ADD/ADHD Medications and diving

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There is ADD, just most people diagnosed with it don't have it.

There is no medical test for it, so it is very easy to misdiagnose it.
 
Hi mfalco,

There is ADD, ...

Of course I entirely agree; only a fool would argue otherwise.


There is no medical test for it, so it is very easy to misdiagnose it.

True, there is no test proper for ADHD, but then this can be said about many, many diseases and disorders. In the early days of medicine, there weren't formal laboratory tests of any sort.

Even with the impressive armamentarium of "tests" we have today, it is not uncommon for diagnosis to be based almost entirely on generally agreed upon constellations of observed signs and symptoms. This is especially true of behavioral and psychiatric conditions. And, if the clinician is properly trained and closely adheres to formal diagnostic criteria, misdiagnoses shouldn't be common.

Systems for diagnosing ADHD have been promulgated by the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, the National Institutes of Health and the American Psychiatric Association. All refer to the criteria in the DSM-IV-TR.

These criteria are:

"DSM-IV Criteria for ADHD

I. Either A or B:

A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

Inattention

Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.

Often has trouble keeping attention on tasks or play activities.

Often does not seem to listen when spoken to directly.

Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).

Often has trouble organizing activities.

Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).

Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).

Is often easily distracted.

Is often forgetful in daily activities.

B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

Hyperactivity

Often fidgets with hands or feet or squirms in seat.

Often gets up from seat when remaining in seat is expected.

Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).

Often has trouble playing or enjoying leisure activities quietly.

Is often "on the go" or often acts as if "driven by a motor".

Often talks excessively.

Impulsivity

Often blurts out answers before questions have been finished.

Often has trouble waiting one's turn.

Often interrupts or intrudes on others (e.g., butts into conversations or games).

Some symptoms that cause impairment were present before age 7 years.

Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).

There must be clear evidence of significant impairment in social, school, or work functioning.

The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder)."

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR. In: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence: Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder. Washington, DC: American Psychiatric Association; 1994:92-93.

Regards,

DocVikingo
 
Sure wish I'd spent the 4 years of misery and hundreds of thousands of dollars to go through medical school. Then I could be getting in on the easy sham-diagnosis money.
 
Vlad The Impailer -- always have enjoyed your sense of humor.

Happy New Year, amigo.

Doc
 
Thank you. That does'nt sound too good. I sure hope he can develop better impulse controls as he matures. Hopefully we will be able to take him off of the medicine altogether. I don't guess I will try it while he is on the medicine. An adverse reaction to pressure on medication is more of a concern than his attention span and reaction skills.

I'm not a doctor, and this isn't medical advice, but the existence of a drug and the possibility of diagnosing a condition doesn't necessarily mean that you must apply the drug to the condition.

Oddly enough, there was an explosion of ADHD diagnosis right after the drug companies and specialty food companies found there was money to be made.

Before the advent of ADHD drugs, there were very few diagnosed cases of ADHD because there was no money to be made from it. Most of the kids made it to adulthood just fine, with a little extra work.

Kids are kids. They're by definition immature, make bad decisions and have trouble controlling impulses. That's why we don't let them drive cars, buy guns or sign contracts. I'm sure if you just give him time and let him be a kid, he'll be just fine.

Terry
 
Before the advent of ADHD drugs, there were very few diagnosed cases of ADHD because there was no money to be made from it. Most of the kids made it to adulthood just fine, with a little extra work.

I doubt you can find evidence of this. ADHD was being diagnosed (often under different names such as MBD) before there were any accepted treatments, and was widely recognized by the late '50's before methylphenidate became available. Some (but in my opinion not most) kids with it came out fine. However, we have very well-done long-term outcome research that shows roughly a doubled risk of incarceration and alcoholism compared with controls.

As far as whether money can be made from something or not, that's a bogus criterion. There is vastly more money to be made from high blood pressure, diabetes, or bacterial infections than treating ADHD, and the amount of money spent annually directly on treatment of all psychiatric conditions combined (not the "cost to society," which includes lost productivity) is less than that of several individual general medical conditions.

Keep in mind, too, that our economy has changed very significantly since the 1940's. There just aren't that many openings for "farm hand" any more, nor for the myriad of manual and menial jobs that constituted the majority of jobs in the past. In a service economy rife with paperwork, computers, etc. the problems that might not be that big a deal for a fur trapper present major issues for a store clerk.

I'm not going to get into an extensive debate, but I think the main problem here is confusion between rambunctiousness and ADHD. By definition (the DSM criteria quoted above), the symptoms of ADHD exceed what is normal for childhood and must cause impairment. Thus, if it's not a problem, it can't be diagnosed as ADHD. If it really is ADHD, it must be a problem. All that leaves is the argument about whether the diagnostic criteria are being rigorously or accurately applied.
 
I doubt you can find evidence of this. ADHD was being diagnosed (often under different names such as MBD) before there were any accepted treatments, and was widely recognized by the late '50's before methylphenidate became available. Some (but in my opinion not most) kids with it

Prescription of methylphenidate to children and youth, 1990–1996

There was a huge explosion ADHD diagnosis right about the same time that the drugs became popular.

It just seems to be a happy financial coincidence for the drug companies, along with all the other solutions looking for a problem.

Terry
 
Vlad The Impailer -- always have enjoyed your sense of humor.

Happy New Year, amigo.

Doc
Thanks Doc, Happy New Year to you too. You need a good sense of humor around here. The board is lucky to have your input.
 
I doubt you can find evidence of this. ADHD was being diagnosed (often under different names such as MBD) before there were any accepted treatments, and was widely recognized by the late '50's before


In any event, I have no stake in this, since I have no kids. I'm just wary of over-medicating anybody.

Terry
 
Terry,

Although it is true that ADHD diagnosis and treatment increased in the time period indicated, you are implying the cause of this is that the drug companies and physicians have been in collusion to over-prescribe ADHD medications. Many factors affect clinical diagnosis and treatment numbers: actual incidence and prevalence of the disorder, changes in diagnostic criteria, more research articles being published, physician awareness/training, just to name a few. It is also possible that physicians (being human) might be more inclined to make the diagnosis if there are effective treatments for such a disorder.

It's interesting that the authors of the article which you cite concluded that Canadian GP's should improve their treatment of ADHD patients and bring their care more in line with existing practice guidelines...not that the disorder is bogus. (I realize you were probably only using the citation to support your "numbers" observation.)

I'm glad that the OP is taking a cautious approach in the matter. Kudos to the informative comments by the physicians on the board.
 
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