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:
- The BBC documentary: Private ADHD Clinics Exposed (28 mins)
- Their “5 Minutes” version: ADHD Undercover: How I Was Misdiagnosed (6 mins)
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.❞
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Mythbusting The Big O
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“Early To Bed…”
In yesterday’s newsletter, we asked you for your (health-related) views on orgasms.
But what does the science say?
Orgasms are essential to good health: True or False?
False, in the most literal sense. One certainly won’t die without them. Anorgasmia (the inability to orgasm) is a condition that affects many postmenopausal women, some younger women, and some men. And importantly, it isn’t fatal—just generally considered unfortunate:
Anorgasmia Might Explain Why You’re Not Orgasming When You Want To
That article focuses on women; here’s a paper focusing on men:
Orgasms are good for the health, but marginally: True or False?
True! They have a wide array of benefits, depending on various factors (including, of course, one’s own sex). That said, the benefits are so marginal that we don’t have a flock of studies to cite, and are reduced to pop-science sources that verbally cite studies that are, alas, nowhere to be found, for example:
- For women: 9 Orgasm Benefits That Might Surprise You
- For men: 9 Ways Orgasms May Benefit Your Health
Doubtlessly the studies do exist, but are sparse enough that finding them is a nightmare as the keywords for them will bring up a lot of studies about orgasms and health that aren’t answering the above question (usually: health’s affect on orgasms, rather than the other way around).
There is some good science for post-menopausal women, though! Here it is:
Misconceptions About Sexual Health in Older Women
(if you have the time to read this, this also covers many very avoidable things that can disrupt sexual function, in ways that people will errantly chalk up to old age, not knowing that they are missing out needlessly)
Orgasms are good or bad, depending on being male or female: True or False
False, broadly. The health benefits are extant and marginal for almost everyone, as indicated above.
What’s that “almost” about, then?
There are a very few* people (usually men) for whom it doesn’t go well. In such cases, they have a chronic and lifelong problem whereby orgasm is followed by 2–7 days of flu-like and allergic symptoms. Little is known about it, but it appears to be some sort of autoimmune disorder.
Read more: Post-orgasmic illness syndrome: history and current perspectives
*It’s hard to say for sure how few though, as it is surely under-reported and thus under-diagnosed; likely even misdiagnosed if the patient doesn’t realize that orgasms are the trigger for such episodes, and the doctor doesn’t think to ask. Instead, they will be busy trying to eliminate foods from the diet, things like that, while missing this cause.
Orgasms are better avoided for optimal health: True or False?
Aside from the above, False. There is a common myth for men of health benefits of “semen retention”, but it is not based in science, just tradition. You can read a little about it here:
The short version is: do it if you want; don’t if you don’t; the body will compensate either way so it won’t make a meaningful difference to anything for most people, healthwise.
Small counterpoint: while withholding orgasm (and ejaculation) is not harmful to health, what does physiologically need draining sometimes is prostate fluid. But that can also be achieved mechanically through prostate milking, or left to fend for itself (as it will in nocturnal emissions, popularly called wet dreams). However, if you have problems with an enlarged prostate, it may not be a bad idea to take matters into your own hands, so to speak. As ever, do check with your doctor if you have (or think you may have) a condition that might affect this.
One final word…
We’re done with mythbusting for today, but we wanted to share this study that we came across (so to speak) while researching, as it’s very interesting:
On which note: if you haven’t already, consider getting a “magic wand” style vibe; you can thank us later (this writer’s opinion: everyone should have one!).
Top tip: do get the kind that plugs into the wall, not rechargeable. The plug-into-the-wall kind are more powerful, and last much longer (both “in the moment”, and in terms of how long the device itself lasts).
Enjoy!
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What’s the difference between ADD and ADHD?
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Around one in 20 people has attention-deficit hyperactivity disorder (ADHD). It’s one of the most common neurodevelopmental disorders in childhood and often continues into adulthood.
ADHD is diagnosed when people experience problems with inattention and/or hyperactivity and impulsivity that negatively impacts them at school or work, in social settings and at home.
Some people call the condition attention-deficit disorder, or ADD. So what’s the difference?
In short, what was previously called ADD is now known as ADHD. So how did we get here?
Let’s start with some history
The first clinical description of children with inattention, hyperactivity and impulsivity was in 1902. British paediatrician Professor George Still presented a series of lectures about his observations of 43 children who were defiant, aggressive, undisciplined and extremely emotional or passionate.
Since then, our understanding of the condition evolved and made its way into the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM. Clinicians use the DSM to diagnose mental health and neurodevelopmental conditions.
The first DSM, published in 1952, did not include a specific related child or adolescent category. But the second edition, published in 1968, included a section on behaviour disorders in young people. It referred to ADHD-type characteristics as “hyperkinetic reaction of childhood or adolescence”. This described the excessive, involuntary movement of children with the disorder.
It took a while for ADHD-type behaviour to make in into the diagnostic manual. Elzbieta Sekowska/Shutterstock In the early 1980s, the third DSM added a condition it called “attention deficit disorder”, listing two types: attention deficit disorder with hyperactivity (ADDH) and attention deficit disorder as the subtype without the hyperactivity.
However, seven years later, a revised DSM (DSM-III-R) replaced ADD (and its two sub-types) with ADHD and three sub-types we have today:
- predominantly inattentive
- predominantly hyperactive-impulsive
- combined.
Why change ADD to ADHD?
ADHD replaced ADD in the DSM-III-R in 1987 for a number of reasons.
First was the controversy and debate over the presence or absence of hyperactivity: the “H” in ADHD. When ADD was initially named, little research had been done to determine the similarities and differences between the two sub-types.
The next issue was around the term “attention-deficit” and whether these deficits were similar or different across both sub-types. Questions also arose about the extent of these differences: if these sub-types were so different, were they actually different conditions?
Meanwhile, a new focus on inattention (an “attention deficit”) recognised that children with inattentive behaviours may not necessarily be disruptive and challenging but are more likely to be forgetful and daydreamers.
People with inattentive behaviours may be more forgetful or daydreamers. fizkes/Shutterstock Why do some people use the term ADD?
There was a surge of diagnoses in the 1980s. So it’s understandable that some people still hold onto the term ADD.
Some may identify as having ADD because out of habit, because this is what they were originally diagnosed with or because they don’t have hyperactivity/impulsivity traits.
Others who don’t have ADHD may use the term they came across in the 80s or 90s, not knowing the terminology has changed.
How is ADHD currently diagnosed?
The three sub-types of ADHD, outlined in the DSM-5 are:
- predominantly inattentive. People with the inattentive sub-type have difficulty sustaining concentration, are easily distracted and forgetful, lose things frequently, and are unable to follow detailed instructions
- predominantly hyperactive-impulsive. Those with this sub-type find it hard to be still, need to move constantly in structured situations, frequently interrupt others, talk non-stop and struggle with self control
- combined. Those with the combined sub-type experience the characteristics of those who are inattentive and hyperactive-impulsive.
ADHD diagnoses continue to rise among children and adults. And while ADHD was commonly diagnosed in boys, more recently we have seen growing numbers of girls and women seeking diagnoses.
However, some international experts contest the expanded definition of ADHD, driven by clinical practice in the United States. They argue the challenges of unwanted behaviours and educational outcomes for young people with the condition are uniquely shaped by each country’s cultural, political and local factors.
Regardless of the name change to reflect what we know about the condition, ADHD continues to impact educational, social and life situations of many children, adolescents and adults.
Kathy Gibbs, Program Director for the Bachelor of Education, Griffith University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Pegan Diet – by Dr. Mark Hyman
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First things first: the title of the book is a little misleading. “Pegan” is a portmanteau of “paleo” and “vegan”, making it sound like it will be appropriate for both of those dietary practices. Instead:
- Dr. Hyman offers advice about eating the right grains and legumes (inappropriate for a paleo diet)
- He also offers such advice as “be picky about poultry, eggs, and fish”, and “avoid dairy—mostly” (inappropriate for a vegan diet).
So, since his paleo vegan diet is neither paleo nor vegan, what actually is it?
It’s a whole foods diet that encourages the enjoyment of a lot of plants, and discretion with regard to the quality of animal products.
It’s a very respectable approach to eating, even if it didn’t live up to the title.
The style is somewhat sensationalist, while nevertheless including plenty of actual science in there too—so the content is good, even if the presentation isn’t what this reviewer would prefer.
He has recipes; they can be a little fancy (e.g. “matcha poppy bread with rose water glaze”) which may not be to everyone’s taste, but they are healthy.
Bottom line: the content is good; the style you may love or hate, and again, don’t be misled by the title.
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7 Signs of Undiagnosed Autism in Adults
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When it comes to adults and autism, there are two kinds of person in the popular view: those who resemble the Rain Man, and those who are making it up. But, it’s not so, as Paul Micallef explains:
The signs
We’ll not keep them a mystery; they are:
- Social interaction difficulties: such a person may struggle with understanding social cues, leading to awkwardness, isolation, or appearing eccentric.
- Need for structure and routine: either highly structured or disorganized, both of which stem from executive function challenges. The former, of course, is a coping mechanism, while the latter is the absence of same.
- Sensory sensitivities: can include sensitivities or insensitivities to light, sound, temperature, smells, tastes, and so forth.
- Spiky skillset: extreme strengths in certain areas, coupled with significant difficulties in others, leading to uneven abilities. May be able to dismantle and rebuild a PC, while not knowing how to arrange an Über.
- Emotional regulation issues: experiences of meltdowns, shutdowns, or withdrawal as coping mechanisms when overwhelmed. Not that this is “or”, not necessarily “and”. The latter goes especially unnoticed as an emotional regulation issue, because for everyone else, it’s something that’s not there to see.
- Unusual associations: making mental connections or associations that seem random or uncommon compared to others. The mind went to 17 places quickly and while everyone else got from idea A to idea B, this person is already at idea Q.
- Being “just different”: a general sense of being the odd one out, standing out in subtle or distinct ways. This is rather a catch-all, but if there’s someone who fits this, there’s a good chance, the other things apply too.
For more on all of these, whether pertaining to yourself or a loved one (or both!), enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- 16 Overlooked Autistic Traits In Women
- What is AuDHD? 5 important things to know when someone has both autism and ADHD
Take care!
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How to Eat (And Still Lose Weight) – by Dr. Andrew Jenkinson
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You may be wondering: what diet is he recommending?
The answer is: some guiding principles aside…. He’s not recommending a diet, per se.
What this book does instead is outline why we eat too much ← link is to where we previously had this author as a spotlight featured expert on this topic! Check it out!
He goes into a lot more detail than we ever could have in our little article, though, and this book is one of those where the reader may feel as though we have had a few classes at medical school. The style, however, is very comprehensible and accessible; there’s no obfuscating jargon here.
Once we understand the signalling that goes on in terms of hunger/satiety, and the signalling that goes on in terms of fat storage/metabolism, we can simply choose to not give our bodies the wrong signals. Yes, it’s really that simple. It feels quite like a cheat code!
Bottom line: if you’d like a better understanding of what regulates our body’s “set point” in weight/adiposity, and what can change it (for better or for worse), then this is the book for you.
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See what other 10almonds subscribers are asking!
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It’s Q&A Day at 10almonds!
Q: I would be interested in learning more about collagen and especially collagen supplements/powders and of course if needed, what is the best collagen product to take. What is collagen? Why do we need to supplement the collagen in our body? Thank you PS love the information I am receiving in the news letters. Keep it up
We’re glad you’re enjoying them! Your request prompted us to do our recent Research Review Monday main feature on collagen supplementation—we hope it helped, and if you’ve any more specific (or other) question, go ahead and let us know! We love questions and requests
Q: Great article about the health risks of salt to organs other than the heart! Is pink Himalayan sea salt, the pink kind, healthier?
Thank you! And, no, sorry. Any salt that is sodium chloride has the exact same effect because it’s chemically the same substance, even if impurities (however pretty) make it look different.
If you want a lower-sodium salt, we recommend the kind that says “low sodium” or “reduced sodium” or similar. Check the ingredients, it’ll probably be sodium chloride cut with potassium chloride. Potassium chloride is not only not a source of sodium, but also, it’s a source of potassium, which (unlike sodium) most of us could stand to get a little more of.
For your convenience: here’s an example on Amazon!
Bonus: you can get a reduced sodium version of pink Himalayan salt too!
Q: Can you let us know about more studies that have been done on statins? Are they really worth taking?
That is a great question! We imagine it might have been our recent book recommendation that prompted it? It’s quite a broad question though, so we’ll do that as a main feature in the near future!
Q: Is MSG healthier than salt in terms of sodium content or is it the same or worse?
Great question, and for that matter, MSG itself is a great topic for another day. But your actual question, we can readily answer here and now:
- Firstly, by “salt” we’re assuming from context that you mean sodium chloride.
- Both salt and MSG do contain sodium. However…
- MSG contains only about a third of the sodium that salt does, gram-for-gram.
- It’s still wise to be mindful of it, though. Same with sodium in other ingredients!
- Baking soda contains about twice as much sodium, gram for gram, as MSG.
Wondering why this happens?
Salt (sodium chloride, NaCl) is equal parts sodium and chlorine, by atom count, but sodium’s atomic mass is lower than chlorine’s, so 100g of salt contains only 39.34g of sodium.
Baking soda (sodium bicarbonate, NaHCO₃) is one part sodium for one part hydrogen, one part carbon, and three parts oxygen. Taking each of their diverse atomic masses into account, we see that 100g of baking soda contains 27.4g sodium.
MSG (monosodium glutamate, C₅H₈NO₄Na) is only one part sodium for 5 parts carbon, 8 parts hydrogen, 1 part nitrogen, and 4 parts oxygen… And all those other atoms put together weigh a lot (comparatively), so 100g of MSG contains only 12.28g sodium.
Q: Thanks for the info about dairy. As a vegan, I look forward to a future comment about milk alternatives
Thanks for bringing it up! What we research and write about is heavily driven by subscriber feedback, so notes like this really help us know there’s an audience for a given topic!
We’ll do a main feature on it, to do it justice. Watch out for Research Review Monday!
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