| For decades, attention-deficit hyperactivity | | | | progress in the quest to solidify the dynamics of |
| disorder has sparked debate. Is it a biological | | | | ADHD. "It's a big deal to get this kind of |
| illness, the dangerous legacy of genes or | | | | nonmedicated sample," he added. |
| environmental toxins, or a mere alibi for bratty | | | | Too Much Diagnosis? |
| kids, incompetent parents and a fraying social | | | | The mainstream scientific consensus is that, as |
| fabric? With 4.5 million U.S. children having received | | | | with other mental illnesses, there's no blood test |
| a diagnosis of the disorder -- and more than half | | | | or brain scan that proves an individual has ADHD. |
| of them taking prescription drugs to control it -- | | | | The disorder instead is diagnosed via a checklist |
| the question has divided doctors and patients, | | | | of troublesome behaviors, including impulsivity, |
| parents and teachers, and mothers and fathers. | | | | daydreaming and forgetfulness. What makes the |
| Scientists maintain that they've been narrowing in | | | | diagnosis particularly difficult, Hinshaw said, is that |
| on the origins and mechanics of disabling | | | | those behaviors all fall within the normal range of |
| distraction, while gathering increasing evidence that | | | | human behavior. People with ADHD are simply |
| ADHD is as real as such less controversial | | | | farther out on the spectrum, and, often, enough |
| disorders as Down syndrome and schizophrenia. | | | | so as to wind up in constant trouble. In addition, |
| Their most recent progress is described in a Sept. | | | | symptoms typical of ADHD can also stem from |
| 9 report in the Journal of the American Medical | | | | other illnesses or injuries. Swanson said scientists |
| Association, based on a new study that indicates | | | | are probably years away from a biological test |
| a striking difference in the brain's motivational | | | | for the disorder, though the new study is a step |
| machinery in people with ADHD symptoms. | | | | in that direction. |
| "This is another big piece in the puzzle saying that | | | | Researchers say they've been closing in on |
| there is something there, that this is not simply a | | | | biological differences in people with ADHD, including |
| matter of anxious parents," said James Swanson, | | | | genetic roots -- some scientists have found the |
| a co-author of the report and a developmental | | | | disorder to be more hereditary than schizophrenia |
| psychologist based at the University of California | | | | and only somewhat less so than height -- and |
| at Irvine. | | | | even the relative size of certain brain structures in |
| 'An Interest Deficit' | | | | childhood. |
| The JAMA study said that, compared with a | | | | Popular skepticism persists, with critics ranging |
| group of healthy subjects, brain scans of 53 | | | | from the extreme of Scientologists, who militantly |
| adults with ADHD revealed a flaw in the way | | | | oppose psychiatry in general, to more mainstream |
| they process dopamine, which among other | | | | voices saying the disorder may exist but is |
| things, alerts people to new information and helps | | | | over-diagnosed -- meaning that the powerful |
| them anticipate pleasure and rewards. Swanson | | | | medications used to treat it are being, in essence, |
| speculated that people with ADHD may even | | | | abused. |
| have a net deficit of dopamine. | | | | "My position is that this is a parenting issue," said |
| The findings offer support for a long-held theory | | | | John Rosemond, the psychologist who writes the |
| about why people with ADHD tend to be so easily | | | | nationally syndicated column "Traditional Parenting" |
| distracted and bored -- so hard to teach in school, | | | | and calls ADHD a "fiction." Rosemond said he |
| so prone to end up in high-stimulus jobs such as in | | | | hadn't yet read about the dopamine study, but, in |
| sales or the media, and so susceptible to gambling | | | | a phrase frequently used by naysayers, |
| and drug abuse. According to the theory, the | | | | maintained that the symptoms associated with |
| trouble is a lack of motivation as well as a deficit | | | | ADHD "describe a typical toddler." |
| of attention: People with the disorder can't | | | | Volkow acknowledged that sometimes ADHD is |
| generate the same degree of enthusiasm as | | | | applied to children who don't fit the medical |
| other people for activities they don't automatically | | | | criteria, including bright kids who misbehave when |
| find appealing. | | | | they get bored. But she added that the disorder |
| "Parents always wonder why their children with | | | | is at least just as often under-diagnosed, in which |
| ADHD can skateboard for hours and practice the | | | | case, she said, "the tremendous misinformation" |
| same thing over and over but can't stay on task | | | | promulgated by critics does harm to people who |
| in school," said Swanson, who said he and fellow | | | | ought to be getting help. Longitudinal studies have |
| researchers have taken to calling the syndrome | | | | shown that untreated children with ADHD are |
| "an interest deficit." | | | | substantially more prone than those without it to |
| The project was led by Nora Volkow, a research | | | | a long list of dangerous outcomes, including drug |
| psychiatrist who is director of the National | | | | and alcohol abuse, academic failure, car accidents |
| Institute on Drug Abuse, together with scientists | | | | and teen pregnancies. |
| affiliated with institutions including the Brookhaven | | | | The syndrome first appeared in the psychiatrists' |
| National Laboratory and the Mount Sinai Medical | | | | atlas, the Diagnostic and Statistical Manual of |
| Center. It took eight years to complete, mostly | | | | Mental Disorders, in 1987, replacing "attention |
| owing to the difficulty of finding people with | | | | deficit disorder," which is still frequently used by |
| diagnosed ADHD who had never taken medication | | | | authors and other commentators. In previous |
| or recreational drugs, which might have subtly | | | | decades, the same group of symptoms had been |
| changed their brains, and had no history of other | | | | referred to with names including "minimal brain |
| serious psychiatric illness. Children weren't involved | | | | dysfunction" and "hyperkinetic impulse disorder." |
| because of regulations against subjecting minors | | | | Progress in the search for biomedical markers for |
| to unnecessary radiation. | | | | ADHD might seem to help justify medication, |
| Volkow's team collected detailed images of | | | | including pharmaceutical stimulants, now the most |
| participants' brains with positron emission | | | | common U.S. intervention. Indeed, research has |
| tomography, or PET, scans after injecting them | | | | shown that stimulants help alleviate the classic |
| with a radioactive chemical that binds to dopamine | | | | ADHD symptoms in the majority of cases. |
| receptors and transporters, which take up and | | | | Volkow, nonetheless, said she believes in trying |
| recycle dopamine as it moves between neurons. | | | | behavioral therapies first, using drugs only if those |
| The imaging showed that, in people with ADHD, | | | | aren't effective. She said her team's findings |
| the receptors and transporters are significantly | | | | underscored the value of having teachers be as |
| less abundant in mid-brain structures composing | | | | engaging as possible and of having parents |
| the so-called reward pathway, which is involved in | | | | reinforce good behavior with skillful praise and |
| associating stimuli with pleasurable expectations. | | | | rewards. |
| Stephen Hinshaw, chair of the psychology | | | | "Our brains are hard-wired to respond to bribes," |
| department at the University of California at | | | | she said. |
| Berkeley, praised the study as being "above and | | | | And that goes even more so, apparently, for |
| beyond the normal rank and file" of incremental | | | | brains with ADHD. |