work-ups by most |
| "Other books use a biological approach, claiming that | | | | physicians. |
| brain functioning explains every behavior." - p 58 | | | | "Almost anyone can squeeze into the parameters - at |
| I might say that I have read several books on the | | | | least on certain days." |
| biological realities of ADD ADHD, and brain functioning | | | | This is misleading to the readers, and simply not true. |
| in general, and none of them have claimed "that brain | | | | Remember, the DSM-IV also includes these important, |
| functioning explains every behavior." They do, | | | | and highly discriminating, criteria: |
| however, point out the differences in both structure | | | | - Six or more symptoms of Inattention, having lasted at |
| and function of a brain with ADD ADHD, or other | | | | least six months, to a degree that is maladaptive; |
| disorders, vs. brains without these disorders. It is | | | | - Six or more symptoms of Impulsivity-Hyperactivity, |
| misleading to suggest that "books (using) a biological | | | | having lasted at least six months, to a degree that is |
| approach" make such a claim. Perhaps one or two do, | | | | maladaptive; |
| but I am not familiar with any at all. | | | | - Symptoms of the disorder were present before the |
| "In other words, their attention is inconsistent rather | | | | age of seven;Impairment is present in a variety of |
| than universally poor." - p 59 | | | | settings; and |
| This is a fair description, although a better description | | | | - There is clear evidence of clinically significant |
| would be that their attention is "inflexible." People with | | | | impairment in social, academic, or occupational |
| neurological difficulties, whether ADD, head injuries, | | | | functioning. |
| autism, fetal alcohol syndrome, forms of depression, or | | | | The reality is that barely anyone can "squeeze into |
| dementias, have varying degrees of neurological | | | | these parameters." But about 5% of the population |
| inflexibility. Neurological flexibility is a sign of a healthy | | | | can. It is careless to suggest that "anyone... at least on |
| brain. It is the ability to move attention from "global" | | | | certain days" can meet the diagnostic criteria. It also |
| forms of attention to "specific" forms of attention at | | | | conveys a negative picture of those who do actually |
| will, in a fraction of a second. These various types of | | | | suffer with the condition. |
| attention are objective and observable (with PETS, | | | | Would you publish a statement that read, "Almost |
| SPECTs, EEGs, QEEGs, and other technologies). | | | | anyone can squeeze into the parameters of |
| People with ADD have difficulty moving from specific | | | | Alzheimer's - at least on certain days?" I would |
| to global, or global to specific, styles of attention. It | | | | certainly hope not, and yet it is published in connection |
| should be noted that inflexibility of attention is a marker | | | | with ADHD. This is disappointing. |
| of a neurological problem, though by itself is not | | | | This is the end to part one of this discussion. |
| diagnostic of any specific problem. | | | | |