ADHD diagnosis and gender-bias

From me to you...online learning has allowed me to spend so much time thinking and writing about contemporary issues in mental health...loving it.

ADHD can appear as early as infancy (Seligman and Rider, 2012) and appears to have neurological foundations resulting in impaired frontal lobes (Seligman et al., 2012). There is some concern that over diagnosing may be occurring; for every two boys diagnosed, one girl is diagnosed (Seligment et al, 2012)—some have wondered what causes the disproportionate number of male diagnoses.

Harrison (2010) suggests that female adolescents with ADHD are an increased risk of “antisocial, addictive, mood, anxiety, and eating disorders” (Harrison, 2010). Harrison’s analysis is particularly relevant because as she points out, the majority of existing research consists of male dominated control groups (Harrison, 2010).  “Despite a possible difference in ADHD symptoms exhibited by boys and girls, our study clearly shows that exactly the same symptom picture is evaluated differently in boys than in girls.” (Bruchmüller, Margraf, Schneider, 2012, p136)

Gender based studies are important for several reasons, mainly because there are such clear behavioural differences between genders, that these variables must be considered in both diagnosing and treating ADHD. ADHD is considered by some to be on the Autism spectrum; females are diagnosed Aspergers far less frequently than males, and it is often attributed to social conventions (that is, it is acceptable for a female to be shy, smart and eccentric). I wonder if this is the case with ADHD; are females better at hiding symptoms, or coping and developing adaptive behaviours to compensate?  There are three times more males diagnosed with ADHD than female and the diagnostic  process is largely heuristic (Bruchmüller et al., 2012) leaving a bit too much grey area.

References

Bruchmüller, K., Margraf, J., & Schneider, S. (2012). Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Journal Of Consulting And Clinical Psychology, 80(1), 128-138. doi:10.1037/a0026582

Accurate Dissemination of ABA

ABA as a field is exploding and it seems that everyone has their own take on it.

Maybe it's more of a question of branding than anything else, but it seems at least to me that everyone is trying to REVOLUTIONIZE the Autism Education Field. From "experts" popping up everywhere, without the education to back up their expertise, to consultants that possess the credentials but not the practical knowledge of the application of IBI; the industry is changing. My only hope is that  the increase in professional interest in Autism is driven by a desire to make meaningful change, and not a desire to capitalize on a growing industry.

1 in 88 has Autism...talk about a growing demographic.

The prevalence of Autism, though intriguing, is not the subject of this post. The true issue I am taking up with, is the tendency for Autism therapy practices to show up on web pages, in consultants portfolios, or on message boards, claiming to be evidence-based and peer reviewed, but negating basic principles of science in so doing. You cannot claim to evidence-based, if you are not fully committed to the application of principles of ABA.

You cannot have your cake, and eat it too! You cannot accept the benefits of associating yourself with an evidence-based science, while also claiming to be anything other than a direct application of ABA. It's false advertising, and it's confusing for parents who aren't able to tell the different between evidence-based and not. We wear the professional hat, and with that role comes power and a (perhaps false) sense of knowledge/expertise.

I am all for finding new-age ways of engaging with your clients ( At MM we are super hands on and play based, BUT and it's a big BUT, it's all within the framework of evidence-based philosophies which we stick to VERY strictly). The principle of behaviourism are pretty much set in stone, and though we can decide how we get from A to B, we have to follow certain rules to get there.

Practitioners shouldn't be wavering on these principles even a little bit if they are claiming to be ABA; it's not a  buffet where you can pick what you want and negate the rest. ABA is evidence-based, but if you're not doing categorical ABA, it's NOT evidence-based. Now believe me if you walk into my center you are NOT going to find robotic discrete trial learning going on, and yet, we are somehow adhering strictly to principles of behaviour in every aspect.

Please require a high standard of your practitioners, your kids deserve it; the ABA industry deserves it.

Appreciation

Progress is really a measure of appreciation; without appreciation of true ability, there is no way to account for or track progress. Tracking your child's progress requires you to appreciate his or her strengths and weaknesses, in a way that is way beyond what you ever expected you could do. Doing what is best for your child means looking at him or her with unconditional acceptance and appreciation; anything but unconditional acceptance is a roadblock to success.