Monday, February 15, 2010

Diagnosis--Do you have the inattentive subtype of ADHD? Part II

Stressed Schoolgirl Taking an Exam

In case you were wondering, it has taken me hours of distraction to write this stupid little post, and I'm not even done yet. This hasn't been fun. This is officially a molasses day. They come and go. This one's here with a vengeance. (It's weird to talk about it in this way--in kind of a public confessional. But whatever. It is what it is.)

I'm tempted to post it as is just to get it over with and get on with my day, but instead, I want to finish. The deal I'm making with myself is that I'm going to keep trying until 1:00pm, and once there, I'm just slapping up whatever I've got.

So, you've taken a gander at part I and feel that the things you've seen might fit for you or someone you know. Now what?

Well, first let's cover the remaining criteria.

Okay, the symptoms that cause impairment need to have been present before seven years of age, right? But that's not all. In addition to that, it's necessary that they be present in two or more settings (e.g. work or school or home.) This prevents somebody from assuming their child had ADHD-I when, in reality, the symptoms are the result of a poor relationship with a teacher, or some other factor not related to inattention. Also, the symptoms need to show clear evidence of "significant clinical impairment" in social, academic or occupational functioning.

What is significant clinical impairment? you ask. Well, that's a really good question, and I think it's probably the most subjective part of diagnosis. Here are a couple of articles about "clinical impairment" that might be helpful.

The role of impairment in making a diagnosis of ADHD
This article makes a case for the symptoms of ADHD-I as being significantly impairing, even if they don't compare in quality to the impairments of other subtypes (see the final portion of the second paragraph).

This article addresses some of the possible changes in the DSM-V regarding the issue of significant clinical impairment.

My take on all of this is the following: if you meet the diagnostic criteria in the different quadrants of functioning, this means that something "not right" is happening. Clearly, you are impaired, otherwise you wouldn't notice a problem. So, I tend to agree with the camp that finds this requirement a little bit redundant, even though I do recognize the importance of what they are trying to accomplish in having included it.

Furthermore, technically one might say that I am not "clinically impaired" because over the course of decades I have come up with coping mechanisms that allow me to conform to mainstream ideals for the most part. Does this mean I am not impaired? No. It means that I have, through years of practice, learned how to compensate for my impairment. And such a view doesn't take into account the many moments in which my defenses fail, and I end up looking like a five-year-old amongst peers and colleagues.

Anyway, the point is (as demonstrated by the first article I shared), significant impairment might simply mean "I want to pay attention as I write a blog post, but I can't." (It's now 2:41, btw. No joke.)

Okay, I'm done. Those are the criteria. Oh, also make sure these symptoms don't actually stem from another disorder whose criteria fit better (like a mood disorder, or an anxiety disorder), and make sure that the symptoms don't occur exclusively during the course of schizophrenia, a pervasive developmental disorder, or a psychotic disorder. (You would be seeing other symptoms that alarmed you besides the ones outlined in these posts were any of these things the case. If you have any specific questions about this, feel free to ask, and I'll do my best to clarify.)

Blah blah blah wrap up tidily blah blah blah.

The end.

5 comments:

  1. marcia barthelow - I figured it out!!February 15, 2010 at 4:43 PM

    Hey Josh, Don't know about what my diagnosis would be, but it's taken me almost a week to make time not to be doing many different things but to actually just lie on the couch in front of the fire and read all of your posts...they are great! I love that you're doing this. And I love (and always have ever since being with you in classes) you!!!

    I'm really so happy that you are offering insights into the feelings and behaviors associated with ADHD-1, and that you are encouraging people to let go of the judgments they might make about "lazy" or "non-motivated" people. I love hearing that just commiting to this post on a daily basis is offering some healing for you, some sense of an ability to focus a little more with some love for the fact that it's hard hard hard to actually do that...anway, I just wanted to say I get so much of what you're writing...maybe just your posts here are helping to reorganize the neural pathways in your brain...who knows...I wish I were still at KYFS and could see you!!! Have a good rest of your day and I look forward to reading your updates, your stories, the little pieces of your life that you offer for us to witness, applaud, grieve and release with you!!! Not sure how to let you know who I am so will embed it in here...It's Marcia from SPU

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  2. You are hilarious, and I think it's because you don't mean to be. I'm sorry that this was such a struggle for you to write but I'm proud of you that you did it anyway!!

    -Sarah

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  3. Marcia! Thanks so much for visiting my blog! I wish you were at KYFS as well--I think that would be an absolute blast. It's really great to hear from you, and thanks for your encouragement about the blog and my own process with it. You are awesome.

    Sarah--glad it gave you a chuckle. It made me laugh too... eventually. One of those "either choose to laugh or choose throw your computer across the room" kinds of situations. It was not a good day. But today's post was easy like Sunday morning, so that's nice!

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  5. Hey Josh! lovin' your blog, accidentally fell to sleep on the couch last night reading it. It's like chips, you can't stop after just 20 posts!
    I'm curious though, what overlaps might there be between the symptoms of ADHD-I and Asperger's? Just wondering if perhaps the Asperger's covers the ADHD-I symptoms, or if a person could have both? Thanks!

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