Is ADHD Being Over-Diagnosed For Cash?

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Is ADHD Being Systematically Overdiagnosed?

The BBC’s investigative “Panorama” program all so recently did a documentary in which one of their journalists—who does not have ADHD—went to three private clinics and got an ADHD diagnosis from each of them:

So… Is it really a case of show up, pay up, and get a shiny new diagnosis?

The BBC Panorama producers cherry-picked 3 private providers, and during those clinical assessments, their journalist provided answers that would certainly lead to a diagnosis.

This was contrasted against a three-hour assessment with an NHS psychiatrist—something that rarely happens in the NHS. Which prompts the question…

How did he walk into a 3-hour psychiatrist assessment, when most people have to wait in long waiting lists for a much more cursory appointment first with assorted gatekeepers, before going on another long waiting list, for an also-much-shorter appointment with a psychiatrist?

That would be because the NHS psychiatrist was given advance notification that this was part of an investigation and would be filmed (the private clinics were not gifted the same transparency)

So, maybe just a tad unequal treatment!

In case you’re wondering, here’s what that very NHS psychiatrist had to say on the topic:

Is it really too easy to be diagnosed with ADHD?

(we’ll give you a hint—remember Betteridge’s Law!)

❝Since the documentary aired, I have heard from people concerned that GPs could now be more likely to question legitimate diagnoses.

But as an NHS psychiatrist it is clear to me that the root of this issue is not overdiagnosis.

Instead, we are facing the combined challenges of remedying decades of underdiagnosis and NHS services that were set up when there was little awareness of ADHD.❞

~ Dr. Mike Smith, Psychiatrist

The ADHD foundation, meanwhile, has issued its own response, saying:

❝We are disappointed that BBC Panorama has opted to broadcast a poorly researched, sensationalist piece of television journalism.❞

Click here to read their full statement!

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  • How To Avoid Slipping Into (Bad) Old Habits

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    Treating Bad Habits Like Addictions

    How often have you started a healthy new habit (including if it’s a “quit this previous thing” new habit), only to find that you slip back into your old ways?

    We’ve written plenty on habit-forming before, so here’s a quick recap before we continue:

    How To Really Pick Up (And Keep!) Those Habits

    …and even how to give them a boost:

    How To Keep On Keeping On… Long Term!

    But how to avoid the relapses that are most likely to snowball?

    Borrowing from the psychology of addiction recovery

    It’s well known that someone recovering from substance addiction should not have even a small amount of the thing they were addicted to. Not one sip of champagne at a wedding, not one drag of a cigarette, and so forth.

    This can go for other bad habits too; make one exception, and suddenly you have a whole string of “exceptions”, and before you know it, it’s not the exception anymore; it’s the new rule—again.

    Three things that can help guard against this are:

    1. Absolutely refuse to romanticize the bad habit. Do not fall for its marketing! And yes, everything has marketing even if not advertising; for example, consider the Platonic ideal of a junk-food-eating couch-potato who is humble, unassuming, agreeable, the almost-holy idea of homely comfort, and why shouldn’t we be comfortable after all, haven’t we earned our chosen hedonism, and so on. It’s seductive, and we need to make the choice to not be seduced by it. In this case for example, yes pleasure is great, but being sick tired and destroying our bodies is not, in fact, pleasurable in the long run. Which brings us to…
    2. Absolutely refuse to forget why you dropped that behavior in the first place. Remember what it did to you, remember you at your worst. Remember what you feared might become of you if you continued like that. This is something where journaling helps, by the way; remembering our low points helps us to avoid finding ourselves in the same situation again.
    3. Absolutely refuse to let your guard down due to an overabundance of self-confidence in your future self. We all can easily feel that tomorrow is a mystical land in which all productivity is stored, and also where we are strong, energized, iron-willed, and totally able to avoid making the very mistakes that we are right now in the process of making. Instead, be that strong person now, for the benefit of tomorrow’s you. Because after all, if it’s going to be easy tomorrow, it’s easy now, right?

    The above is a very simple, hopefully practical, set of rules to follow. If you like hard science more though, Yale’s Dr. Steven Melemis offers five rules (aimed more directly at addiction recovery, so this may be a big “heavy guns” for some milder habits):

    1. change your life
    2. be completely honest
    3. ask for help
    4. practice self-care
    5. don’t bend the rules

    You can read his full paper and the studies it’s based on, here:

    Relapse Prevention and the Five Rules of Recovery

    “What if I already screwed up?”

    Draw a line under it, now, and move forwards in the direction you actually want to go.

    Here’s a good article, that saves us taking up more space here; it’s very well-written so we do recommend it:

    The Abstinence Violation Effect and Overcoming It

    this article gives specific, practical advices, including CBT tools to use

    Take care!

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  • What are compound exercises and why are they good for you?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    So you’ve got yourself a gym membership or bought a set of home weights. Now what? With the sheer amount of confusing exercise advice out there, it can be hard to decide what to include in a weights routine.

    It can help to know there are broadly two types of movements in resistance training (lifting weights): compound exercises and isolation exercises.

    So what’s the difference? And what’s all this got to do with strength, speed and healthy ageing?

    What’s the difference?

    Compound exercises involve multiple joints and muscle groups working together.

    In a push up, for example, your shoulder and elbow joints are moving together. This targets the muscles in the chest, shoulder and triceps.

    When you do a squat, you’re using your thigh and butt muscles, your back, and even the muscles in your core.

    It can help to think about compound movements by grouping them by primary movement patterns.

    For example, some lower body compound exercises follow a “squat pattern”. Examples include bodyweight squats, weighted squats, lunges and split squats.

    A woman does a Bulgarian split squat.
    A Bulgarian split squat is a type of compound movement exercise. Evelin Montero/Shutterstock

    We also have “hinge patterns”, where you hinge from a point on your body (such as the hips). Examples include deadlifts, hip thrusts and kettle bell swings.

    Upper body compounded exercises can be grouped into “push patterns” (such as vertical barbell lifts) or “pull patterns” (such as weighted rows, chin ups or lat pull downs, which is where you use a pulley system machine to lift weights by pulling a bar downwards).

    In contrast, isolation exercises are movements that occur at a single joint.

    For instance, bicep curls only require movement at the elbow joint and work your bicep muscles. Tricep extensions and lateral raises are other examples of isolation exercises.

    A woman sets up to lift a heavy weight while her trainer observes.
    Many compound exercises mimic movements we do every day. Photo by Ketut Subiyanto/Pexels

    Compound exercises can make daily life easier

    Many compound exercises mimic movements we do every day.

    Hinge patterns mimic picking something off the floor. A vertical press mimics putting a heavy box on a high shelf. A squat mimics standing up from the couch or getting on and off the toilet.

    That might sound ridiculous to a young, fit person (“why would I need to practise getting on and off a toilet?”).

    Unfortunately, we lose strength and muscle mass as we age. Men lose about 5% of their muscle mass per decade, while for women the figure is about 4% per decade.

    When this decline begins can vary widely. However, approximately 30% of an adult’s peak muscle mass is lost by the time they are 80.

    The good news is resistance training can counteract these age-related changes in muscle size and strength.

    So building strength through compound exercise movements may help make daily life feel a bit easier. In fact, our ability to perform compound movements are a good indicator how well we can function as we age.

    A woman gets a box down from a shelf.
    Want to be able to get stuff down from high shelves when you’re older? Practising compound exercises like a vertical press could help. Galina_Lya/Shutterstock

    What about strength and athletic ability?

    Compound exercises use multiple joints, so you can generally lift heavier weights than you could with isolation exercises. Lifting a heavier weight means you can build muscle strength more efficiently.

    One study divided a group of 36 people into two. Three times a week, one group performed isolation exercises, while the other group did compound exercises.

    After eight weeks, both groups had lost fat. But the compound exercises group saw much better results on measures of cardiovascular fitness, bench press strength, knee extension strength, and squat strength.

    If you play a sport, compound movements can also help boost athletic ability.

    Squat patterns require your hip, knee, and ankle to extend at the same time (also known as triple extension).

    Our bodies use this triple extension trick when we run, sprint, jump or change direction quickly. In fact, research has found squat strength is strongly linked to being able to sprint faster and jump higher.

    Isolation exercises are still good

    What if you’re unable to do compound movements, or you just don’t want to?

    Don’t worry, you’ll still build strength and muscle with isolation exercises.

    Isolation exercises are also typically easier to learn as there is no skill required. They are an easy and low risk way to add extra exercise at the end of the workout, where you might otherwise be too tired to do more compound exercises safely and with correct form.

    In fact, both isolation and compound exercises seem to be equally effective in helping us lose body fat and increase fat-free muscle mass when total intensity and volume of exercises are otherwise equal.

    Some people also do isolation exercises when they want to build up a particular muscle group for a certain sport or for a bodybuilding competition, for example.

    An older man does bicep curls in the gym
    Isolation exercises have their role to play. Photo by Kampus Production/Pexels

    I just want a time efficient workout

    Considering the above factors, you could consider prioritising compound exercises if you’re:

    • time poor
    • keen to lift heavier weights
    • looking for an efficient way to train many muscles in the one workout
    • interested in healthy ageing.

    That said, most well designed workout programs will include both compound and isolation movements.

    Correction: This article has been amended to reflect the fact a weighted row is a pull pattern, not a push pattern.

    Mandy Hagstrom, Senior Lecturer, Exercise Physiology. School of Health Sciences, UNSW Sydney and Anurag Pandit, PhD Candidate in Exercise Physiology, UNSW Sydney

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • What does it mean to be immunocompromised?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our immune systems help us fight off disease, but certain health conditions and medications can weaken our immune systems. People whose immune systems don’t work as well as they should are considered immunocompromised.

    Read on to learn more about how the immune system works, what causes people to be immunocompromised, and how we can protect ourselves and the immunocompromised people around us from illness.

    What is the immune system?

    The immune system is a network of cells, organs, and chemicals that helps our bodies fight off infections caused by invaders, such as bacteria, viruses, fungi, and parasites.

    Some important parts of the immune system include: 

    • White blood cells, which attack and kill germs that don’t belong inside our bodies. 
    • Lymph nodes, which help our bodies filter out germs. 
    • Antibodies, which help our bodies recognize invaders.
    • Cytokines, which tell our immune cells what to do.

    What causes people to be immunocompromised?

    Some health conditions and medications can prevent our immune systems from functioning optimally, which makes us more vulnerable to infection. Health conditions that compromise the immune system fall into two categories: primary immunodeficiency and secondary immunodeficiency.

    Primary immunodeficiency

    People with primary immunodeficiency are born with genetic mutations that prevent their immune systems from functioning as they should. There are hundreds of types of primary immunodeficiencies. Since these mutations affect the immune system to varying degrees, some people may experience symptoms and get diagnosed early in life, while others may not know they’re immunocompromised until adulthood.

    Secondary immunodeficiency

    Secondary immunodeficiency happens later in life due to an infection like HIV, which weakens the immune system over time, or certain types of cancer, which prevent the body from producing enough white blood cells to adequately fight off infection. Studies have also shown that getting infected with COVID-19 may cause immunodeficiency by reducing our production of “killer T-cells,” which help fight off infections.

    Sometimes necessary treatments for certain medical conditions can also cause secondary immunodeficiency. For example, people with autoimmune disorders—which cause the immune system to become overactive and attack healthy cells—may need to take immunosuppressant drugs to manage their symptoms. However, the drugs can make them more vulnerable to infection. 

    People who receive organ transplants may also need to take immunosuppressant medications for life to prevent their body from rejecting the new organ. (Given the risk of infection, scientists continue to research alternative ways for the immune system to tolerate transplantation.)

    Chemotherapy for cancer patients can also cause secondary immunodeficiency because it kills the immune system’s white blood cells as it’s trying to kill cancer cells.

    What are the symptoms of a compromised immune system?

    People who are immunocompromised may become sick more frequently than others or may experience more severe or longer-term symptoms than others who contract the same disease.

    Other symptoms of a compromised immune system may include fatigue; digestive problems like cramping, nausea, and diarrhea; and slow wound healing.

    How can I find out if I’m immunocompromised?

    If you think you may be immunocompromised, talk to your health care provider about your medical history, your symptoms, and any medications you take. Blood tests can determine whether your immune system is producing adequate proteins and cells to fight off infection.

    I’m immunocompromised—how can I protect myself from infection?

    If you’re immunocompromised, take precautions to protect yourself from illness.

    Wash your hands regularly, wear a well-fitting mask around others to protect against respiratory viruses, and ensure that you’re up to date on recommended vaccines.

    Immunocompromised people may need more doses of vaccines than people who are not immunocompromised—including COVID-19 vaccines. Talk to your health care provider about which vaccines you need.

    How can I protect the immunocompromised people around me?

    You never know who may be immunocompromised. The best way to protect immunocompromised people around you is to avoid spreading illnesses. 

    If you know you’re sick, isolate whenever possible. Wear a well-fitting mask around others—especially if you know that you’re sick or that you’ve been exposed to germs. Make sure you’re up to date on recommended vaccines, and practice regular hand-washing.

    If you’re planning to spend time with someone who is immunocompromised, ask them what steps you can take to keep them safe.

    For more information, talk to your health care provider.

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

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  • It Didn’t Start with You – by Mark Wolynn

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    There is a trend in psychology to “blame the parents” for “childhood trauma” that can result in problems later in life. Sometimes fairly, sometimes not. This book’s mostly not about that.

    It does touch on our own childhood trauma, if applicable. But mostly, it’s about epigenetic trauma inheritance. In other words, not just trauma that’s passed on in terms of “the cycle of abuse”, but trauma that’s passed on in terms of “this generation experienced trauma x, developed trauma response y, encoded it epigenetically, and passed it on to their offspring”.

    So, how does one heal from a trauma one never directly experienced, and just inherited the response to it? That’s what most of this book is about, after establishing how epigenetic trauma inheritance works.

    The author, a therapist, provides practical advice for how to do the things that can be done to rewrite the epigenetic code we inherited. Better late than never!

    Bottom line: it is well-established that trauma is inheritable. But unlike one’s eye color or the ability to smell asparagus metabolites in urine, we can rewrite epigenetic things, to a degree. This book explains how.

    Click here to check out It Didn’t Start With You, and put things to rest!

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  • Reading As A Cognitive Exercise

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Reading, Better

    It is relatively uncontroversial to say that reading is good for cognitive health, but we don’t like to make claims without science if we can help it, so let’s get started:

    There was a 2021 study, which found that even when controlling for many other factors, including highest level of education, socioeconomic status, and generalized pre-morbid intelligence:

    ❝high reading activity, as defined by almost daily reading, was associated with lower odds of cognitive decline, compared to low reading activity❞

    ~ Dr. Carol Chan

    Source: Can reading increase cognitive reserve?

    However, not all reading is the same. And this isn’t just about complexity or size of vocabulary, either. It’s about engagement.

    And that level of engagement remains the key factor, no matter how quickly or slowly someone reads, as the brain tends to automatically adjust reading speed per complexity, because the brain’s “processing speed” remains the same:

    Read more: Cognitive coupling during reading

    Everyone’s “processing speed” is different (and is associated with generalized intelligence and executive functions), though as a general rule of thumb, the more we practice it, the faster our processing speed gets. So if you balked at the notion of “generalized intelligence” being a factor, be reassured that this association goes both ways.

    Read more: The unique contribution of working memory, inhibition, cognitive flexibility, and intelligence to reading comprehension and reading speed

    So is the key to just read more?

    That’s a great first step! But…

    The key factor still remains: engagement.

    So what does that mean?

    It is not just the text that engages you. You must also engage the text!

    This is akin to the difference between learning to drive by watching someone else do it, and learning by getting behind the wheel and having a go.

    When it comes to reading, it should not be a purely passive thing. Sure, if you are reading a fiction book at bedtime, get lost in it, by all means. But when it comes to non-fiction reading, engage with it actively!

    For example, I (your writer here, hi), when reading non-fiction:

    • Read at what is generally considered an unusually fast pace, but
    • Write so many notes in the margins of physical books, and
    • Write so many notes using the “Notes” function on my Kindle

    And this isn’t just like a studious student taking notes. Half the time I am…

    • objecting to content (disagreeing with the author), or
    • at least questioning it, or which is especially important, or
    • noting down questions that came to my mind as a result of what I am reading.

    This latter is a bit like:

    • when you are reading 10almonds, sometimes you will follow our links and go off down a research rabbit-hole of your own, and that’s great!
    • sometimes you will disagree with something and write to tell us, and that’s great too (when this happens, one or the other or all of us will learn something, and yes, we have published corrections before now)!
    • sometimes what you read here will prompt a further question, and you’ll send that to us, and guess what, also great! We love questions.

    Now, if your enjoyment of 10almonds is entirely passive, don’t let us stop you (we know our readers like quick-and-easy knowledge, and that’s good too), it’s just, the more you actively engage with it, the more you’ll get out of it.

    This, by the way, was also a lifelong habit of Leonardo da Vinci, which you can read about here:

    How to Think Like Leonardo da Vinci: Seven Steps to Genius Every Day – by Michael J. Gelb

    a very good book that we reviewed last year

    How you read (i.e. what medium) matters too!

    Are you reading this on a desktop/laptop, or a mobile device? That difference could matter more than the difference between paper and digital, according to this study from 2020 that found…

    ❝The cumulation of evidence from this and previous studies suggests that reading on a tablet affords different interactions between the reader and the text than reading on a computer screen.

    Reading on a tablet might be more similar to reading on paper, and this may impact the attentional processes during reading❞

    ~ Dr. Ugo Ballenghein et al.

    Read more: Cognitive engagement during reading on digital tablet: Evidence from concurrent recordings of postural and eye movements

    What if my mind wanders easily?

    You can either go with it, or train to improve focus.

    Going with it: just make sure you have more engaging reading to get distracted by. It’s all good.

    Training focus: this is trickier, but worthwhile, as executive function (you will remember from earlier) was an important factor too, and training focus is training executive function.

    As for one way to do that…

    Mindfulness training improves working memory capacity and GRE performance while reducing mind wandering

    If you’d like a primer for getting going with that, then you may enjoy our previous main feature:

    No-Frills, Evidence-Based Mindfulness

    Enjoy!

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  • Passion Fruit vs Pomegranate – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing passion fruit to pomegranate, we picked the passion fruit.

    Why?

    Both of these fruits have beaten a lot of other contenders, so it’s time to pit them against each other:

    In terms of macros, passion fruit has more protein, carbs, and fiber, the ratio of which meaning also that passion fruit has the lower glycemic index. So, we say passion fruit wins on macros.

    In the category of vitamins, things are more even; passion fruit has more of vitamins A, B2, B3, B6, and C, while pomegranate has more of vitamins B1, B5, B9, E, and K. In light of this 5:5 tie, and since passion fruit’s overall vitamin coverage is better (in terms of meeting RDA needs) but pomegranate’s vitamins are often in shorter supply in diet, we’re calling it a tie on vitamins.

    When it comes to minerals, passion fruit has more calcium, iron, magnesium, phosphorus, potassium, and selenium, while pomegranate has more copper, manganese, and zinc. That’s already an easy 6:3 win for passion fruit, before we even consider the fact that passion fruit’s minerals’ margin of difference is greater too.

    Adding it up makes for a clear win for passion fruit. As ever when it comes to plants, enjoy both if you can, though!

    Want to learn more?

    You might like to read:

    What’s Your Plant Diversity Score?

    Take care!

    Don’t Forget…

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