Why are ADHD benefits in the firing line?

[FunStork]

I've been seeing this a lot recently.

Feels like the media is very much against ADHD benefits claims.

Why is that the one that seems to be getting all the focus?

Another one from BBC Verify tonight:

https://www.bbc.co.uk/news/articles/c24ym9yd8p6o

Is this an orchestrated campaign?

Because people are conflating it to get benefits, you can apply for a blue badge on the basis of ADHD. I predict that there will be a massive shift in the UK, like there has been recently in Australia, because the numbers of people claiming for ADHD and Autism is increasing so quickly, the systems can’t keep up. They will stop funding, DLA for many and those that actually really need it, will have to fight for it back, and those who did it because they could, will destroy the system. Much like Disney and the disability passes, too many people using (and abusing) a system has a knock on affect for those that truly need it

ah well you are right about the traits being on a continuum but people who compare an ADHD diagnosis to being pregnant are also right because you either meet the diagnostic criteria or you don’t.

It is also true to say that ADHD brains do, on average, have certain physiological differences but these are so variable that you cannot do a scan or some other objective test on an individual and diagnose ADHD. However, if you do these scans or tests on 1000 people with ADHD and 1000 who don’t have ADHD, you will find that the ADHD brains are physiologically different. I think this is what people are getting at with the pregnant analogy although it is clumsy to say the least .

No, it isn't the same as being pregnant at all. That's a crazy comparison! For starters pregnancy tests look exclusively at objective biological markers of pregnancy rather than the more subjective behavioural markers that the ADHD diagnosis process looks at. Pregnancy tests have a true false positive test result rate of 0.01%. It is incredibly accurate and it is very rare for a healthy, pre-menopausal woman to have detectable levels of HcG. The level of certainly associated with both diagnoses is completely different and pregnancy is binary in a way that ADHD simply isn't. It isn't possible to have a few traits of pregnancy or to be subclinically pregnant. It is truly scary that you have bought into all of this nonsense to the extent that you think such comparisons are in anyway accurate.

As I reference upthread, lots of character traits are reflected in observable differences in the brain. A brain scan will also detect these. People who are extremely kind have greater grey matter density in specific areas of the brain and show differences in connectivity in their social and economical networks. People that are intelligent have higher levels of grey matter and larger neurons. The same is true for loads of character traits and if we do scans of thousands of people we could group people in different groups depending on what you're looking at. ADHD is just a subset of these traits bundled under an umbrella and then we pretend this makes you ND and means your brain is wired differently than the so called totally NT brain when the reality is barely anybody has the totally NT brain.

The problem is that the ND/NT distinction has entered identity politics. People can't concede that actually we are all on a spectrum, the diagnostic threshold is pretty arbitrary and most people will have significant struggles with how their brain functions and ND traits in their lifetime. I suppose it makes people with a diagnosis feel less special and different and it obviously threatens the idea that everyone can be supported and insulated from their ND traits. If we all have them then to a certain extent we have to live with them unless we are talking about extreme cases. 53% of Gen Z believe they are ND. Whether this is clinically true or not, the point is that they must be experiencing some pretty significant struggles to believe it's a possibility. Who is to say that their struggles are less than someone that neatly fits a diagnosis? People with BAP for example can experience specific ASD more intensely than someone with an ASD diagnosis. Their life can be detrimented more and yet in this crazy binary world they would be considered NT. Meanwhile the richest man in the world is ND and apparently cannot be categorised as being higher functioning than someone that can't communicate and will never live independently. They are both simply ND and Autistic. The world has gone mad!

Again I entirely agree. This is identity politics corrupting the concept of a clinical diagnosis.

If it is acknowledged that there is an ASD spectrum that can be more or less severe then it logically follows that this spectrum continues across the diagnostic threshold. How could it not? I know that this is heresy but yes you can be a little bit ASD or a little bit ADHD in the sense that you might have a lot of the same traits but not cross the (incredibly subjective) diagnostic threshold whereas you obviously cannot be a little bit pregnant. That is a wholly wrong analogy in every way.

If this was not the case you would not have threads like one on here right now where a mother is essentially asking which private provider she should select to be certain of a diagnosis for her £4000. You can pay for a diagnosis in the sense that you can pay for someone to have a more liberal interpretation of the guidelines at a borderline and get a diagnosis privately that the NHS would not make. I see this happen very frequently. Clearly noone will act in a wholly unethical or indefensible manner but they might be a little more generous in their interpretation where money is involved. The same Drs (in all fields not just psych) can and do practice a little differently when being paid privately than by the NHS after all the customer is always right. I do not work privately for many reasons and this is one of them.

Your point about scans etc is still evidence of this being a spectrum disorder. There is no scan or other biological test for ADHD precisely because there is no reliably discernible difference between ‘NT’ and ‘ND’ brains at an individual level. No Dr could pick out one from the other reliably by looking at a scan.

The fact that there will be some degree of clustering of features at a population level, still with considerable overlap, just goes to back up the point that it is a fake distinction made by humans applying a threshold to a continuous variable to make a binary.

NT vs ND is NOT a binary in the way that sex is and anyone who says it is is being captured by an identity politics narrative. If they simultaneously are gender critical they need to apply the same level of critical thinking to this. If they believe in gender woo as well then there is officially no hope.

I agree with your point about pregnancy - although I think it is different to the point I was making.

Saying “we are all on a spectrum” does not make the distinction between having and not having ADHD meaningless. Hypertension,
osteoporosis and obesity are all examples of medical conditions that are on a continuum and I don’t think anyone argues that these diagnoses are meaningless.

The evidence for the existence of ADHD lies in decades of research and goes beyond behaviour traits and brain physiology. It is known for example that there is a genetic element because it is passed down in families. There bas also been research into giving ADHD stimulant medication to people with and without ADHD. It makes people with ADHD feel much better. All this is strong evidence that ADHD is a neurodevowntal disorder rather than a collection of personality traits.

Getting a diagnosis for ADHD is nothing about feeling special or less special. It is about getting an understanding and explanation for symptoms and more importantly treatment (ADHD stimulants are incredibly effective for those who can take them). The diagnosis exists because doctors feel that the symptoms are clinically significant and, what’s more, it is highly treatable. Nobody would criticise anyone for getting a diagnosis and treatment for some other treatable condition and dismiss is as identity politics.

I totally agree with this. There isn't money for everyone and those with severe needs should absolutely get the help and the support they need. I said upthread there should, if anything, be more support for disabled children/adults and their famililes who care for them. The DLA we receive for our severely disabled daughter is a drop in the ocean of the extra costs of her care, which is financially and emotionally crippling.

It’s OK to be sceptical of identity politics and the motives of some private doctors and parents. However I don’t understand why you are rejecting decades of scientific research that together provides strong evidence that ADHD is a clinically meaningful condition.

I’m not. It is a clinically meaningful condition. I have never disputed that.
It is also over diagnosed in some sectors of the population (and under diagnosed in others more in need sadly).
My objections are to its characterisation as a binary NT ND divide which is artificial and to over diagnosis in private clinics.

There are lots of reasons why comparing ADHD to obesity, osteoporosis and hypertension doesn't work including:

All of the other conditions have diagnosis based on objective medical tests that are based on biology rather than behaviour. I can't emphasise how important this is, especially for conditions and traits that exist on a spectrum. We can observe someone's BMI is over 30, we can't objectively observe that you are so debilitated by your ADHD symptoms that you warrant a diagnosis. This is exacerbated further by the fact we know that people with ADHD traits are more likely to have extreme levels of introspection and exaggerate how traits impact their lives. We know this due to studies carried out on reported brain fog but unless we carry out in depth tests on cognitive abilities etc then it's very hard to disprove a patients personal testimony of how symptoms are impacting them.

I don't know why you are so sure ADHD is any different from all other traits. We know that lots of traits are inherited, both good and bad. We also know that medications, therapy and supplements can help all sorts of traits. ADHD isn't unique in this. We know magnesium helps people that are easily agitated and omega 3 helps with pessimism. Does this mean that anyone with these traits has a neurodevelopmental disorder?

I have never heard anybody identify strongly with having osteoporosis or hypertension. They haven't internalised the label or view it as a core part of their Identity. They also don't make up binary distinctions like ND/NT which are clearly nonsense and don't reflect the fact that all these things are a spectrum and the threshold is arbitrary. If you have a diagnosis your challenges might exceed non diagnosed people's but then they might not. You could easily have more in common with someone with subclinical ADHD than someone with full blown, extreme symptoms and yet you would be categorised with the extreme cases automatically as almost a different subset of human with different wiring.

Some people have ADHD in that they have a collection of behavioural and cognitive traits that are at the extreme end of a spectrum that causes them functional impairment. This is presumably based on them also having an extreme end variant of neurophysiology although we are yet to understand what the exact biological basis is. When we do it won’t be some kind of wholly different physiology it will be something like a bit more dopamine release in response to a given stimulus than most people have.

Funny that! I have a friend who did the same and told me I could claim for mine! (And he’s not neurodivergent or anything like it!)

Personality traits are of course heritable. EUPD is pretty heritable but that’s a dirty word. ID twins have a 5x higher rate of EUPD, which very few people argue is ‘neurological’, than non ID twins.

The idea that some things produced by your brain are neurological and some are ‘mental health’ is also largely a socially constructed fake historical distinction that applied better in a pre molecular biology world.

I’m not against more people having ADHD diagnoses really. I just think people are so unquestioning of the assumptions behind the whole diagnostic framework in psychiatry which is deeply flawed. People have no trouble at all in accepting this where they agree (EUPD) and yet when it comes to a diagnosis that you want (ADHD) then the same professionals are wholly trustworthy reliable and ethical..

Your argument seems to be a that ADHD doesn’t exist because the traits are on a continuum so therefore the diagnosis point is arbitrary. The value that defines hypertension is also arbitrary if you like because the person just below the line might be in a worse position than another person who is just above the line.That is where the similarity between that and Adhd ends.

There is large body of scientific evidence over decades that ADHD exists and it is a neurodevelopmental disorder. I’m not sure why you (and others) reject this. There are plenty of consultant psychiatrists diagnosing ADHD too. They all think it exists and it is a neurodevelopmental disorder. Why do you not believe them?

I think there is no doubt that traits associated with ADHD exist and that in some people they are expressed in an extreme way which can be disabling. I believe that the current criteria is far too wide for a diagnosis and I detest the binary approach to ADHD and other ND disorders. It is completely unscientific and giving people false certainty. This is why I refer in my initial post to people with ADHD being insistent that their brains are wired differently (everyone's brain is!) or that ND people are some strange subset of the human race when they clearly aren't. People have really drunk the ND koolaid and it's frightening.

I would like to see a world where ND traits are acknowledged as part of the normal human condition due to their prevelance. It is assumed that most people struggle with them to some extent and we as a society work towards giving people tools and strategies to cope in the modern world with them. They shouldn't be a core part of anyone's identity because it's not robust enough of a concept to build an identity on. It's just part of who you are and it serves the Individual and society best if we acknowledge how grey, complex and subjective this area is. .

The criteria have been broadened due to the increased understanding of ADHD as a result of scientific research. What is unreasonable about that?

ADHD UK think 3-4% of adults in the UK have ADHD, so it is not that prevalent. (Not their figures - they’re NICE and Lancet numbers) https://adhduk.co.uk/about-adhd/

I’ve always thought it’s a bit questionable that the people wanting it to be a hard binary are often autistic people who are well known for black and white binary thinking and not being keen on shades of gray.

People are so strident about all this that most of us are happy to nod and smile along whilst it’s not hurting us but at the point where the number of people wanting reasonable (and quite often rather unreasonable) adjustments in a workplace exceeds the number of poor sods left to do the unpalatable stuff or the proportion of people claiming lifelong PIP for these conditions starts to become a drain on the taxpayer then people start to question the narrative.

Which is the answer to OPs question. People do question more constructs of disabilities that they can less easily understand. The issue of what’s a disability is also socially constructed and depends on societal norms agreeing that a person can occupy the ‘sick role’ (Parsons). Our current society is divided on whether we accept that the sick role applies for ADHD and the widening of diagnostic criteria and rejection of any suggestion that some might be more severe than others reduces the chances that society will accept ADHD as a disability in an unconditional way like we do for cancer or MS.

I agree that adhd diagnosis is endemic among adopted children. The issue has always been, same as with autism, whether it's an inherent condition, perhaps genetic, or the result of adverse early life experiences.

Early life experiences is much broader than "attachment", though the two are related.

Both my adopted daughters have adhd diagnoses. I met their birth parents and I would guess their birth father could have it. So it could be genetic. But equally it could be due to the scary neglect they experienced.

They have older half sisters (mum's children), who don't have adhd traits. They don't share the birth father but also they weren't neglected.

So we can't strip it out

Thing is, no one cares about "attachment" or early life experiences - it is much better imo to go down the medical route because it could be treated and people will be more understanding.

Why isn’t he on medication to help? Also there is a lot of management and OT etc to help with adhd! It’s a condition you have to work on every day! Just giving up and saying you can’t is no excuse! My son has severe adhd and autism and applied for thousands of jobs before he got one with Amazon that suits people very well with adhd because of the nature of the job! They also employ a lot of people with adhd and autism! At 26 your son shouldn’t consider himself disabled and not able to work! My son refuses to claim anything as he points out “I'm not disabled like you mum!” He’s currently working for someone else who is severely affected by his autism and yet makes on average £30,000 a week so can employ other people to do what he can’t!

I completely agree with this. Thank you for articulating it so well.

It's also true that as our understanding of the human brain improves and modern society becomes more difficult to operate in, we begin to see that actually even the 'strong', healthy, so called NT people are struggling too and have their own differences and challenges. They simply don't have the capacity to effectively manage their own struggles and to also make the adjustments for all those who want to occupy the 'sick role'. I quoted up thread that over half of Gen Z believe they are ND. This confirms that the majority of young people are finding things tough and believe to some extent that society should be making allowances for their behaviour. There can't be more people needing adjustments than those available to make them. The whole system breaks.

The conditionality placed upon the acceptance of ADHD is because there is no objective test for it and so many people identify with the symptoms that the overlap between the 'disabled' and those expected to accommodate and fund the disabled becomes problematic. ADHD traits are pervasive in the general population. I think most people can recognise the extremes but who can really objectively evaluate the one person's forgetfulness and scatty behaviour is worse than another person's. People often aren't very self perceptive and are liable to under and over exaggerate symptoms and impacts.

Whether society can or should accommodate ADHD is a policy question and you are entitled to your opinion.

Whether ADHD diagnoses are clinically meaningful and whether it is a neurodevelopmental disorder is a scientific matter. Psychiatrists and scientists feel there there is enough robust evidence to diagnose it and this is not something that most of us are entitled to have an opinion on.

I think its quite a funny observation though. In its not binary but only the non autistics can see its not binary (so people fall into two belief groups)

Of course we can have an opinion on the threshold for an ADHD diagnosis and whether the criteria is too wide. It is widely debated by experts in the field. There isn't even one definitive universal diagnostic model or threshold at the moment so I don't know why you're pretending that all of this is set in stone. If you meet the criteria under one model and not the other, do you have ADHD?

Do I think ADHD diagnoses are never clinically meaningful? No. Do I think they are always clinically meaningful in a way that distinguishes people from the general population? Also no.

Everyone is different. My daughter has epilepsy anf and can't take adhd drugs as they reduce the effectiveness of the epilepsy drugs.

@Nearly50omg - does DS have any of the other likely co morbid conditions, that can go hand in hand with ADHD like

autism
epilepsy
the specific learning difficulties like dyslexia, dyspraxia, dysgraphia, dyscalculia, speech and language disorder, poor working memory, poor information processing
sensory processing disorder
behaviour disorders like oppositional defiance disorder and conduct disorder
mood disorders like anxiety and depression
sleep disorders
tourettes

Imo, there is a world of difference in neurodivergence, between someone with the old diagnosis of Asperger’s syndrome (high functioning autism) or just ADHD, than someone with multiple conditions from the above list? For instance, a child with the above specific learning difficulties and sensory overwhelm is going to struggle far more in the classroom, than a child, who can decode well, spell well, is good at maths, no sensory processing difficulties, and has good working memory and information processing?

While psychiatrists may say ADHD has no objective biological symptoms, specific learning difficulties can be assessed and diagnosed through the use of objective assessments by educational psychologists, speech and language therapist and occupational therapists. I’d have also thought the behavioural, tic and mood disorders have some clear symptoms?

I wouldn’t call a child, who cannot understand what is being said in the classroom, cannot follow instructions, cannot read the material and therefore does not understand what they are expected to do, and even if they could; their working memory is so poor, they cannot remember all of that, so they don’t know what to do; as suffering from learned helplessness?

It’s like putting the average English child into a classroom in China, and saying they are suffering learned helplessness, when in fact they cannot understand, read, speak or write Mandarin?

Those children end up leaving primary school possibly at reception level in reading, writing and maths; they are not going to be able to cope at secondary; and then may go on as adults to suffer anxiety, depression, post traumatic stress and even EUPD?

It is no good, people with high functioning ND saying proudly they can work, as if everyone with ND could if they made the effort, without recognising that some people are considerably more disabled than them, in many ways.