Dr. Craig B. Wiener
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Correct diagnosis?

6/9/2014

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"Correct diagnosis" means the individual meets the established criteria. "Misdiagnosis" means the label is used when the criteria are not met. The "accurate" rate of diagnosis relates to using the specified criteria in a reliable fashion.

Is the complaint about "high numbers" a concern that professionals are not correctly applying the criteria and/or a plea for us to change the criteria to encompass fewer people?


Pat Pernico, in a recent Psychotherapy Networker (i.e., Rush to Judgment: Beware of the ADHD Diagnosis), advises using caution when giving an ADHD diagnosis. She states,  “if the individual actually had ADHD, there would be no other factors to account for trouble sleeping, difficulty completing or following tasks at school or at home, impulsively and hyperactivity.”

However, simply because we have not found “other factors” does not mean that there are no other factors (within the domain of psychology) that might reasonable account for the ADHD behaviors. Identifying “other factors” always depends on the insight and wisdom of person doing the identifying.

Along these same lines, what are the criteria to distinguish between “psychological avoidance” and “neurological ADHD distractibility” when deciding on a differential diagnosis (i.e., ADHD or something else)?  Until we address these concerns, we will rule out ADHD when the practitioner makes a claim for psychology, but we will cling to the construct “really has ADHD” when the practitioner makes no such claim. The lack of consensus in applying the ADHD label will often relate to these kinds of problems.     

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The Problematic Hyperfocus Explanation  

6/5/2014

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This account was put forward to address concerns that individuals diagnosed with ADHD were showing focused attention in a variety of situations and circumstances. Since this was true, ADHD could not be an “inability to maintain focus”. ADHD then became an inability to “regulate attention.”

The problem is that "inability to regulate attention" is assessed when people show inefficiencies in response to work. It is interesting that hyperfocus occurs during pleasurable activities, while failures to maintain focus occur in response to assigned activity (i.e., what others want them to do).  

 A learning paradigm (as compared to neurological delay) may be a more reasonable way to account for ADHD data. Individuals may hyperfocus to maintain involvement with activities they like and they show distractibility (i.e., escape, avoidance) and other inefficiencies (e.g., rushing, carelessness, desperation) when dealing with stipulations, evaluations, and other adversities. 

Why introduce a neurological account when a psychological account has not been ruled out???       

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    Dr. Craig B. Wiener

    Dr. Craig B. Wiener has worked with individuals diagnosed as ADHD since 1980.

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