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Expert Q&A

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Why don't the mediacallthe disorder'ADHD' instead of ADD?

Asked by Ryan, Memphis, Tennessee

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With the change to ADHD from ADD in the past decades (DSM-III-R, 1987 - DSM-IV-TR), why are professional sites such as CNNhealth.com's Mental Health still utilizing archaic terminology in some articles?

I understand that the public was never fully transitioned to the terminology, so I don't expect correct use from TV/media, but parents are often very confused about the differences, and the further use on informational sites such as this only exacerbates the issue.

Expert Bio Picture

Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Ryan,

You are quite right, and I stand corrected.

In the most current iteration of the "bible" of psychiatric diagnoses, which is officially The Diagnostic and Statistical Manual of Mental Disorders -- Fourth Edition Text Revision but is more commonly called the DSM-IV-TR, ADHD is the official term for the entire range of attention and hyperactivity conditions that were once divided between the terms ADHD (attention deficit hyperactivity disorder) and ADD (attention deficit disorder). Although the new terminology is bulkier than the old way of saying things, there is logic to it, because attention difficulties and hyperactivity seem to reflect a single underlying process even in people (typically women) who have only the attention problems.

We are all victims, I suppose, of the times in which our conceptions are formed, and when I picture ADHD, I see a young boy bouncing off the walls of a classroom while hollering uncontrollably. When I picture ADD, I see a quiet, passive little girl sitting in the back of the classroom bothering no one, but with a mind totally adrift and unable to focus. They seem like such different scenarios that I instinctively want to reach back in time to give them different names. Hence my mistake.

There is a deeper issue here, however, that I'd like to address briefly. In days past, when I was primarily a clinician, I was known among medical residents as a terrible stickler for DSM exactness -- one resident once called me a "walking CD of psychiatric diagnostic knowledge." In the context, I wasn't sure if it was a compliment or an insult, but it made the point. I was the kind of teacher who would ask the students whether the patient in front of us met "criteria 295.30A.1" at the current time.

In the last decade, I have increasingly become a researcher working on brain stress-immune system interactions linked to depression and sickness, and this work has profoundly altered my opinion about the status of psychiatric diagnoses. We have made stunning advances in the last decade in terms of understanding what causes depression and what goes wrong in the brain and the body when it takes hold of someone. We have also come to see that even minor mental disorders, such as mild depression, have disastrous consequences for people's health and well-being.

In these ways, transitioning from a clinician to a clinician-scientist has made the reality of mental illness more palpable than ever for me. On the other hand, recent scientific advances make it clear that the very exacting diagnostic categories upon which psychiatry hangs its hat are not nearly as real as I once thought. Said another way, the idea that mental disorders are discrete illnesses with hard and fast boundaries is just plain wrong. Said even more radically, I have come to believe that diagnoses like ADHD or major depression or bipolar disorder are not nearly as real as the actual individuals who suffer from problems with attention or mood or reality testing or hyperactivity.

There are important clinical implications of this change of view on my part. One is that our current psychiatric illnesses are mostly valuable as descriptions of what bothers people -- the diagnoses help doctors talk to one another and to patients in straightforward ways that make sense. But they can become impediments to the future when they come to be seen as unchangeable realities inflicted upon us from the hand of God. What matters most is not the exactness of our disease names (because these names do not accurately reflect underlying disease processes), but the need for us to identify all the actual symptoms any given patient has and to treat those until they are gone, or as close to gone as we can get them.

These ideas are more complex than I have presented them here, and space limitations prohibit me from elaborating more fully. But if you are interested in these issues -- and my take on them -- I invite you to read an article I wrote for the Psychiatric Times newsletter. Here you will find a far more extensive discussion of the implications of the new mind-body science for the way we diagnose and treat mental illnesses.

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