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why does add dx require symptoms since childhood?


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Hi y'all

I've been talking with my doctor about a possible AD(H)D dual diagnosis, and I'm getting good (so to speak!) scores on the ADD tests - clear current symptomology - but she keeps inquiring into my secondary school experience, whether I had trouble paying attention before college, etc.

My question is, what does this matter? We've got adult-onset diabetes, right? I can't remember dick about high school, and who would want to? Do the meds somehow not work if your symptoms haven't been present since childhood? That seems preposterous.

It seems like she's worried about nailing the diagnosis instead of just treating the symptoms, whatever umbrella you want to put them under (maybe none). Can someone explain this emphasis to me on when the trouble started?

Thanks team

-k

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the idea that ADD could continue into adulthood is (fairly) new in and of itself.

as far as i know, there's no such thing as adult onset ADD.  ADD-like symptoms can be caused by other problems... but ADD itself is a life-long thing.

stims can treat a lot of symptoms... but if the underlying reason for your attention issues is that you're a pot head or have a thyroid condition, then the dx REALLY does matter in this case.

try to remember your report cards?  what did they say?  i don't remember having attention issues, but i was consistently graded as not performing as well as i could, etc. try and find old report cards, if possible. 

but no, basically, there's no adult onset ADD... just people who missed the DX boat as children.

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ADD is genetic.  If you have it you've always had it.  ADD like symptoms can be caused by a lot of other conditions, however.  Head injuries and other brain damage commonly results is symptoms that are very ADD like.  Depression and anxiety effect attention as well and bpd effects impulse control. 

Increasingly the view in psychiatry is that it's best to just treat symptoms and not worry so much about causes and names but a lot of pdocs still like to give labels.

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I used to think my ADHD symptoms appeared in my teen years. But when I went trough neuropsychiatric testing, it clearly showed I've had symptoms since early childhood. But since I'm somewhat intelligent and always did well in school, no one had an idea.

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My question is, what does this matter? We've got adult-onset diabetes, right? I can't remember dick about high school, and who would want to? Do the meds somehow not work if your symptoms haven't been present since childhood? That seems preposterous.

It seems like she's worried about nailing the diagnosis instead of just treating the symptoms, whatever umbrella you want to put them under (maybe none). Can someone explain this emphasis to me on when the trouble started?

Thanks team

-k

<{POST_SNAPBACK}>

My dx of ADD without Hyperactivity was made 2 years ago, at age 43. My tdoc spent as much time with me on my childhood history as he did my current symptoms. Just to be as conclusive as possible, I guess. Especially since ADD w/o H, is much harder to dx, particularly in girls. Because you're just sitting there staring out the window you look like a "good girl", invisible. My parents were of no help, but my own memories of distraction as a child were sufficient to satisfy him with regard to that aspect.

Now, 2 years later, we only deal with symptoms and how to manage. For me it's more difficult, because I'm a born speed freak I can't be trusted to take stimulants responsibly. So I avoid them, and I'm on Cymbalta, which allegedly works at cross purposes with Strattera...so, I'm kind of managing with behavior modification, cognitive therapy approaches. With more or LESS success.

S9

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something that i think should be considered is how some people in childhood were able to mask symptoms or accommodate them, or out of necessity learned how to deal with them (because of family experiences or other disorders, etc).  there were many adhd symptoms i would have had in childhood that i didn't, only because i had a f***ed up family life and had to learn to deal with things myself.  if i had a functional family i can imagine my symptoms would have been displayed quite differently and maybe i'd have been dx'd before i was 28 years old. 

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If you can cover the late homework, forgotten supplies, etc. with decent

test scores -- as far as most schools are concerned:

"Inattentive ADD" == "good girl/boy"

It doesn't help that most schools really don't have high expectations of the

students in the normal classes. In the advanced classes, there seemed to

be more emphasis on understanding the structure and process than on the

specifics - this plays to many ADD strengths and less to the weaknesses.

It's harder to remember the school years too. Think about it - "inattentive".

The already-incomplete input never gets written to memory unless something

exciting/memorable enough happens to wake you up. So how are you

supposed to remember school beyond "It sucked"

If your doctor really wants to know about your school years, you'll have to

bring in either the packrat ADD parent or the non-ADD parent who

remembers those years...  Were you an A/B student with B/C/D/F conduct

grades (She had it in for me, and I have witnesses.) but no record of getting

into serious trouble?  Maybe very good grades in things that interested you

and very low grades in areas that didn't, but independent of your actual

abilities? How many times did you miss the bus, and why?

A mother with an ADD child will soon learn to check every pocket before

doing laundry.

Any chore not on a strict everyday routine will simply not get done.  And the

routine can't be "At 5 o'clock do X" but "As soon as you are home, do X" -

external cues worked, internal/time-based cues didn't.

Accustomed items not in their accustomed places won't be seen. Hell, accustomed

items IN their accustomed places won't be seen.  But anything unusual or not

meant to be found, will be.  (The only way to hide Xmas presents is to not bring

them home.) This isn't the OCD or Aspie "Mommy,  Mommy it's not where

it's supPOSEd to BE!", but "Mommy, I can't find my ... I LOOKED there... oh.

HERE they are!"  The same kid who can't find the glasses he's wearing can spot

an arrowhead 3/4-buried in clay 20 ft away...

Parents of teenagers get used to "Nothing" being the answer to "What did you

do/learn at school" and "I don't know" being the answer to questions starting

with "Why did/didn't you ". Parents of ADD kids get used to that by about 1st

grade, with "Um. I forgot." being close seconds in both categories.

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hey again you all

this is all tremendously helpful. I want to return to VE's note up there and ask - are AD(H)D medications being adopted for treating these symptoms _without_ a dx? For instance are ritalin or strattera being prescribed to help people who are having extensive cognitive problems on account of, say, taking anticonvulsants? I haven't heard of such a thing, but really I'm just a very interested pedestrian.

Thanks again.

-k

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--- agree or disagree with The Amen Clinic, Dr. Amen's treatments, etc. This is a description  taken from my results from the screening which my pdoc suggested I take. ADD/ADHD must first be Dx in childhood, but that doesn't mean it was ever looked for or was Dx'd when you were a child. Some other possible earlier signs or symptoms to think about when looking back at childhood beahvior though, at least for ADD Inattentive. Italics are my own. -- my comments inserted --

ADD Inattentive Type

The onset of these symptoms often become apparent later in child-hood or early adolescence. The brighter the individual, the later symptoms seem to become a problem. -- some people develop very effective coping mechanisms and problems may not appear until school work recceahes a certain level of difficulty--.  The symptoms must be present for at least six months and not be related to a depressive episode or the onset of marijuana usage. Using marijuana can often make a person seem as though they have ADD without hyperactivity. It is important to screen for pot usage in teen-agers or adults.

Girls with ADD are frequently missed because they are more likely to have the non-hyperactive form.

The severity of the disorder is rated as mild, moderate or severe. Even though these children have many of the same symptoms of the people with AD/HD, they are not hyperactive and may appear hypoactive. Additional symptoms for this subtype include: excessive daydreaming, frequent complaints of being bored, appearing apathetic or unmotivated, appearing frequently sluggish or slow moving or appearing spacey or internally preoccupied -- the classic "couch potato."

Most people with this form of ADD are never diagnosed. They do not exhibit enough symptoms that "grate" on the environment to cause others to seek help for them. Yet, they often experience severe disability from the disorder. Instead of help, they get labeled as willful, uninterested, or defiant.

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