June 10, 2010

There Is No Link Between ADHD And Organophosphate Pesticides


pedatrics journal.jpgcome on you guys: what do the authors want to be true?


Pediatrics has a now famous study in which it was found that kids exposed to certain pesticides had significantly increased risk for ADHD.

There is universal praise for this piece of garbage, bow to the only true god: Evidence!

Michael L. Goldstein, MD, who was not involved in the study, said the study results are "very interesting findings from a very well-done study from a good database." The report, he said, "certainly got my attention when I read it; I was really impressed by it. I think it is a groundbreaking study..."
There are no dissenters, the worst that is said is "well, correlation isn't causation."

Sorry, there is one dissenter-- a pesticide rep:

Garry Hamlin of Dow AgroSciences, which manufactures an organophosphate known as chlorpyrifos, said he had not had time to read the report closely. But, he added, "the results reported in the paper don't establish any association specific to our product chlorpyrifos."
Ha! And the fact that he objects must mean it's true.  (Never mind chlorpyrifos was specifically not associated with an increased risk in this study.)

But the problem isn't the data-- in psychiatry, the problem is almost never the data.


adhd pesticide data.jpg

The study purports to show some relationship between pesticides and ADHD.  But this is silly; a priori, pesticides at high enough doses disrupt cognitive function.  Duh? So what's the point of the study?  Have they found that kids are getting exposed to much higher levels to pesticides than we ever thought?  Or that the pesticides are even more toxic than previously known?  No.  So?

The purpose isn't to show that pesticides can cause ADHD; the purpose is to solidify in your mind that ADHD is real.

While you're busy teasing apart statistical or methodological issues, such as whether a single static urine sample is sufficient to infer pesticide exposure in general, or the lack of control for diet, or how did they calculate the odds ratio?  you are not questioning whether ADHD is a real disorder, and that what they say it is here is what others say it is elsewhere.

But it's a trick.  You cannot use a correlation between two variables to prove the validity of one of the variables.

You cannot use a statistical correlation between pesticides and ADHD to reinforce the validity of ADHD, but that is what they did.  And everyone fell for it.

II.

Note that the rate of ADHD in this study (12%) is double the national average.  You don't have to agree with me on this, but:  that national average is likely inflated, i.e. kids were diagnosed ADHD that should have been bipolar, or anxious, or normal.  So whatever happened in this diagnostic sniper attack (telephone interviews of parents, and did not exclude symptoms that could/did occur in another disorder) is suspect.   

Regardless, it is indisputable that under the best circumstances-- a two hour interview with PET scan and genetic testing-- the diagnosis "ADHD" is not biologically homogeneous.  Whatever Billy has, even if it appears identical to what Jamal has, may be biochemically completely distinct.  Early HIV and the flu both appear identical in the beginning, but I'm not having sex with either.

This doesn't mean that "it doesn't exist"-- the behaviors are real. Nor does it mean the same medicine (e.g. Adderall) can't help it/them.

So now to the study, which finds a correlation between pesticides and an increased risk for a report of a cluster of behaviors.  No argument from me at all.  But the rigorous explanation of this study is that pesticides increase the risk for these behaviors, not "ADHD."

III.

If I've lost you, think of it like this: if this study found not just correlation but causation-- if the study proved that pesticides actually caused all of the symptoms that are detected by the ADHD inventory, then that isn't ADHD, any more than psychosis caused by cocaine is the same as schizophrenia.  This would be pesticide poisoning.  And if you're treating it with Adderall, you're an idiot.

IV.

Stated explicitly: the purpose of these studies is not to establish a link between variables, but to gain popular support from the public for one of the variables so that it becomes insanity to ask whether it's real.

Here's an example.  If the study determined a link between pesticide exposure and IQ, you'd say, "oh, I guess that makes sense that pesticides would lower intelligence."  If you do enough of these studies, say, 10,000 of them, you wouldn't have learned anything more about pesticides and intelligence-- because what else would there be to say? but you would have drowned in the passive assertions that IQ measures intelligence.  So it would become insane to question whether IQ is a good measure of intelligence ("oh come on, you're not asking rigorous questions, we've been doing it this way for decades").  At best-- another trick-- the debate may turn towards whether the Wechsler test is a valid measure of IQ. 

Maybe it is, maybe it isn't; but there are other kinds of studies that would tell us that.  You can't use these correlation studies to reinforce the validity of IQ.  But that's what would happen,10,000 garbage studies later.  "Oh, yeah, IQ.  Everyone knows about that."


V.

"You're just silly.  You haven't discussed construct validity..."

If you had this thought, then you're the problem.  I have discussed construct validity, without saying the words "construct validity," because the words distract from the discussion.  Same with "statistical significance."  But that's the move, drown the public in jargon and they'll cling tightly to whatever they do understand, which in this case is the title: "Pesticides linked to ADHD."

Every second you spend talking about construct validity is a second you aren't talking about the fact that the kid in front of you has something far more serious than ADHD.

If you are a talking to a scientician and they say "construct validity" or sling around a chi-squared, grab their tie and slam their face into the desk, and then run, run, run, you are being lied to.

VI.

"Why didn't you publish this post earlier, when the story first came out????"

You mean because the further away we get from the hot news cycle, the less you're interested in the truth? And so apathy allows it to stand as true, because it all seems plausible (face validity, bitches.)  That's social science for you.

But the answer to your question is simple: I don't get paid to criticize studies.   I have a job and a life and an alcohol problem that doesn't leave much room for blog posts.

If you don't like something going on in politics, there are ways to voice that.  But looking deep into a "scientific" concept requires a level of sophistication which, if you possess it, means you're probably busy with a day job.  So you have neither the time nor energy to dissect articles in Pediatrics-- and, anyway, no forum.  I, at least have a semi-popular blog;  but even so I'm subject to the same time and monetary constraints.  If I need money for rum, do I spend an extra hour at work, or write a post?

Had it not been for the little money I do get from this blog, maybe I would not have written this post at all, because... why bother?  And so all you are left with is their dogma.  Search the internet, the Letters To The Editor.  Anyone else saying what I just said in this post?  You may not agree with my post, but you are nevertheless better for having read and considered it.

I'm not saying I'm the only one who thought it; I'm saying that those who thought it, or could have thought it, are busy with other things, and the people who should have thought of it physically can't.

What do you think would happen if the NIMH paid astrophysicists to look into psychiatry? Ain't never gonna find out, they have their own problems.  Specialization doesn't mean I'm the best, it means stay off my lawn.  

Since I/us/astrophysicists don't have the resources to publish at all/as fast as Pediatrics or CNN, they get to decide what's true.
 
The people who get paid to look at ADHD are all unanimously on the same side, that's what conveys the illusion of objectivity.  Pretending to be divided pro- or anti-Pharma, or "dopamine hypothesis" vs. "noradrenergic hypothesis" makes it look like there's a lot of vigorous debate, but debating what color is a ki-ran just means ki-rans are real.

Please don't misunderstand me, I am not blogging for money.  I'm showing you that so much of what you think you know, what you think is fact, is established not by the force of evidence but by the absence of resources for the opposition.   The ones with the money are all unanimously in agreement. 

So yes, I would have liked to have posted day one; but I would have liked it better if someone else on the inside said, "umm, wait a minute?  Really?  We're going to CNN with this?"


-------
http://twitter.com/thelastpsych

---

More on pesticides here.

Note: I added another section to the earlier Love Means Not Letting The Other Person Be Himself.










Comments

Golden. Great analysis, as ... (Below threshold)

June 10, 2010 5:24 PM | Posted by izrik: | Reply

Golden. Great analysis, as usual.

"The ones with the money are all unanimously in agreement."
I assume that you're not trying to imply that 'the ones with the money' are engaging in a deliberate attempt to hoodwink the public, but rather that the common outlook of those involved in research makes certain assumptions come to the fore. Is that correct?

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I understand. Thanks. I w... (Below threshold)

June 10, 2010 7:59 PM | Posted by Ken Roberts: | Reply

I understand. Thanks. I was confused about this theme of yours before.

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Whatever the cause, there d... (Below threshold)

June 10, 2010 8:58 PM | Posted by Jennifer: | Reply

Whatever the cause, there does seem to be an increase in neurobehavioral disorders. Now one could argue this is due to better screening and recognition of issues - Kids aren't just "weird" anymore but have something to treat or work on at home. I say this with love since my daughter has SPD - sensory processing disorder. For so long people thought it was only those with Autism and ADHD who has SPD, but now we seem to see that you can have JUST the sensory part. Kids like my daughter are getting the extra help they need, which is a good thing. I'll share some websites that have helped us - hope they help someone else:
http://brainbalancecenters.com - non-medical, education
aitinstitute.org - alternative therapy for extreme sound sensitivity and APD
ictsonline.com - traditional occupational therapy

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kids were diagnosed ADHD... (Below threshold)

June 10, 2010 10:54 PM | Posted by Jack Coupal: | Reply

kids were diagnosed ADHD that should have been bipolar, or anxious, or normal.

Yeah, that shows that a wide spectrum of kids show similar behaviors.

The ADHD industry is one of those weird ones, where schoolteachers do the diagnosing. Then, the MD signs off on the judgement. Until subjective criteria stop designating a kid as having ADHD, the fraud like that published in Pediatrics will continue and kids will suffer the consequences.

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I was one of the people who... (Below threshold)

June 11, 2010 12:08 AM | Posted by Anonymous: | Reply

I was one of the people who had that exact thought, "he didn't even mention construct validity!" Ok, you got me. Force of habit, though I admit that's no excuse. It's truly amazing how after almost two decades of research (economics), one really does want to argue "process" and the technical/statistical aspects of a study.

Forest for the tress, I suppose.

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Maybe I am confused, but wh... (Below threshold)

June 11, 2010 12:12 AM | Posted by MJ: | Reply

Maybe I am confused, but what is ADHD if it isn't a convenient label for a set of behaviors? The diagnosis doesn't say what it is, just what it looks like. The "cause" or biological basis could be some environmental exposure to something like pesticides, it could be some genetic change, or it could be something else entirely different. Who knows.

But unless you wanted to make all diagnostic labels like ADHD only refer to cases were we didn't know the cause, then there isn't much point to saying that a behaviors caused by a theoretical pesticide poisoning aren't a form of ADHD. Under that reasoning there would be no ADHD because every case of ADHD is caused by something.

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Whatever Billy has, even... (Below threshold)

June 11, 2010 1:35 AM | Posted by Duh: | Reply

Whatever Billy has, even if it appears identical to what Jamal has, may be biochemically completely distinct.

Exactly. That's why docs who understand that difference don't give Ritalin to autistics.

PS. If you know such a doc let me know.

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Wait, we already know one s... (Below threshold)

June 11, 2010 1:44 AM | Posted by Double Duh: | Reply

Wait, we already know one such doc. :)

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"Where is it going? How doe... (Below threshold)

June 11, 2010 3:38 AM | Posted by Alex-5: | Reply

"Where is it going? How does it end?" (c) The Matrix

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"Nor does it mean the same ... (Below threshold)

June 11, 2010 7:57 AM | Posted by Anonymous: | Reply

"Nor does it mean the same medicine (e.g. Adderall) can't help it/them."TLP
Who is the Adderall helping? The owners of the patient, not the patient.
"the behaviors are real"TLP, sure, but how about a confrontation of this unwanted behaviour?
Szasz "sane behavior is attributed to reasons (choices), insane behavior to causes (diseases)"

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"I have a job and a life an... (Below threshold)

June 11, 2010 8:04 AM | Posted by Anonymous: | Reply

"I have a job and a life and an alcohol problem"TLP . If you have enough money for alcohol, you don't have a problem do you?

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Trying to see what you're u... (Below threshold)

June 11, 2010 8:48 AM | Posted by Andy: | Reply

Trying to see what you're up to here.

Those who could help us see the things in themselves through debate, can't, they're too busy specialising in things, doing things to get dosh.

ADHD: just a handy way to summarise a bunch of behaviours, no?

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Right. Have you stopped bea... (Below threshold)

June 11, 2010 10:29 AM | Posted by Penultimate: | Reply

Right. Have you stopped beating your wife?

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It's the way the world is r... (Below threshold)

June 11, 2010 12:56 PM | Posted by Mr.Krinkle: | Reply

It's the way the world is run. As quoted by the inimitable Tony Montana from the American Classic, Scarface, "First you got the money, then you got the power, then you get the bitches!" Truer words were never spoken.

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"I'm showing you that so mu... (Below threshold)

June 11, 2010 1:14 PM | Posted by Andrew: | Reply

"I'm showing you that so much of what you think you know, what you think is fact, is established not by the force of evidence but by the absence of resources for the opposition. The ones with the money are all unanimously in agreement."

Ditto this for the environmental movement. Geez. You and your partner, the government, are going to save the world? While you're at it, please make scarce resources limitless and change the laws of physics to make the parasitic energy sources (wind and solar) more cost effective. Thanks.

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Mostly in agreement with th... (Below threshold)

June 11, 2010 1:36 PM | Posted by Alex: | Reply

Mostly in agreement with this post, but I found it a bit odd that you created a strawman from the voice of your commenters to take a jab at for the last third of it. I guess commenters on here to tend to be fairly hostile/critical, but I'm also going to assume you don't want 50+ "great job! yay! Cheers!" comments either. I'll let you figure out what the psychology of expectations of behavior as it applies to blog comments is.

Also, there was once a profession that earned money criticizing technical/scientific reports *as* their day job, science journalists. Of course these have mostly been replaced by english majors saying "OMG Blondes have more sex, this study proves it!" and editors saying "Yep, sounds like that story will make us click-throughs!"

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It would be ironic if playi... (Below threshold)

June 11, 2010 11:56 PM | Posted by RC: | Reply

It would be ironic if playing in a pesticide-laden backyard DECREASES a child's likelihood of ADHD. I wonder if that might be the case.

It's been reported for some time now that the recent increase in allergies, asthma, and other autoimmune diseases is related to our modern, excessively sterile environment. According to the theory, children who don't play outside and get dirty don't develop healthy immunes systems.

I wonder if the recent rise in psychiatric illness might be at least partly related to this? Could our immune cells be attacking our neurons, causing ADHD, depression, anxiety, autism, etc. in higher numbers? There appears to be a very significant interplay between our nervous system and our immune system, so the theory isn't that far fetched.

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"Specialization doesn't mea... (Below threshold)

June 12, 2010 12:17 AM | Posted by Anonymous: | Reply

"Specialization doesn't mean I'm the best, it means stay off my lawn."

I think it's great you make posts like you have, however people don't always need the level of expertise you have to realise shit just doesn't add up.

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Great post.What ab... (Below threshold)

June 12, 2010 3:41 PM | Posted by Diazinon: | Reply

Great post.

What about the NTE gene, which was reported to mediate the link between organophosphates and hyperactivity in mice? If this panned out, wouldn't that go against your post and in effect support a genetic predisposition to organophosphate-induced-ADHD?

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Quick question. Medically ... (Below threshold)

June 13, 2010 3:20 PM | Posted by Anonymous: | Reply

Quick question. Medically speaking, the only difference between homeopathy and standard medicine is evidence, bias, process, I'm confused.

It would seem to me that homeopathy is more a standard of preventative medicine than actual medical work, no?

Why in God's name would the medical industry let these quacks take your jobs away from you when they clearly have no idea what they're doing. You people really need a new publicist.

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"if the study proved that p... (Below threshold)

June 13, 2010 10:07 PM | Posted by Anonymous: | Reply

"if the study proved that pesticides actually caused all of the symptoms that are detected by the ADHD inventory, then that isn't ADHD, any more than psychosis caused by cocaine is the same as schizophrenia. This would be pesticide poisoning. And if you're treating it with Adderall, you're an idiot."

Yeah, just like that leukemia caused by radiation is radiation poisoning, not cancer. And if you're treating it with chemo, you're an idiot. See: I can make irrelevant analogies too!

If we don't understand the underlying cause of the set of behaviors labeled ADHD, then how do we know whether pesticides cause damage in the same way as 'naturally occurring' ADHD symptoms? If they respond the same to Adderall does it make a practical difference to the doctor prescribing?

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What frustrates me about st... (Below threshold)

June 13, 2010 10:09 PM | Posted by Velvet Elvis: | Reply

What frustrates me about studies like this which posit a 12% ADD rate is that it makes it harder for those of us who truly due have ADHD to justify our need for stimulants and a destruction free work areas and the like.

I don't have to solidify in my mind that ADHD is real. It fits me to the T, going all the way back to childhood. It shouldn't be my job to legitimize to others my need for stimulants, a low-distraction work area, or to do yoga every couple of hours, wherever I may be. Such studies which misrepresent the nature of ADHD force me to do so and it pisses me off.

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So not only do you demand z... (Below threshold)

June 13, 2010 10:25 PM | Posted, in reply to Velvet Elvis's comment, by Andrew: | Reply

So not only do you demand zero distractions at work, you get to take periodic breaks for yoga, too? Sign ME up for ADHD!

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mmm, confusionIsn'... (Below threshold)

June 13, 2010 11:45 PM | Posted by The (P)Irate Piper: | Reply

mmm, confusion

Isn't adhd supposed to just be a single-acronym way of referring to a cluster of behaviors? Similar to fruits being a way to refer to things that have seeds. Or Jerk is a single word to refer to a (albeit vague) cluster of behaviors.

--One doesn't do mean things because one is a jerk, but rather they do mean things first and that makes them a jerk.--

I'm not sure how we can have a debate over the existence of something when it is just a description. I can call the yogurt I'm eating pink or jaksambak but it still exists as whatever it is and the color is the same regardless of whatever name I give to it.

The (P)Irate Piper
http://theiratepiper.wordpress.com/

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How is a five minute yoga b... (Below threshold)

June 14, 2010 12:39 AM | Posted by VelvetElvis: | Reply

How is a five minute yoga break different from a five minute smoke break?

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31 cents and a few years le... (Below threshold)

June 14, 2010 1:41 AM | Posted, in reply to VelvetElvis's comment, by The (P)Irate Piper: | Reply

31 cents and a few years less of life otherwise spent worrying about affording retirement

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I thought, behind the less-... (Below threshold)

June 14, 2010 2:02 AM | Posted by Bruno: | Reply

I thought, behind the less-than-optimal conveyance, there was something interesting said. I for one have always been uneasy about "ADHD" and it's apparent epidemic status.

There are probably plenty of 'poor people't that are depressed. We could lump that type of depression in with the rest, call it one big 'syndrome' and treat it pharmaceutically (which will work great for those of us sick and tired of hearing 'lazy people' 'whining') or realize that lumping disparate things together is not good science.

That's what I got out of his rant anyways...

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His argument seems to be: y... (Below threshold)

June 14, 2010 2:03 AM | Posted by Charlee: | Reply

His argument seems to be: you can't refer to ADHD as a syndrome; it's a list of symptoms. When you refer to a list of symptoms (a vague list of symptoms at that: DSM-IV) as if it was a syndrome it presents us with the danger. That danger is in how we treat the patient.

A syndrome is generally localized to a mechanism. At the moment, it doesn't look like "the mechanism" for ADHD exists; it looks to be more of a plural. Now, when you have a list of symptoms that, when manifest, always call for x drug, that's dangerous.

We don't know if the poisoning caused frontal lobe damage, and we don't exactly know how frontal lobe damage leads to symptoms that are currently lumped under ADHD. We don't even know what ADHD is. And yet we have literature that takes the existence of a syndrome, currently under the umbrella of ADHD, as axiomatic.

That's dangerous, no matter which "side" you're on.

At the least, he's calling for scientific prudence. Time and time again we've seen in science that there's never a moment where prudence is not appropriate.

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I had a hard time reading t... (Below threshold)

June 14, 2010 2:04 AM | Posted by Jesika: | Reply

I had a hard time reading this because I didn't know if the writer was being sarcastic or not...

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I don't see how this make A... (Below threshold)

June 14, 2010 4:07 AM | Posted, in reply to Charlee's comment, by Velvet Elvis: | Reply

I don't see how this make ADHD any different from bipolar or clinical depression.

I've heard a neuro-psychiatrist say there are like over 20 different kinds of bipolar based on both neuroimaging and types of episodes and frequency.

As far as medication response goes, where are we with depression? We've got depression that responds to SSRIs, depression that responds to norepinpheric drugs, we've got depression that only responds to stimulants, we've got depression that only responds to MAO-Is, we've got depression that only responds to opiates, we've got depression that only responds to ECT. In each case, at the physiological level each is likely a different beast even if all present as the same as far as DSM criteria go.

Psychiatray can only advance once we have the technology to move on from treating the mind and treat the brain, neurology and psychiatry merging. Freud would have agreed btw.
]

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I really hope english isn't... (Below threshold)

June 14, 2010 4:09 AM | Posted by Velvet Elvis: | Reply

I really hope english isn't your native language.

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*shrug*I've never ... (Below threshold)

June 14, 2010 4:20 AM | Posted, in reply to The (P)Irate Piper's comment, by Anonymous: | Reply

*shrug*

I've never had to ask for yoga as an accommodation, though I would if prevented from practicing it.

When I was in school I did yoga in the hallways between classes. Every job I've ever held I've taken 5 minutes to do it when I had a free moment. When anyone asked what I was doing I'd just say "yoga, it helps me keep my focus."

Yoga is just as important to me in dealing with ADHD symptoms as stimulants and I really see no reason why they should be treated differently.

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Behaviors are not symptoms.... (Below threshold)

June 14, 2010 8:23 PM | Posted by Anonymous: | Reply

Behaviors are not symptoms. Look at a medical dictionary.

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"The purpose isn't to show ... (Below threshold)

June 14, 2010 8:38 PM | Posted by Information addict: | Reply

"The purpose isn't to show that pesticides can cause ADHD; the purpose is to solidify in your mind that ADHD is real."

Regardless of whether science is clear on what causes ADHD, I thought we were past the time of having to justify its existence. Not everything that "looks" or seems like ADHD is in fact ADHD, but ADHD is real.

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A five minute yoga break in... (Below threshold)

June 15, 2010 7:48 AM | Posted, in reply to VelvetElvis's comment, by Anonymous: | Reply

A five minute yoga break involves deeply breathing in oxygen, and concentrating on one's physical and emotional state in a soothing way. It's practicing self soothing and is a constructive stress management and coping tool. Doing makes you life better both now and in the long run - there are positive cumulative effects. Nothing esoteric here, just simply basic biology and understanding of body/mind or body/emotions (however one wants to frame it). Moods are physical, one can change one's state via a physical or mental approach but the most direct and easiest way to change one's mood/thoughts is physical.

On the other hand, a five minute "smoke break" involves deeply breathing in a toxic mix of chemicals and addictive tobacco and is often used by people as a means to suppress or avoid emotions, or to stew in them. It's a poor coping tool because it creates stress (through the addiction), and it makes your life crappier and has negative cumulative effects. It may even kill you. It certainly has a huge effect on biology and impact on emotions and physical, mental and emotional habits and coping skills. It's an addiction and a self destructive habit. It's pretty obvious that it adds to depression in a variety of ways.

A five minute break spent going for a walk would also be a healthier alternative to smoking - whether one was using it as a meditation or merely to soothe oneself and calm the body down so the mind can function in a calmer mode. The reason why something like yoga or walking works is because deeply breathing in oxygen is soothing and tells our bodies to calm down (which, in turn, effects our mood and thinking).

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"The purpose isn't to show ... (Below threshold)

June 17, 2010 3:58 AM | Posted by Neuroskeptic: | Reply

"The purpose isn't to show that pesticides can cause ADHD; the purpose is to solidify in your mind that ADHD is real."

The purpose of almost all science is to enhance the authors' CV. If there was a conspiracy to convince people of the reality of ADHD it would be a lot more effective.

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I quit smoking years ago.</... (Below threshold)

June 17, 2010 4:29 AM | Posted, in reply to Anonymous's comment, by VelvetElvis: | Reply

I quit smoking years ago.

My argument was that if a 5 minute smoke break every few hours is permissible in the workplace, a 5 minute yoga break should be no more of an imposition.

As I said, I've never had to ask for it as an ADHD accommodation. If any employer actually said "no, you can't do that" I'd be prepared to justify it as a workplace accommodation while undergoing the process of seeking a less anal-retentive employer.

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i dont have a day job, but ... (Below threshold)

June 26, 2010 12:03 AM | Posted by fckn a: | Reply

i dont have a day job, but im sophisticated- I just have poor executive function: so I can parse Pediatrics articles with the best of them, but fck writing an analysis for unsophisticated people afterward.

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I just discovered your blog... (Below threshold)

June 26, 2010 11:54 PM | Posted by Gina Pera: | Reply

I just discovered your blog, in searching for a deeper discussion of this ADHD-organophosphates study. By "deeper discussion," I mean a report that isn't written straight from the press release. ;-)

You make excellent points, though I don't pretend to understand all of them. Thank you.

Here is the response I wrote when asked about the study....FYI:

I think it's important to note that the authors do not attribute organophosphates as causative to ADHD; at this point, they are simply noting the association.

That said, there is substantial evidence of the neurotoxic effect of many organophosphates. (In fact, they were developed as biowarfare weapons.) It makes sense that a neurotoxin might tilt the epigenetic balance of gene expression and, if not causing ADHD itself, causing neurological symptoms that mimic ADHD.

Moreover, organophosphates are almost omnipresent in many homes and the outside environment--on food, in the air, in soil, on pets (flea dips, sprays, etc.), in home gardens, and in the home itself (pesticides). Huge swaths of land have been sprayed to combat West Nile disease. The list goes on.

Another point: My understanding is that the people most vulnerable to the toxic effect of organophosphates are those who are deficient in the "good" minerals such as magnesium and calcium, because they compete for the same receptors. There is some evidence that ADHD is associated, at least in part, with these "good mineral" deficiencies. (And perhaps so are many people whose symptoms mimic ADHD and aren't understood by the many physicians, and especially psychiatrists, who do not understand the role of nutrition in brain-or-the-rest-of-the-body health).

Moreover, when handling any household chemical or making household purchasing decisions, it's important to carefully read instructions, limit exposure (with protective gear), and in many ways be exceedingly cautious. Perhaps the parents of these children in the study have ADHD, too, and aren't as careful as they should be. (ADHD is 76 percent heritable, after all.) There could even be a limbic-system over-reaction to household invaders such as ants and fleas, spraying the house with these toxic chemicals without thinking of health consequences.

It would have been interesting to have studied the parents, too, and measured household levels of organophosphates. In other words, there are many reasons for "association" rather than "causation."

Still, we need to examine all chemicals in the environment that affect the nervous system. It's only common sense, IMHO.

Gina Pera, author
Is It You, Me, or Adult A.D.D.?
http://www.ADHDRollerCoaster.org

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Eek. I just noticed that th... (Below threshold)

June 26, 2010 11:56 PM | Posted by Gina Pera: | Reply

Eek. I just noticed that the ad on this page is for Terminix. I don't think it takes a double-blind study to know that it's best to avoid pesticides in the home. Most pest problems can be resolved with better caulking and hygiene.

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RC wrote: It's been reporte... (Below threshold)

June 27, 2010 12:03 AM | Posted by Gina Pera: | Reply

RC wrote: It's been reported for some time now that the recent increase in allergies, asthma, and other autoimmune diseases is related to our modern, excessively sterile environment. According to the theory, children who don't play outside and get dirty don't develop healthy immunes systems.

---

It might have been reported but I haven't seen much evidence for the "hygiene" hypothesis.

In fact, many children who don't play outside and get dirty have allergies in the first place!

I've recently read two popular books on allergies and asthma, both written by medical historians. I'm so unimpressed with what allergists think they know about allergies.

A simple mineral such as magnesium has been shown to alleviate asthma in some circumstances, and anecdotal reports indicate that magnesium supplementation can help allergy sufferers, too, perhaps via the same mechanism as with asthma.

But do allergists or allergy researchers have one tiny clue about this? No. They are either chasing the career-making novel discovery or a new pharmaceutical. A simple, cheap, abundant mineral such as magnesium -- vital to hundreds of cellular processes -- holds little allure (or profit?).

For those who know the importance of calcium-magnesium balance in the body and who also have observed the mind-boggling amounts of calcium being pushed on children (and women), it's no secret why we're seeing higher rates of asthma, for example.

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Anonymous wrote: On... (Below threshold)

June 27, 2010 12:07 AM | Posted by Gina Pera: | Reply

Anonymous wrote:
On the other hand, a five minute "smoke break" involves deeply breathing in a toxic mix of chemicals and addictive tobacco and is often used by people as a means to suppress or avoid emotions, or to stew in them.

-----
And what is your evidence of this? Perhaps the emotion-stifling payoff is true for some people. But get this: Tobacco is a very effective (but often deadly) dopamine-delivery system.

Many people with ADHD didn't know they had ADHD until they quit smoking!

So, I'd be very reluctant to psychoanalyze the reasons someone smokes, especially when there's no evidence.

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I think your article has al... (Below threshold)

August 11, 2010 10:58 PM | Posted by Sue: | Reply

I think your article has also perfectly described how the "consensus" around global warming was created.

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<a href="http://helpguide.o... (Below threshold)

August 11, 2010 11:32 PM | Posted by Anonymous: | Reply

http://helpguide.org/mental/adhd_add_signs_symptoms.htm

If people can't see this is a load of shit, I feel bad for humanity.

THIS IS THE NORMAL BEHAVIOR OF LITTLE GIRLS AND BOYS. Little girls are often spacey and detatched (see: "alice in wonderland" as a ubiquitous example), little boys are often hyperactive and impulsive. ALL children have trouble with attention. It is part of maturity to be able to put aside your inner world, your thoughts and desires, and to just concentrate on a task even if it is unpleasant. THAT IS CALLED MATURITY. It is not a disorder.


I also think that "adhd/add" may represent a personality variant. We are all not meant for work in offices or study in school. Some of us are meant to be EMTs and soldiers and firefighters and entertainers and stuff. You are not a defect if your brain is incapable of sitting down with a book and reading it for a long time. Our society makes it out like it is part of being a normal human to study for long periods and get a professional job, but the reality is very few people have the brain type cut out for that work. Unfortunately there are very few jobs left for people better suited for more active less focused work, because of how industry has destroyed america.

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Sorry anon, but you seem to... (Below threshold)

August 11, 2010 11:49 PM | Posted, in reply to Anonymous's comment, by Gina Pera: | Reply

Sorry anon, but you seem to have only a superficial (and mostly misinformed) understanding of ADHD.

I know people with ADHD who had their hearts set on being firefighters or EMTs but undiagnosed ADHD got in the way.

Even firefighters can't get by with neurospatial deficits that might have them confused left from right (or, as in the case with hose connectors, clockwise from counterclockwise).

ADHD is not just about having trouble sitting and reading a book. Good grief.

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I would argue if someone ca... (Below threshold)

August 12, 2010 12:12 AM | Posted by Anonymous: | Reply

I would argue if someone cant tell if their left or their right, they have a neurological disability which has NOTHING IN COMMON with garden variety ADHD/ADD.

ADHD/ADD as far as I can see in all people I have met with it, officially diagnosed with it, merely represents personality variants (not scholastically inclined) or generalize immaturity and emotional underdevelopment secondary to excessive psychiatric care.

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Perhaps you want to educate... (Below threshold)

August 12, 2010 12:57 AM | Posted by Anonymous: | Reply

Perhaps you want to educate yourself, because you don't really understand the core issues with ADHD.

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Gina, having confusion over... (Below threshold)

August 12, 2010 7:29 AM | Posted by Anonymous: | Reply

Gina, having confusion over left and right or not remembering if things turn clockwise or counterclockwise is pretty normal, it's hardly something specific to ADHD. It's the amount of people trying to claim pretty normal human fallibility and quirks are pathological and symptoms of ADHD (particularly when they can personally gain from pathologizing normal human fallibility) is what makes it difficult for people who really do have ADHD. The university student who drinks all the time and then claims he can't concentrate and convinces himself and others he has ADHD so he can get speed and special treatment and not have to give up the binge drinking and partying to study. Or the parent who plants their kid in front of the tv, feeds them crap and generally ignores them then claims their kids have no self control because they have ADHD, etc.
Concentration is a learned skill, it's not innate. And, yes, everyone requires practice (and the discomfort that goes with practicing) to be good at it so simply having difficulty concentrating or memorizing without effort isn't a sign that you have ADHD. Sure we live in a culture and mediated environment that doesn't encourage paying attention, contemplation or support concentrated effort for the most part but we can still choose to think and behave differently (most of us can because most of us don't actually have ADHD, we just have poor mental habits and hygiene and prefer to remain unaware of our actions and responsibilities and even to pathologize ourselves as a means to deny our own accountability to ourselves and to others in favor of painting ourselves as a victim.

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I think you are being paran... (Below threshold)

August 19, 2010 4:47 PM | Posted by Kevin: | Reply

I think you are being paranoid in claiming that the purpose of this study is to solidify the existence of ADHD as a clinical syndrome. I believe ADHD to be real and not to be a figment of academic research objectives supported by the NIMH and underlaid by big pharma plots to take over the world. However I also agree that the authors have overstated thier results in saying that organophosphate exposure may contribute to ADHD prevalence. There is no cause and effect here simply a correlation.

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[...]Gina, having confusion... (Below threshold)

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I just wanted to let you kn... (Below threshold)

December 7, 2010 5:20 PM | Posted by Anonymous: | Reply

I just wanted to let you know about a free Adult ADHD CME activity I just came across called "Today’s Patient in ADHD: A Focus on Transitional Care Across the Lifespan." This activity provides insights and learning geared toward treating the most challenging adult patients with ADHD in an interactive online format. You can earn 1.25 AMA PRA Category 1 Credits™ Register at: http://mycmesite.com/adhd

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my psychiatrist has a degre... (Below threshold)

December 7, 2010 7:51 PM | Posted by Anonymous: | Reply

my psychiatrist has a degree from Stanford. in most literate american social circles, this indicates an above average level of intelligence.

my psychiatrist has diagnosed me with "severe ADD" telling me that I am the inattentive dreamer high intelligence type. while this is very flattering to me, I don't buy it as I did not get good grades in school and I did not excel at anything in my young life, not even popularity contests. I am not very exceptional in any one area of life. although I was pretty good in sports, I won a scholarship to college for my sport, but I was not gifted enough for professional competition.

anyway so i told my psychiatrist that I think these "add" symptoms are caused by my nutritionally poor diet which consists of coffee, muffins, and ice cream. said psychiatrist will not hear of it. not even for the sake of healthy scientific debate. i find that strange that he will not entertain the idea that maybe ADHD is 'bullshit'. he is supposedly a very intelligent person- he graduated from Stanford. why so rigid in his thinking?

he prescribed me ritalin and adderall. I took them for a while, but nothing in my life improved. I still can't finish reading 'the autobiography of malcolm x' , a book I started reading 2 years ago. and I still can't listen to classic jazz albums in their entirety.

i dont take the medications anymore and I feel the same now as when i was taking them. I dont believe in ADD. I think some people simply have poor concentration, are born without ambition, are naturally lazy, and lack initiative.
I have told my psychiatrist this on many occasions to no avail. I can't persuade him.

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Why were you prescribed Rit... (Below threshold)

December 7, 2010 10:47 PM | Posted, in reply to Anonymous's comment, by JR Rixon: | Reply

Why were you prescribed Ritalin AND Adderall at the same time? I've never heard of that before and I'm a pharmacist's assistant; I fill ADHD prescriptions at least 20 times a shift and they are always for one or the other, not both.

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As far as Asthma, look up a... (Below threshold)

September 18, 2011 10:32 PM | Posted by Jimmy Flatbush: | Reply

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More lies spewed by the Big... (Below threshold)

February 29, 2012 8:25 PM | Posted, in reply to Gina Pera's comment, by The Truth: | Reply

More lies spewed by the Big Pharma shill, who never has bee diagnosed with ADHD, yet knows everything about it.

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December 18, 2012 8:35 AM | Posted by Anonymous: | Reply

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I am new to this blog site.... (Below threshold)

April 30, 2013 4:32 AM | Posted, in reply to Anonymous's comment, by Emilymkf: | Reply

I am new to this blog site. I am a psychiatrist who chooses by preference to see adults with ADHD.

It was painful to read you describing yourself as "maybe born with..."
And seeing the words you might be feeling " naturally lazy" "poor concentration" "without ambition" "lack initiative".

I'm responding to someone who wrote this in 2010. And wondering where such harsh words came from that you should be calling yourself out by these labels.

Excuse me also, because I do not wish to intrude on your treatment. Or to make comments about your psychiatrist. Just to try to convey my sense that it is a harder road to follow when you have contempt for your self. I don't think you were born with that. I wish you well if you see this.

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To TLP: ADHD IS MY SPECIAL ... (Below threshold)

April 30, 2013 4:51 AM | Posted by Emilymkf: | Reply

To TLP: ADHD IS MY SPECIAL INTEREST. I LOVE WHAT YOU SAID ABOUT HOW LANGUAGE WORKS. GIVE SOMETHING A NAME, GET A LOT OF PEOPLE TO RESPECT YOU BECAUSE YOU ARE IN SOME POSITION SOCIETY THINKS INFUSES YOU WITH EXPERT STATUS, WHICH I DON'T BELIEVE IN EITHER. SO THEN WE HAVE TURNED OFF ONE MORE BRAIN SWITCH TO LET US BE ABLE TO TAKE IN OUR OWN PERCEPTIONS.

THIS MEANS YOU TOO, MISS TLP. REMIND YOUR READERS THAT YOU ARE ENTERTAINING, SOMETIMES INFORMATIVE, AND ARE LOOKING AT THINGS TO TEAR DOWN IN THIS FIELD WHICH IS NO MORE OR LESS NUTS THAN ANY OTHER FIELD OF SELF-DESCRIBED EXPERTISE.

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You are naive. OF COURSE a ... (Below threshold)

October 10, 2014 3:23 PM | Posted by Ryan: | Reply

You are naive. OF COURSE a scientist of Agrochemicals would dismiss the study. Did you know that the FDA is full of ex-Monsanto employees? And if you're such a genius, explain why the prevalence of ADHD has been rapidly going up. FYI, the organophosphates lead to buildup of acetylcholine, which is a strong dopamine antagonist. Current treatment options include dopamine agonists like amphetamines, and increasingly, cannabis in some states, because people with ADHD have low dopamine function. One homeopathic treatment, I found, is Datura, a strongly anti-cholinergic plant. So you don't know crap. Your little article overthinking the single (valid) study is worth nothing and should be blasted off the face of the internet. You know nothing.

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Did he died?... (Below threshold)

October 11, 2014 6:01 AM | Posted, in reply to Ryan's comment, by Anonymous: | Reply

Did he died?

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The alert icon is no longer... (Below threshold)

October 11, 2014 6:43 PM | Posted by JAS: | Reply

The alert icon is no longer responsive. I see several inappropriate posts, including links to "buy ritalin," etc.

Like the previous poster questions, Did he died?

Has The Last Psychiatrist abandoned this blog?

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