31 thoughts on “DSM Revisions and ADHD: Should You Care?

  • January 3, 2012 at 7:06 am

    It’s hard to summarize the planned changes for the DSM-5 because, contrary to what you’ll read in many places, the DSM is still being worked on. Nothing’s been finalized. So what will and will not appear in the final volume is pure conjecture and speculation at this point.

    The DSM-5 website is the best place to start to see what’s being considered: http://www.dsm5.org/

    They compare what’s being proposed to what is already in the DSM-IV on the site, but only on a disorder-by-disorder basis.

    Here’s my previous summary about major changes in the DSM-5:

    http://psychcentral.com/blog/archives/2010/02/11/a-review-of-the-dsm-5-draft/

    As for input, the DSM-5 had an unprecedented open-comment period in 2009 (in comparison, the DSM-IV had no open comment period for the public). In May 2010, the APA announced that 8,600 comments they had received helped them make changes to the DSM-5 draft:

    http://psychcentral.com/blog/archives/2010/05/30/you-do-make-a-difference-in-the-dsm-5/

    (Keep in mind, the revision process started something like 12 years ago!) So unfortunately, the time for comments is long-closed, as they gear up to finalize things and get ready for publication next year.

    I can’t speak for clinicians, but I know that when the DSM-IV came out, practitioners didn’t much like it. It meant they had to learn new diagnostic criteria for many of even the common disorders they diagnosed, as well as learning all about brand new disorders added to the manual. The same will likely be true for this revision.

    Sorry I can’t really speculate on how this may impact people with a specific diagnosis. By and large, I don’t believe there are any significant changes in the ADHD category, other than the recognition from practice that adults often carry fewer symptoms than children do.

    Best,
    John

    Reply
    • January 3, 2012 at 7:29 am

      Dear John,

      Thank you so much for your quick response. This certainly clarifies a few of my questions. I was pretty sure it was too late to comment on the DSM-5 revision process to the committee, and I was aware of the call for input when it came, but had barely been diagnosed with ADHD at the time and was still trying to wrap my head around the diagnosis and what it meant for me personally. Ironic that it was through blogging for Psych Central that I’ve found my voice, but found it too late to add it to the debate.

      None the less, I’m grateful for the opportunity to share these and other issues with the ADHD community, and would like to welcome anyone else out there with thoughts about this topic to feel free to add them to our discussion.

      Cheers,
      Zoë

      Reply
  • January 3, 2012 at 7:25 am

    Some diseases have a positive and negative syndrome. These include bipolar disorder (mania and depression­), schizophre­nia and Graves’ disease. The conclusion of my own research is that ADHD is the positive syndrome of autism.

    There is pronounced co-morbidi­ty between autism and ADHD (http://www­.ncbi.nlm.­nih.gov/pu­bmed/19908­138), and overlappin­g genetic influences (http://www­.ncbi.nlm.­nih.gov/pu­bmed/20148­275). Both conditions have a pre-school age of onset and the ratio of 4 affected males for each female is the same in both. Folate pathway enzyme abnormalit­ies are seen in both autism and ADHD and there is also an associatio­n with prenatal exposure to similar chemicals, including pesticides­, phthalates and mercury in both.

    A fuller explanatio­n can be read on my blog:

    http://www­.nfkbdisea­ses.wordpr­ess.com

    Reply
    • January 3, 2012 at 7:41 am

      Thanks for your input, William.

      I’m amazed at how many other conditions / disorders appear to overlap or have a connection with ADHD, and this would make a good topic for a future post.

      As for my question, will the DSM-5 help mental health practitioners more readily identify ADHD as opposed to conditions with similar symptoms and presentations, the only connection I’ve found to the proposed DSM-5 revisions that mentions other disorders is found in the “Hyperactivity and Impulsivity” category:

      2. E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

      From: American Psychiatric Association DSM-5 Development Proposed Revision for Attention Deficit/Hyperactivity Disorder

      …the discussion continues. Thanks for your input.
      Z.

      Reply
  • January 3, 2012 at 6:34 pm

    I think that ADHD and ADD are often over diagnosed in a country were we have now standardized human behaviour. Shy is social anxitey sadness or grief is now depression and so on. I have a very hyper three year old girl and one time my neighbor said are you going to get her medicine for that ADD. I looked at her in shock and went off like a bomb Three year olds are suppose to be active they are not suppose to sit in front of the television with drool running out of their mouth all day long so its easier for me to do what I want to do or need to do. As far as adults go with ADD or ADHD good grief! I am a textbook definition of ADD and I do well in my career, I did well through college learn some self discipline, its not a diseases its poor self discipline. The DSM also has a mental illness for teenage rebellion I wonder what will the psychological community come up with next as a “mental” illness.

    Reply
    • January 3, 2012 at 7:13 pm

      Hello Melissa.
      I appreciate your taking the time to read and to respond to my blog post. You are entitled to your opinions, as are we all, but as stated, I’m not quite sure what they are.

      First, you state that:

      ADHD and ADD are often over diagnosed in a country were we have now standardized human behaviour.

      Then, you state:

      its not a diseases its poor self discipline.

      …which seems to imply that ADHD does not exist, in which case, it is not “over-diagnosed” it cannot be diagnosed at all because in fact it does not exist.

      Also, to say that shyness is the same as “social anxiety” and to equate “sadness” or “grief” to depression (I presume you’re referring to clinical depression here, as you’re responding to a blog post about the DSM), is pure poppycock and shows a profound ignorance around what a clinical diagnosis and appropriate treatment entails. To trivialize either of these conditions by this comparison is not only erroneous, it is dangerously misleading. Surely someone experiencing “sadness” would not commit suicide, whereas plenty of people with deep clinical depression have. These are not trifling distinctions: they are potentially life and death differences.

      To be honest, I don’t have the energy right now to respond fully to your comment. I have written at length about why ADHD exists (see, Flat or Round? You Be the Judge!, and how my diagnosis and treatment has helped me immensely where exercise, diet, meditation, therapy, etc. couldn’t. The fact that you’re calling it a case of “poor self discipline” is simply ignorant and insulting. (Ignorant in the formal sense of the word, meaning: lacking knowledge, comprehension, or education).

      If my Herculean efforts to be a more productive and kinder person EVEN BEFORE MY DIAGNOSIS were not a case of “self discipline,” I don’t know what is. Further, BEFORE my diagnosis and treatment, and in spite of the fact that I read very slowly, I’m highly distractable and impulsive, etc., I managed to get a second university degree through sheer determination and tenacity – two hallmarks of a self-disciplined and highly motivated person as far as I’m concerned.

      Treatment for ADHD has allowed me to USE the self-discipline I already had more effectively. I hate to think of where I’d be if I DIDN’T have that innate self-discipline.

      I’m led to wonder, if ADHD doesn’t exist (and you are certainly not the first to question the existence of adult ADHD), and if the DSM is so inherently flawed, why on earth are you reading a blog about ADHD and a post about a cultural artifact that clearly has no value to you?

      How about we just agree to disagree.

      Z.

      Reply
  • January 3, 2012 at 11:19 pm

    First, I will confess that I have no clinical/medical background and my experience with ADHD likes, primarily, in my own experiences with it and my observations of my son. Those experiences and observations are limited to the inattentive flavor of the disorder. Still, I’m motivated and have been doing a great deal of reading/questioning over the last few years. By this point there must be something I can add to the discussion so… here goes…

    I’ve been coming to terms with an ADHD diagnosis of my own (and that of my son) for almost three years now. One of the conclusions I’ve come to over this time is that the ADHD term needs to be scrapped. While it made sense to take the various diagnoses and put them under one label once it was realized that it they were all descended from one underlying dysfunction in the brain, it’s done nothing but fuel the already mad frenzy of confusion and lies surrounding the diagnosis. Countless people (including children) are, in my opinion, being harmed by this trend.

    We need to let go of the safe/familiar ADHD label and start over again, bringing the diagnosis back to the core problem of comparatively poor functioning in the prefrontal cortex and other areas of the brain. Create as many subtypes out of that as you need to but let’s start with that instead of trying to lump seemingly unrelated symptom groups into an already existing and maligned label.

    Too many explanations of ADHD try to start with the symptom base and work backwards to the diagnosis and then the cause and, in my experience, people just don’t buy into it. As soon as you’ve established a picture of the symptoms, they’re already making judgements about the people in question or their environment and these judgements color their ability to impartially hear the rest of the explanation.

    I’ve tried many times, with my most recent version put up for criticism in my blog (honest, that’s not meant to be a plug), to develop explanations that aren’t excessively long winded but still draw the picture of ADHD from the ground up and don’t bring individual behaviors into the picture until the mechanics of the disorder are already established. I’ve had relatively good experience in the past, in the sense that I’ve observed… well, perceived… a greater deal of empathy from people I’ve tried this approach with than the others.

    It seems to me that, until we start making changes in how we present the disorder and how we classify it, we will be forever dealing with comments like those from Melissa. Sometimes I can’t decide whether I want to scream, cry or both when I hear the things people say about ADHD with such confidence and authority, despite having put even less time into researching it than I have.

    Reply
    • January 3, 2012 at 11:47 pm

      Hi Michael.

      Wow, thanks for your long, insightful, and passionate contribution to this discussion. And please don’t worry about mentioning your blog, the more voices from ADHDers the better. I would love to hear if you have in fact come up with a new name for the condition that you feel more comfortable with. Also, I’m wondering if it’s the label, or the attitude towards it that has to change? In other words, do we have to just keep plugging away at educating the public? After all, a term like “depression” took several decades for people to understand as well as we do today. It’s still not a warm & fuzzy word (or diagnosis), and there’s probably no way to make it so, nor should we, but it doesn’t hold the stigma that ADHD does. I think it takes more than picking the right name to overcome the stereotypes, misperceptions, misinformation and outright prejudice and stigma. I wish we could do it with just a name change, but unfortunately, it’s going to take a lot more than that. (Keep up the blogging! It’s important!)

      Also, I quickly read one of your blog posts and skimmed another (it’s late and I’ve been up since 5:30 a.m. working), and would like to encourage others to read your excellent work, too.

      Michael’s Blog:
      This is how it feels.
      My Current Understanding of ADHD

      Ok, so I can barely think at this point, so I’d better get some sleep. Thanks again for taking the time to read my blog, and especially for taking the time to write your comment.
      Z.

      Reply
  • January 4, 2012 at 12:56 pm

    Hi Zoe,

    Thanks for all you do. I’m finishing my phd in engineering this year, and was finally diagnosed with ADHD about a year ago. It’s been amazing to be able to stop asking myself “what’s wrong with me?” all the time, and begin to learn about and understand the glaring inconsistencies between my intellectual capability and my inability to be on time, keep anything remotely clean or organized, etc. etc….

    I sense and empathize with your frustration addressing comments from people who are obviously mis- or uninformed about the physiological nature of ADHD, and the difference between the normal attentional deficits or lapses that affect everyone sometimes, and the debilitating, chronic neurochemical condition that warrants an ADHD diagnosis. Surely you’ve been dealing with and confronting this situation for a long time. As an academic researcher, I’d like to become a more public voice to advocate for the understanding of ADHD. How do you handle the internal emotional reaction to these types of situations?

    Thanks!
    Sacha

    Reply
    • January 4, 2012 at 4:29 pm

      Dear Sacha:

      You’re so welcome, and thank you for taking the time to read my blog and to share some of your story. I’m so glad the world has another ADHD advocate! Yay!

      I totally relate To your first paragraph; it’s such a relief to validate who we intrinsically know we are as opposed to what our, at times inappropriate behaviours might seem to otherwise indicate. On the other hand, it’s pretty depressing to think what might have been had we received their diagnosis much earlier in life. I don’t know about you, but I went through an emotional rollercoaster after my diagnosis which included an intense grieving stage. This seems to be pretty common amongst those of us who are diagnosed late in life, as you already know if you’ve been following my blog.

      As for my frustration in regard to comments that come from those who are ill-informed and are inconsiderate, rude, or downright hostile or aggressive, I’m sorry to say that I usually handle them much better than I did the last one. It’s one thing to be ill-informed but respectful; it’s quite another to be judgmental, insulting, or otherwise abusive in one’s commentary. I admit that I was already at the end of my rope, exhausted, and had very little patience the last time I responded to such a remark. This is no excuse, but it is the reason that I was less able to adhere to my personal Intention to always, no matter what, respond with courtesy if not kindness to all remarks, no matter how over-the-top they might be.

      As for your question, “How do you handle the internal emotional reaction to these types of situations?” I have quite a few strategies in place:

      – I let myself express my uncensored anger to close friends or in writing; I would never do so in public, or in my professional realm. However, I think it’s important to accept one’s feelings and not judge them, and to express them in a safe way (i.e. in a way that will not harm others); but it’s equally as important to have a cool down period to gain one’s perspective, and to take time to create a more measured response that takes into account the fact that there are many truths. I realise that no matter how much effort I put into educating others about ADHD, these comments are still likely to come for some time, and I can’t afford to let them sap my energy. I need my energy to work for positive change.

      – if I’m in a vulnerable state when I receive a negative comment, I might go outside for a walk along the river to give myself a chance to release any negative feelings and to come back to emotional balance

      – while walking, I remind myself not to take anything personally; I review the material in The Four Agreements by Don Miguel Ruiz, one of my favourite philosophical gurus

      – I write my response when I’m ready, remembering that this is yet another opportunity to spread information rather than misinformation; and to educate others about ADHD

      – I let go of the outcome and remind myself that I’m only in control of MY words, beliefs, and actions, not anyone else’s, and that there’s only so much I can do

      – If I’ve done my best (another of the Four Agreements), then that’s enough

      Hope that helps!
      Take care, and let us know how it goes.
      Cheers,
      Zoë

      Reply
  • January 7, 2012 at 7:36 pm

    The DSM issue is a complicated one and seems to push a lot of people’s buttons. I can empathize with people who are concerned about the proliferation of mental illness diagnoses.

    As a HSP, who writes about HSP health, I am aware that ADHD is included in the list of illnesses that affect highly sensitive people. So to me the good news seems to be that we are finally recognizing the health challenges of highly sensitive people although I hope that in doing so, we are being mindful and not just pathologizing the stress and strain of human life.

    Reply
    • January 8, 2012 at 11:48 am

      Maria,
      You make some excellent points, and I agree; the intricacies of crafting such a tool as the DSM is a complicated and emotionally-wrought issue. I’m glad you’ve shared your insights, especially in regard to the connection between ADHD and being an HSP.

      Thanks for taking the time to weigh in!
      Z.

      Reply
  • January 10, 2012 at 10:15 pm

    I was out the pharmacy & my Adderall went from $20.00 to $ 134.00 that is some increase in price, they also told me that I might not be able to get adderall any more, I am highly allergic & adderal has been the only med I can take for my ADHD I don’t know what I am going to do.

    Reply
    • January 10, 2012 at 10:46 pm

      Hi Adele.
      I’m so sorry to hear you’re struggling. A while ago, I gave a few ideas about help with paying for prescriptions. My comment including these ideas (one of which only applies to Concerta, but the other is more general) is the third one to this blog post here at Psych Central:

      DEA Doesn’t Seem to Care About ADHD Medication Shortage

      I have no idea if the pharmacists in the US offer free advice, but they do in Canada. Perhaps there is a pharmacist who can discuss an alternative with you, taking into account your allergies? There are so many medications for ADHD, and new ones coming on the market all the time, perhaps there is one that might work for you and also be affordable. I wish I could help more, but those are a few ideas. Please don’t give up on finding an appropriate treatment, it might just take a little more digging. Also, if you are not on your ADHD medications, remember there are alternative treatments that a lot of folks (including me) have found help to manage their symptoms. Physical exercise and meditation seem to be two of the most effective.

      Does anyone else have any ideas for Adele?

      Good luck, Adele. I hope you find what you need!
      Cheers,
      Zoë

      Reply
  • January 12, 2012 at 4:35 pm

    Dear Zoe,

    This is written as a devoted, professional ADHD insider, looking from the outside inwardly toward the field’s scientific inquiry.

    Here are a few comments of mine, made regarding your 2011 blogs. Your essay, “The DSM-V Should We Care,” really captured my attention, even more than several others of your contributions, for multiple reasons. In reviewing my Zoe Blog file with a half-dozen, never sent responses, written out to your essays, in which your insightful rhetorical questions were elaborated upon.

    I never completed my responses because I realized that to actually answer your niftily constructed queries, required me stepping outside our domain’s popular literature.

    Men such as John Ratey and Ned Holloway, as ADHD authorities you aptly quote, are both friends, especially John. I feel a lifetime’s indebtedness for my psychological salvation, due in large part to their publications.

    I took the time to read over all your Psych Central blogs and discovered an isomorphic pattern amongst the entire series. The following six qualities appear in all your blog essays.

    • Your touching upon highly relevant and sophisticated issues surrounding ADHD

    • You infer or state the likelihood of pertinent data existing, not found in available literature

    • Your posing, in light hearted fashion, critical, rhetorical questions

    • The comments you make of there being potential answers to your proposed questions

    • You ask either directly or indirectly if some knowledgeable professional is accessible to complete your reasonable, implicitly loaded queries
    • Your expressions of righteous incredulity that our existing literature appears devoid of the pertinent data

    It is frustrating to me personally as a well informed ADHD professional specialist, who takes in a larger perspective of the foundational neuroscience supporting the field’s empirical evidence, to witness your questioning without responding.

    The researchers, theoreticians, and clinicians constituting the body of ADHD North American professional and lay publications, are owed much gratitude, appreciation, respect, and love by me on a multitude of levels.

    Ironically, my professional stance provides me a vantage point, from which their numerous islands of strength as well as their domains of neglect, become obvious.

    As one who bootstraps much of my technical knowledge, and pulling from a wide swath of inter-disciplinary science, all of the varied domains are concerned with essential functions, relevant to that cluster of symptoms, known as ADHD. My point of view is askew from the mainstream ADHD North American literature, probably due to my unique type of acquired ADHD.

    The last thing I want to do publicly is to appear critical or judgmental toward the professionals, who have quite literally, liberated me from the needless suffering of life, until my self-diagnosis occurred in 1996, when at age forty-seven. Never the less, this is the 21st century and with clearly defined patterns emerging, a vivid description of the field’s incoherence has become obvious and deserving of “attention,” from an insider, looking from the outside, inwardly.

    Finally, a comment of the exchanges published by other than yourself on the DSM-V, an intentionally imperfect document, that compared to editions I and II, reflects one of the most reasonable advances in mental health science in a centuries progress, warts and all. The DSM issue is thorny beyond your wildest imagination, as witnessed by more recent commentary on Psych Central’s continued discussions. My view of the DSM-V discussion thus far, is the dialogue is behind the normal curve of thought in scientific philosophy and still struggling over false dualism’s, as residual arguments from our per-scientific era, debated during the “Behaviorism Wars” (Skinner vs. Rogers), circa 1969 through 1980. The astute questions from your “Should we Care,” have been asked and answered for ADHD, three years ago, in a shamefully shallow, official public forum for feedback.

    To view my less inflammatory comments, specially addressing ADHD with related subjects of medications, psycho-pathologies, and the disorder’s nature, survey my practice’s website on Psychotherapy Discussions.

    Reply
    • January 12, 2012 at 7:44 pm

      Dear John:

      I must confess I am not entirely certain what you are trying to say here, but by your choice of words it appears that you are unhappy with my blog posts. If you have a specific concern about my blog posts, I’m unclear as to what it is.

      I’m also confused by: “Men such as John Ratey and Ned Holloway, as ADHD authorities you aptly quote, are both friends…” I honestly cannot recall having quoted John Ratey, ever (although I have quoted Nancy Ratey, author of The Disorganized Mind), and I have never heard of your friend Ned Holloway, and so of course could not possibly have quoted him. If, however, you are referring to Dr. Ned Hallowell, aka Edward M. Hallowell, M.D., co-author of Driven to Distraction and many other books, (and I try not to make assumptions, but perhaps that’s whom you are referring to), if that is the case, absolutely of course I have quoted him. I have interviewed Dr. Hallowell on various occasions both in person and otherwise, for blog posts here at ADHD from A to Zoë, as well as for feature articles for ADDitude Magazine. I too remain grateful to both Dr. Hallowell’s and Dr. Ratey’s contributions to the field.

      In regard to absence of literature in the field of ADHD, I still contend that there is precious little published research specifically in regard to girls and women with ADHD. I am pleased that this is changing, and have certainly accessed and refer to the studies that are available in my ongoing work as a journalist, blogger, and author who takes a special interest in women with adhd. In addition to my research, I attend online webinars with other professionals, and conduct ongoing interviews with professionals in a wide variety of fields to gain a deeper understanding of the complex and myriad issues of ADHD.

      Simply put, I am trying to educate myself and others about ADHD, particularly in adults and with a special focus on women. And yes, I do try to present some of the information with humour. One of the messages I take from your comment, although this is not particularly clear either, is that it appears that you do not enjoy my form of humour. I am quite comfortable in the knowledge that not everyone will enjoy my particular sense of humour, or my writing, or agree with the opinions expressed herein.

      That said, I’m delighted that I have had an overwhelmingly positive response to my blog, which I have been writing now for nearly two years. I trust that you will look elsewhere if you find my writing of no value; I invite your comments if you would like to correct me on any points I make, or to express a different opinion. These discussions add a lot to any blog, and of course I realize I am not infallible. If I put forward any inaccurate information, you are welcome and encouraged to respectfully correct me, and for that I would be grateful.

      Zoë

      Reply
  • January 12, 2012 at 7:33 pm

    I saw the part on the “open comment” period on DSM 5 that Dr Grohol mentioned, and would like to comment on that subject.

    How come anytime there’s an “open comment” period or meeting on just about anything, the public (especially those most affected by any changes) hardly EVER hear about them???

    Reply
    • January 12, 2012 at 8:03 pm

      Phil,
      I too am frustrated. In particular, I am frustrated with myself in that no matter how much effort I put into it, there is just so much information out there that I can’t possibly keep track of it all. The point of it for me is, I actually do have ADHD. I have only been diagnosed late in life (at age 47) and as such have only been implementing strategies and treatment for a relatively short time.

      Sometimes I just think that there’s so much info available that it’s impossible not to miss some crucial piece at some point or another. Personally, all I can do is to continually seek to improve my organization, networks, time management, etc., all in an effort to keep on top of at least the priority issues for me. I realize I can’t know it all, or know everything about any one topic, but what I do hope to do with this blog, in part, is to at least raise some questions and some awareness around some key issues or topics of interest. Readers can then at least search independently for more information on any given topic online.

      Z.

      Reply
  • January 13, 2012 at 12:00 am

    Zoe,
    I will explain shortly, but in no way are your pieces anything outer than outstanding materiel, attempting to shine light on neglected areas of ADHD study.

    I tap dance around being critical of a field that could and should provide you with direct answers to each and every. I would love to pour fort with answers to your questions but am concerned that the ADHD is not prepared to hear the facts.

    Seven years with the upper levels of administration at CHADD, has me me shy to speak my mind. The sub-text to my comments was quite plain. All of your comments over the year have been absolutely on target, yet are not allowed impliedly acceptable as part of public discourse over ADHD.

    One small example concerns the DSM-V, which has been a done deal years ago,without any room for meaningful debate. My guess is that by 2006-7, the APA had the situation closed off for any further conversation. The actual issues run far deeper than reflected in the current running blogs.

    I will review my comments to try figuring why they “appear unhappy,” when the opposite is the case.

    You will hear from me soon.

    Reply
    • January 13, 2012 at 9:49 am

      Hi John.
      I’m so glad to hear from you again. When I finally calmed down and went to bed (late) last night, I began to feel very badly in that I was less than kind at times in my response to your comment. Please accept my apology.

      I hope we can agree that we’ve had a misunderstanding. Perhaps I did not read your comments carefully enough (although I did read them over twice, slowly). The harshness that crept into my response (and this is no excuse, but a reason) was partly born of the fact that your comment arrived just prior to a very nasty e-mail from a total stranger. I was blindsided, shocked, and just digesting the meaning of it when that individual phoned me at home, after business hours (this was a professional contact, not personal, and a total stranger). Within the first minute it became clear that the individual was angry about something else, and that I’d become a target for this anger. Our phone call ended on a much more positive note, and we seemed to reach an understanding (I believe, but one can never be sure), but I was none the less pretty shaken up by the incident, especially as it came upon the heels of your comment. I probably should have waited until the next day to have responded to your comment, but I felt that your lengthy comment deserved a response. I thought I’d calmed down enough to do that.

      Again, thank you from the bottom of my heart for clarifying your true sentiments.

      And to be clear, I truly am open to criticism, differences of opinion, and especially to be corrected on any point; I would not be writing this blog if weren’t. It’s just difficult sometimes to be in the public eye, especially when one is an HSP, and especially when one is over-tired and under pressure with work (as I am at the moment).

      *sigh* I guess if being human were easy, I’d get terribly bored. I do, after all, have ADHD!

      Take care, John.
      Z.

      Reply
  • January 13, 2012 at 9:18 am

    I’m just saying that usually when they have an “open comment” period on something that is to be changed, the public usually doesn’t hear about it until it’s too late…

    I really enjoy your posts!! Keep writing, you’re doing better than I probably would!!

    Reply
    • January 13, 2012 at 9:24 am

      Thanks, Phil. I need all the encouragement I can get right now. Yesterday was quite a day.
      Take care!
      Z.

      Reply
  • January 14, 2012 at 8:36 pm

    Zoe,
    As my clients are told when they unnecessarily apologizing, “forget about and it rarely never necessary with me personally.”

    This was carefully composed before reading your addition and very touching comments. I cannot imagine being blind-sighted by a hostile email let alone have home calls, harassing me, particularly under your circumstance. So here is my attempt to make clear the original blog contribution, that you can consider to be my first such internet experience.

    Alright, this is my third “finalized draft” of my response from the first entry. After reviewing all of your years’ blogs, I concluded your thought process and fundamental attitude toward the field is ideally suited for being a potential vehicle for significant change by means of your public communications.

    I have realized after careful reflection, my fastidious attempt to be just ambiguous enough, to allow you to read my “between the lines” sub-text, was a failure. In retrospect, something different occurred, that now makes perfectly good sense. My neglect of having considered your relatively recent diagnoses, the comments I made intended to be recognized by you as an attempt to communicate an inferred message. The opposite happened, and instead triggered your “negative expectations,” brought on by my poorly articulated text, and suggested to you displeasure for your remarkable and thoughtfully constructed blogs. I had erroneously assumed you would disambiguate my professional predicament as an “insider, looking from the outside, inwardly,” without having first framed my precarious circumstances.

    The famous scientific philosopher Daniel Dennett, terms my mistake as the “frame issue,” an unfortunate oversight on my part. Borrowing from the emanate psychiatrist, social phenomenologist and systemic humanist R.D. Lang, who characterized my professional predicament best in a book of poems, titled “Knots,” be opens with:
    “They are playing a game—I see they are playing a game. If I tell them I see they are playing a game, then they will say I am ‘crazy or bad.’ Therefore, I must play a game—-at not playing a game.”

    Today’s Social neuroscientists call this “strategic deception,” technically a component part of Executive Functioning, which secures one’s social affiliations. The Social-Cognitive Developmental Theorists, the academic canapé for ADHD study, would refer to this as being “self-efficacious deception.”

    Neuropsychology sometimes classifies my concerns as being a sub-set of “social viscosity” (to flow with people), sometimes expressed as “political acumen,” a critical social skill-set for coordinating collaborative actions, which becomes critically adaptive for maintaining one’s social positioning within a group.

    Consider this real-time, real-life example of the situation, I find myself when writing.
    What is known by me about the DSM-V is only the “tip of the iceberg,” yet each and every question posed by your Should We Care, can be answered by me in detail, particularly those concerns regarding ADHD. Other then my publicly explaining how the APA has concluded discussion about ADHD years ago and is currently in their final phase of field validation studies, the document should be considered as almost on its way to the printer. Stretching my neck out, I could add the community of ADHD science was basically cut out of the process, which was a “bit upsetting” amongst our nation’s researchers, which is yet “another under statement” on my part. My publicly blabbing about the “back story,” over the complex dynamics that took an egregious several years to finally arrive at our Fifth Edition, would be “professionally inappropriate.” In “Social Neurocognitive” terms, I have no “Permission Schemata” from the larger professional collective for my sharing this data publicly.

    Since my self-diagnoses in 1997, I have learned the difference between “right and wise,” now preferring to error behaviorally on the side of “wise over right.” My initial comment was a poor attempt to choose wisdom. You might conceder the last communication as an experiment in constructing a trans-dialectic pathway for my side-stepping over the group’s homeostatic dynamics. I an attempt to work toward a meaningful change, this was an effort in searching for new ways to communicate with a wider audience while avoiding breaking the professional meta-rules that implicitly dictate, fitting comportment when discussing substantive inside issues. There are even professional “confidentially agreements” that have singed by me over the years, so to say the meta-rules are implicit is yet another understatement.

    The covert dynamics of cultural orthodoxy and ideological rigidity found inside our applied psychological behavioral and medical sciences, especially the field of ADHD study, are in desperate need of collective reappraisal, overtly discussed in ADHD science. If the field does not change their insulated networking, “willfully blind” refusal to become laterally inclusive, extending ourselves to intra and inter-disciplinary connections, then ADHD science will inevitably become doomed by increasingly marginalized and discounted by or allied, mainstream neurological, psychological, psychiatric, and neuroscience fellow networks.
    As with so many ADHD traits such as “social perspective taking, error insensitivity, flexible shifting of mind-sets, and self-constructed identities,” this filed “does play well with others,” which all reflect the disorder’s impaired “self-efficient” conduct, of our collective behavior.

    The fact, that for me personally or professionally, I may not believe in “resistance” as a meaningful concept, when it comes to considering as objective, a complex interpersonal phenomenal as existing apart from being a state within our cognition, then my unique view can become a useful optic in this particular situation. Without some of us holding on to a belief that such rigidity in ADHD science is not preeminently ossified, then some change must be possible. There should be a strategy for addressing the field’s orthodoxy; given the situations seemingly fixed state is not an essentially empirical objective fact that we must live with. It stands to reason that change is a realistic potential for the field, given adequate amplitude and clarity in communication, there must be an option of supporting an emergent social reality for the professions feed-forward maturation.

    If a single person can change, as we both know to be true based upon our personal experience, then it stands to reason any collection of persons can just as well mature into more actualized persons.
    The vicissitudes of life experiences, have taught me that people finding them sleeves impotent and ineffective in solving any problem they may confront or avoid, their reflex is most often to instantly become blameful toward an external force, with attributions of causation. A preferred language construct for the applied behavioral sciences, is to assert an attribution of the person or groups as being “intractable,” with “the problem” being there as “resistance to change.” As one who embraces a process-oriented, Interactive-Constructivist frame of reference (optic), with the Locus of Control being in our “propitiatory domains” as Central Executive Agents. Consequently, as change agents that share responsibility for our life’s difficulties, rather than as “victims of the problem’s plight,” then a reason must exist for there being some way out of R.D. Lang’s “double-bind.”

    If such a way out can be found, which I believe is a probable actuality, it is within our conceptualization of the problem’s nature, and not an apparent, externally difficult problem that we confront. We must apply the instrumental pragmatism that a cognitive process-oriented worldview, infers. Such a social-cognitive frame, would suggest we view human problems as well as their solutions, as existing “above the eyes and between the ears” and not “out there” as an eternality, if we actually want a constructive impact upon our life circumstances.

    I am committed to finding such a pathway toward progressively improving, our field’s feed-forward elevation of those self-inflected and perpetuated limitations. Much like a retail shopper, “if we break it, we own it,” which also means we can “fix it.” As resources are many as we build upon our set of problem solving skills to address our own “broken parts” of an otherwise, masterfully designed and constructed product, currently known as ADHD.

    Now, placing my initial comments and intended message, so poorly executed, into this perspective of ideas and concepts, understanding you are ideally with the “right stuff,” does my words make better sense to you? Can you see my comments are meant only to be positive and supportive of your blogs? Do you notice my attempt to make accessible to you personally, the greater knowledge base you infer as existing, present as an addition in responses to all your well-reasoned quandaries? The fact is, your questions have answers, and yes, as such information does exist, for each and every blog you have published. Your easy, intuitive knack for capturing the profound and observing “neglected hot spots” in a scientific area of study, grounded in 21st century’s science of human volitional consciousness. This a quality my experience has shown to be typically limited to philosophy majors, even when their graduate education is in medicine, neuroscience, psychology or all three as with me closest colleague.

    Oh, by the way, your response never felt harsh, only fittingly confused. I suspect you intuited my clumsy composition, upon review, suggested my lack of negativity, which you had initially misinterpreted. It is so easy for me to relate to the vulnerable stress of one’s writing become subject to public scrutiny, that it has taken me sixty-two years to venture fort, the tinniest bit.

    Your receptivity to critique is apparent, with is but one more aspect to your having the “Right Stuff.” Additionally, your having figured out that being openly vulnerable is the most effective protection can be included to my list of “Right Stuffiness.”

    Reply
    • January 15, 2012 at 7:54 am

      Dear John:
      Wow.
      Yes, I think I understand where you’re coming from better. I hope things improve too. And I agree that ultimately, we are all responsible for our own lives. (Buddhism 101; personal responsibility aka karma). It is valuable to have others to point the way, lead the way, or to bump into when we’ve gone our own way. Nice bumping into you!
      (And as it happens, I majored in Philosophy for my first Bachelor Degree).

      All the best,
      Zoë

      Reply
  • January 16, 2012 at 12:52 am

    Wow, I read all that. Y’all give me a shout when y’all can break this down into a understandable blog format. In the meantime I will be working on my compensating for ADHD skills. I am not sure Zoe, but I think he said you are doing relevant work, very well. Off to to skip, hop and hoop my way to the Xen needed to face tomorrow. Toodles…

    Reply
    • January 16, 2012 at 11:04 am

      Denim,
      I think you got it.
      Happy skipping & hopping!
      Z.

      Reply
  • January 16, 2012 at 6:53 pm

    That’s all I usually do, until someone pisses me off….

    Reply
  • February 1, 2012 at 6:23 pm

    Recently, I started my own personal ADHD blog for women, focusing on the positives of ADHD and ways I’ve overcome the challenges. (Including ideas I got from classes, books, therapy and other resources.)

    One of the things I think complicates matters with diagnosing ADHD is the wide range of clinical opinions among doctors. I have a couple friends who said they just went to a general practitioner or psychiatrist, described symptoms and got stimulant medication prescribed. My diagnostic process (at age 18); however, was very involved and included a number of psychometric tests, intelligence/learning battery, compilations of reports from teachers dating back to elementary school, my current teachers’ reports, family members check list, medical/family history of psychiatric issues, and personal interview with the clinician. It was only after all of that other psychiatric concerns were ruled out and ADHD stimulant medication was recommended.

    The DSM V isn’t something I’ve thought a lot about for ADHD, but the proposed revisions for Autism Spectrum Disorders has been on my radar because, as a music therapist, I work with children who have autism.

    Thank you for your post – it has prompted me to research proposed DSM V revisions for ADHD!

    Reply
    • February 1, 2012 at 7:52 pm

      Hey, Creative Mind:

      You are very welcome. I agree with you about the unevenness of diagnosis. It’s shocking, really. When I read over yours, I feel a bit cheated to tell you the truth. Mine was a kind of, “Hey – my life is spinning out of control! I think I have ADHD; here’ s my Jasper/Goldberg Adult ADD Questionnaire, whaddaya think?” kind of thing. Followed up by, “Yes, I agree. Here’s your prescription,” and that was it. I did the back-tracking over school reports, interviewed my sister, and spoke with current friends to substantiate my diagnosis further, not to mention relentless research, etc., and I have to say, I’m pretty sure the diagnosis is accurate. Still, I believe knowledge is power, and the more we know about ourselves and what we’re working with, the better-informed our decisions will be about where we want to put our energies going forward.

      I guess we’re still a long way off (if ever) from having uniformly thorough diagnoses available across N. America. Heck, some psychiatrists are still in denial that adult ADHD even exists (scary, but true).

      So we’ve got a long way to go, baby, and I’m so glad to have you on board!

      I had a quick peek at your blog, btw – it rocks! I love the funky look!
      I’ll try to drop in from time to time, but with my book, a documentary, this blog, mag articles, etc. on the go, I’m a bit maxxed out at the moment.

      Anyway, all the best to you, and thanks for sharing your story with us here and at your blog.

      btw – I couldn’t find your name anywhere on your blog? Have you chosen to write it anonymously? I’d be interested in hearing about that decision, if you’d like to share.

      Take care,
      Z.

      Reply
  • February 1, 2012 at 6:25 pm

    And I just wanted to add – of all the blogs I’ve been digging through – yours is my absolute favorite! You have a nice blend of clinical and personal goodies to share! Thank you!

    Reply
    • February 1, 2012 at 7:34 pm

      Thanks so much!
      I’m glad you’re enjoying my blog.
      All the best with yours!
      Z.

      Reply
 

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