【英語要約】ADHDの正体 その診断は正しいのか

Review

It can be said that the understanding of mental illness has increased in recent years. However, there are few people who can explain exactly what ADHD and developmental disorders are, and how they differ from other diseases. Even people who are actually diagnosed with ADHD may not be able to accurately grasp the full picture of the disease. Then, you may not be able to judge whether the doctor's treatment policy really suits you. Or maybe there are some people who have vague difficulty living in social life and interpersonal relationships and are worried that "I may be ADHD".

This book raises the question of whether the "adult ADHD" that has been increasing in recent years is an extension of the developmental disabilities of children as previously thought. Based on various evidences, we will clarify that adult ADHD has a large cause even when it is not a genetic factor. Adult ADHD often doesn't get better just by prescribing the drug, and the problem needs to be addressed from another side. The hint is in the word "attachment".

This is not limited to people who have been diagnosed with ADHD. Isn't this a common problem for many modern people who feel somehow difficult to live? The assertion in this book, which proposes countermeasures and preventive measures, can be broadly taken as a good direction for general public problems.

Main points of this book

Point 1

Although ADHD has been considered to be a congenital developmental disorder, the number of people who have been diagnosed in recent years has rapidly increased, and genetics can no longer be considered a factor.

Point 2

Adult ADHD is particularly affected by environmental factors, and is often caused by unstable attachment. The problem of attachment in the process of parenting is passed on from parent to child, and genetic factors and parenting factors are mixed.

Point 3

The disadvantages of drug therapy for pseudo ADHD due to attachment disorder are greater. Rather than trying to temporarily control symptoms, we need to deal with the underlying problem of attachment.

Adult ADHD

Rapid increase in ADHD

ADHD is a disorder characterized by hyperactivity/impulsivity and inattention, and is considered to be one of the developmental disorders caused by congenital troubles in brain development. Mostly improvements are seen as they grow. However, the number of cases of "adult ADHD" is increasing rapidly. This is the case when the symptoms remain even after becoming an adult, or when they are not noticed as a child and are diagnosed only when they become adults.

The number of people who have been prescribed drugs but are not getting better is increasing, and the number of people seeking a second opinion is increasing. Clinicians are often skeptical about diagnosing ADHD and prescribing anti-ADHD drugs, even if the patients themselves are expecting the drug.

In order to clarify the nature of this discomfort, I decided to thoroughly reexamine the situation surrounding ADHD. Developmental disorders such as ADHD have attracted the attention of so many people that it is no exaggeration to say that it is a boom. Why is this happening? Are the diagnosis and medical treatment performed properly? The answer to that might be a rather inconvenient truth.

Is ADHD in adults a developmental disorder?

Until the mid-1990s, ADHD was primarily considered a child's disability. In the United States, where drug therapy for ADHD was given early on, there were a huge number of cases in which drug administration could not be stopped even in adulthood. In response to urgent complaints from clinical sites, the diagnosis and medication of ADHD for adults has recently been accepted even in Japan. On the other hand, as diagnostic criteria have been relaxed, cases such as prescribing even people in their 60s have become prominent. For both patients and therapists, there is a situation where the effects of the drug cannot be realized.

"Adult ADHD" was based on the diagnosis of neurodevelopmental disorders that persisted from childhood to adulthood. However, in 2015, the results of research that directly questioned such a premise were announced. A 38-year follow-up study of 1037 children born at the same time in a local city in New Zealand was conducted. The results are as follows. More than 90% of people diagnosed with ADHD in childhood healed with age. On the other hand, about 90% of adults diagnosed with ADHD were not ADHD in childhood. In other words, adult ADHD was shown to be different from child ADHD, and the premise that it was a developmental disorder became questionable.

In fact, other studies have found several distinct characteristics between adult and child ADHD. But whatever the cause of "adult ADHD," there is no doubt that they need help.

Is inheritance the only factor that causes ADHD?

Forming the concept of ADHD

ADHD is said to be a congenital neurodevelopmental disorder, but what is the reason for this?

It was in 1957 that a diagnostic concept called "hyperactivity/impulsive disorder" was proposed, which is almost equivalent to the concept of ADHD today. With the economic growth after World War II, when the atmosphere where academic performance is very important is spread throughout society, children who are unable to concentrate on classes and become annoyed around have a disorder called "hyperactivity disorder". It came to be explained. Also, the possibility of treatment with drugs gave hope. Children with hyperactivity were then classified as disabled, and hyperactivity was a natural problem at the nerve level, and it was explained that they should be treated with drugs.

At the same time, it was confirmed that the condition called "autism" has a strong congenital factor, and became commonly referred to as developmental disorder together with ADHD. The concept of "developmental disability", which does not seek the cause of environmental factors such as the family, does not cause parents to feel guilty, gives hope to teachers and counselors for improvement, and spreads rapidly. It was

If you have a natural disability, you should not have a sudden increase. But in reality, the diagnosis of ADHD has continued to increase. Contrary to the solid name of neurodevelopmental disorder, its reality is not very certain. While there is a high probability of finding a mutation in autism that causes it, no gene mutation that also causes ADHD has been found for decades. Rather, what has become clear in subsequent research is that ADHD is made up of a diverse group of things and is strongly influenced by environmental factors.

Pseudo ADHD

A study of Romanian orphans examined whether the length of time a child lives in an institution in a British family before being adopted changes the proportion of those who grow up and meet the diagnostic criteria for ADHD. As a result, it was shown that living in an institution for a long time, that is, an unfavorable parenting environment at an early age, is a factor that later causes the symptoms of ADHD. However, this should be called a pseudo ADHD to be exact. Moreover, this pseudo-ADHD tended to grow stronger in adulthood than in childhood.

Although the prevalence of ADHD is increasing in society as a whole, learning disabilities and intellectual disabilities are not increasing. I think that what is not the original developmental disorder accounts for a large part of the increase. It can be said that symptoms associated with adverse environmental factors such as abuse and neglect are related. Thus, disorders such as interpersonal relationships and emotions caused by the failure of the caregiver are called attachment disorders.

[Must read!] How to prevent adult ADHD

Attachment Disorder and ADHD

For developmental disorders due to genetic factors, no one, including myself, is held responsible and can receive assistance as a disorder. On the other hand, attachment disorders often have greater difficulty and difficulty in living, but since it is difficult to tell what happened as a child, it is difficult to make a diagnosis.

A connection with a special caregiver, such as a mother, is called "attachment" and is a biological phenomenon that is widely recognized in other mammals. Oxytocin, a hormone, plays an important role. Oxytocin not only supports persistent ties like parent-child ties, but also enhances sociality and empathy, protects us from stress and anxiety, and is closely related to our physical and mental health and well-being. Recently, the relationship between hyperactivity and carelessness has also become known. Children with ADHD have been reported to have reduced levels of oxytocin. Oxytocin has a calming effect.

In the period from birth to about one and a half years old, attachment is born with those who have been caring lovingly. It is the foundation of all interpersonal relationships. Oxytocin works well when you have a stable attachment. On the other hand, if there is no one to care for you, you can only form unstable attachments.

"Unfortunate events" that change stable attachment into unstable form include parental death and divorce, parental mental illness and drug/alcohol dependence. This overlaps somewhat with the risk factors for diagnosing ADHD. In addition to the original ADHD due to developmental disorders, diagnosed ADHD also includes pseudo-ADHD caused by nurturing factors including attachment disorders. In some cases, childcare factors are exacerbating the original ADHD, and the fact is that childcare factors are often involved. More than 90% of adult ADHD is pseudo ADHD, and it seems that a considerable number of ADHD of children are mixed.

Inheritance first or environment first

It has long been thought that children with ADHD are not only often scolded, but also susceptible to violent abuse, which makes their attachment to their parents unstable. However, most adults with ADHD, who have recently been diagnosed, show symptoms most often after age 12. Therefore, it is unreasonable to explain that the problem of attachment occurred because ADHD was first.

When pseudo ADHD occurs, the process is seen in which, after years of attachment damage due to abuse, the effects appear as symptoms of pseudo ADHD and intensify. Socio-economic factors such as poverty also increase the risk of ADHD through the effects of attachment and parenthood. Studies have shown that children with ADHD tend to be more symptomatic when their mothers have attachment problems with their parents.

The established theory that ADHD is a neurodevelopmental disorder with a strong genetic factor was strong. However, if environmental factors were included in what was previously calculated as a genetic factor, it means that there was a strong interaction between genetic factors and environmental factors. Studies have examined whether children born to ova and those who are adopted shortly after childbirth are more likely to inherit ADHD symptoms from their mothers or adopted mothers. While there was no correlation with the actual mother's symptoms, a significant correlation was observed with the adopted mother's symptoms. Certainly, children can have a positive and impulsive tendency due to genetic influences. However, adoptive mothers with ADHD tend to be more hostile towards children with similar characteristics, which can cause children to exhibit ADHD symptoms as well. Not only does the environmental factor add to the genetic factor to push the ADHD onset switch, but the genetic factor influences the environmental factor and attracts a harsh environment.

Problems due to destabilization of attachment

Perhaps the root of the rapid increase in mental and behavioral disorders such as ADHD is the destabilization of attachment. Not only these mental illnesses, but abuse, bullying, DV, divorce, etc. are also associated with unstable attachment. They are falling into an "attachment collapse" that causes further instability in attachment.

Disorders that increase the risk of onset due to unstable attachment, that is, "attachment-related disorders," have various symptoms, and their medical conditions change depending on age and time. However, if the underlying problem is regarded as an attachment disorder, then the underlying pathology can be understood and appropriately dealt with without being overwhelmed by surface symptoms.

Experience that can be accepted

Diagnosis of ADHD, such as attachment disorder, and drug therapy may cause more demerits than merit. In adolescents and adults, central stimulants are at risk of dependence. In the case of pseudo-ADHD, which is based on attachment disorder, if only drug therapy is performed and the allowance for psychological aspects and family relationships is omitted, on the contrary, it may leave a big root.

A widely used treatment other than drug therapy is the psychosocial approach. In addition to programs that support children themselves, many methods have been developed to encourage parents and teachers to stabilize their attachments. In both cases, it is important to learn and practice techniques that will be a safe base for children, rather than setting therapeutic goals to improve symptoms and problem behaviors. Instead of using medicine suddenly, just watching for a while with support for dealing with children will reduce unnecessary medication considerably. Even if the problem behavior is intense, the positive experience that you will receive it will change the child dramatically.

To become a safety base, it is important to respond and respond to the needs of children. In addition, it is also necessary to have empathy to grasp the feelings and intentions of the child from the standpoint of the child. However, there are cases where parents have unstable attachments in the first place. First of all, the starting point for improvement is that the parents themselves accept it as a safety base.

It's up to you to get involved and improve the problem. When we take a child's problem as their own, parents will also undergo dramatic changes, and parents and children will be able to achieve great growth.

Recommendation of reading

This book builds on solid evidence-based discussions. Reading through will give you a correct understanding of ADHD. It dispels the beliefs, prejudices, and vague knowledge that I have had.

What should I do to avoid being frustrated by the carelessness of others? What causes dependence on TV and games as a child? Why are some people who have been abused able to create a warm family? Even if you think ADHD is not familiar to you, this book is full of hints to eliminate the difficulty of living.

おすすめの記事