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