Further thoughts on the causation of ADHD

This comes from a discussion I was having on an ADHD users forum.
It is clear to me that the oculomotor problems contribute to many of the specific ADHD symptoms, especially in academic and workplace environments, and they effectively suck up a lot of working memory.

So I was asked whether I thought the eye problems caused ADHD or the ADHD caused the eye problems.

My response:

The full causation is more complex than just that.
Ultimately there is an upstream problem in the brainstem and cerebellum.
This can be identified on physical examination once you know how.
The issue is the nosology of this problem.The old term minimal brain dysfunction was maybe more helpful- as it incorporated dyslexia, dyspraxia, ocular convergence issues, sensory processing disorder and ADHD under the one umbrella.
Now those things are seen as “co-morbids’ with little thought given to why they are comorbid, or what was the reason for the old classification.
The Swedish have proposed another good reclassification called “Deficits of attention Motor Control and Perception”.

Another very powerful brain based model is called cerebellar cognitive affective syndrome- and that provides the clue to some of the linkages between these conditions.

There is a little said here but the article is well out of date:
https://en.wikipedia.org/wiki/Cerebe…ctive_syndrome

The list of associated disorders is interesting: depression, bipolar, ADHD, autism, dyslexia, schizophrenia.

So here comes the association with these neck subluxations. As of 5 years ago we now have hard proof of exactly the kinds of impairments to the craniocervical junction that these chiropractic ‘subluxations” can cause.
This is due to pioneering work by Dr Ralph Demadian (inventer of the MRI and the upright MRI) and several other neurosurgeons, radiologists and chirpractors.

I have put a list of the readily available evidence (from things like talks given to the Cranio Cervical Syndrome Symposium) on my blog. These talks are not papers but they are based on peer reviewed papers. This page is a bit of a mess, because there is just so much of it. Im grabbing as many papers as I can get without having to pay for them and will put it all up very soon.
https://atlassubluxation.wordpress.c…presentations/

Now so far as the cerebellum is concerned I would say that the now proven intermittent interference in vertebral artery blood flow in subluxations will directly compromise cerebellar blood flow via the Posterior inferior Cerebellar Artery – depending on your personal anatomy and your personal spine issues.

Quote:
“The posterior inferior cerebellar artery (PICA) is the vessel that perfuses the lateral medulla, and is usually occluded due to thrombosis or embolism in its parent vessel, the vertebral artery.”

However its anatomy is highly variable- and many people will have a better functioning circle of Willis that will compensate better for compression of the Vertebral artery. Those sorts of anatomical variants are heritable traits– another possible target for genetic investigations.

So what is showing up is that these subluxations cause amongst other things a reversible, highly individual cluster of symptoms- for which the name “Cervical Medullary Syndrome is proposed.

This syndrome is interesting as it includes most of the symptoms of most psychiatric disorders and is highly associated with neuropsychiatric as well as “soft” neurological signs.

Looking at the cluster of symptoms I note that virtually anything in the “Affective Spectrum Syndrome” (a familial clustering of disorders that includes fibromyalgia, bipolar and ADHD) could be fully explained by this “Cervical Medullary syndrome”

Affective Spectrum Disorder:

Family Study of Affective Spectrum Disorder
James I. Hudson, MD, ScD; Barbara Mangweth, PhD; Harrison G. Pope, Jr, MD, MPH; Christine De Col, MD; Armand Hausmann, MD; Sarah Gutweniger, MA; Nan M. Laird, PhD; Wilfried Biebl, MD; Ming T. Tsuang, MD, PhD, DSc

(REPRINTED) ARCH GEN PSYCHIATRY/VOL 60, FEB 2003

Quote:
Affective spectrum disorder (ASD) represents a group of psychiatric and medical conditions, each known to respond to several chemical families of antidepressant medications and hence possibly linked by common heritable abnormalities. Forms of ASD include major depressive disorder (MDD), attention-deficit/ hyperactivity disorder, bulimia nervosa, cataplexy, dysthymic disorder, fibromyalgia, generalized anxiety disorder, irritable bowel syndrome, migraine, obsessive- compulsive disorder, panic disorder, posttraumatic stress disorder, premenstrual dysphoric disorder, and social phobia. Two predictions of the ASD hypothesis were tested: that ASD, taken as a single entity, would aggregate in families and that MDD would coaggregate with other forms of ASD in families.

 

https://atlassubluxation.wordpress.c…lary-syndrome/

Now what I am proposing is that affective spectrum disorder is one of the presentations of cervicomedullary syndrome, and ADHD is a subset of both affective spectrum disorder and cervicomedullary syndrome- one which has more cerebellar effects than some other variants.
I believe that the saccading issue is one of the major generators of symptoms in the classroom, because if you have got it and nobody notices you experience reading in the classroom as “boring” and wont do it.
So the oculomotor problem generates many of the symptoms that are characteristically ADHD.
Other symptom clusters are generated by sympathetic dominance, a degree of learned helplessness, and direct brain fog so characteristic of ADHD PI and also fibromyalgia and depression, and CFS) probably represents a direct energy supply issue to the brainstem.

These issues are less severe if your posture is more upright- and that is a real benefit of exercise and meditation.

The last issue to bae addressed is “dopamine” and this popular idea that ADHD is a dopamine deficiency disorder, or an issue with the transporters or something like that.

I suspect the dopamine issue in ADHD is that the need to constantly adjust and adapt to an unstable body means that multiple fast re-fixations of attention are needed- and those neurones just get a bit fatigued. Stimulants do help, a lot, but lets face it- retrofitting an explanation on to a serendipitous discovery that stimulants worked, especially at a time when we had such little knowledge of neurology, might be superficially attractive but it is not intellectually justifiable.

__________________
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What is the wider significance of Cervicomedullary syndrome?

This post is somewhat speculative, but it is very clear to me that the nomenclature of psychiatric conditions is in an awful mess. Some conditions include physical symptoms, some do not, some like ADHD, are alleged to be neurobehavioural conditions but their descriptions include no information about neurological examination or neurological signs. ( These can actually be found). They also include many symptoms without making reference to the neurological paths that could generate them. The nomenclature is so bad that there is inadequate distinction between syndrome, symptoms, and actual discrete medical conditions.

More recently there has been a push to make more brain based definitions. One of those is cerebellar cognitive affective syndrome 9which overlaps many psych conditions) and it appears to me that so is “Cervicomedullary syndrome”, being proposed by some neurosurgeons.

So lets go through the symptoms again- and I will make some comments beside them)

Symptoms:

Double vision

Memory Loss

Cognitive Changes—- this could include brain fog, or many of the inattentive symptoms of ADHD

Anxiety/Depression
note here that these states are being described as smptoms. Much of the drug research around them is predicated on the idea that they are distinct illnesses. In fact they are syndromes- that are symptoms of another bigger syndrome. No wondeer people get muddled.

Dizziness/Vertigo

POTS                              I would add any dysautonomia/ orthostatic intolerance , consistent with current thinking that sees them as part of the same problem.

Tinnitus

Difficulty swallowing

Sleep apnoea———–  I suggest also snoring without apnoea, and probably UARS.

Respiratory abnormalities

Blue hands in the cold weather

Sensory loss

Fatigue

Unsteady walking

Clumsiness/ incoordination

Urinary dysfunction

Irritable bowel syndrome

Gastro oesophageal reflux

Speech difficulties
So it is clear that Cervicomedullary syndroe (which is predicated on the idea of a local energy supply impairment to the brainstem) can cover an awful lot of ground.

So here are some questions that I am mulling over with my friends. I don’t know the answers to all of them, but I do think they are good questions:

1) Cervicomedullary syndrome actually contains most of the physical symptoms of many emotional states, and psych and functional neurological illnesses – hence the idea of reframing mental illness with a view to that being a foundational element. (Simple concept here- if your system is constantly skewing your emotional perceptions and responses (including subliminal facial expressions), then how can you function? You may feel more threatened than you logically should. Equally due to the tensing up into forward head posture in adverse conditions (or when recalling them) it is likely that that will further compromise the craniocervical junction and cause undue persistence of emotional states ( a big issue in humans).

This observation can be taken further by considering the proposed syndrome Affective Spectrum Disorder- which was based on the observation that many of these conditions are familial (but a family may have multiple members with different conditions on this list:
 Family Study of Affective Spectrum Disorder
James I. Hudson, MD, ScD; Barbara Mangweth, PhD; Harrison G. Pope, Jr, MD, MPH; Christine De Col, MD; Armand Hausmann, MD; Sarah Gutweniger, MA; Nan M. Laird, PhD; Wilfried Biebl, MD; Ming T. Tsuang, MD, PhD, DSc

(REPRINTED) ARCH GEN PSYCHIATRY/VOL 60, FEB 2003

Quote:
Affective spectrum disorder (ASD) represents a group of psychiatric and medical conditions, each known to respond to several chemical families of antidepressant medications and hence possibly linked by common heritable abnormalities. Forms of ASD include major depressive disorder (MDD), attention-deficit/ hyperactivity disorder, bulimia nervosa, cataplexy, dysthymic disorder, fibromyalgia, generalized anxiety disorder, irritable bowel syndrome, migraine, obsessive- compulsive disorder, panic disorder, posttraumatic stress disorder, premenstrual dysphoric disorder, and social phobia. Two predictions of the ASD hypothesis were tested: that ASD, taken as a single entity, would aggregate in families and that MDD would co-aggregate with other forms of ASD in families.

All the above could be accounted for by the symptomatology of cervicomedullary syndrome with an overlay of adjustment disorder as the unfortunate patient struggles to self regulate an utterly unreliable system.

2)Forward head posture and hunching will worsen it. (This may be one reason why some people become symptomatic many years after a whiplash— ie they hit a period of high work demand, or emotional adversity and the descent into poorer posture sets off a self reinforcing loop.

3) Impaired energy status in the brainstem is a critical element of the problem- and it may not just be direct impingement on vessels. My own recent experience with cold laser clearly shows how potent this can be in improving energy status in inflamed tissues. (We already have work that shows this sort of inflammation and damage in tissues of the brainstem).

4) Clumsiness and ataxia are both elements of cervicomedullary syndrome. Both will worsen spinal alignment. (On this note I have been staggered at the improved integration in my movement since I have started the treatment. I’m not usually all that coordinated).

5) Direct sun exposure is important and should be considered an important part of an exercise regime. Same wavelengths as the IR cold laser. Later afternoon sun and early morning sun have a better incident angle for the back of the neck- esp above and below the arch of C1. Midday sun has the same IR, but the UV can be problematic and the angle of incidence is not ideal.

6) – and this is really pushing the envelope of credibility-maybe the old yogic practice of sun eating has direct benefit to structures in the posterior pharyngeal wall- inc vagus and glossopharyngeal nerves.
(However- lets face it- the old guard has been wrong on almost everything else- so why not this one too?)

7) Given the role of the locus coeruleus in maintaining upright posture and alertness- the role of norepinephrine in improving alertness both in ADHD (stimulants) and depression (SNRI effects) may be very important.

8) other concurrent issues like secondary dysbiosis may explain specific characteristics of conditions like depression

9) The debilitating effects of dysautonomia (and other symptoms which accentuate forward head posture) may create another negative feedback loop which causes persistent dysfunction.

10) Manic episodes may be explained by situations which cause a sudden improvement in medullary energy (ie LC activation, or lots of sun) in individuals who have an underlying hemisphericity which predisposes to SNS dominance.

11) Individuals with the above neuropsychiatric conditions are going to have lots of issues as they will think their adversity is caused by other people- thats what we are taught to think. Being able to explicitly demonstrate how their difficult emotions arise and the issues this causes with subverbal empathy may make untangling this ens of the problem in therapy much faster and easier. Lastly- schizophrenia- I don’t know to meaningfully speculate.

Bottom line- this book is going to come down to “the chiropractors have been right all along”– and it is going to cause a few conniptions in all the right circles.

 

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Is Bipolar driven by a brainstem mechanism?

 Sometimes you miss the weirdest things. I have been really noticing just how bloody good I am feeling with all this low level laser treatment. With my history of Biploar I am always somewhat suspicious of feeling good- especially in spring.  However this time I
I know why in terms of anatomy and neurophysiology.

I also know that what is going on is remarkably analagous to descriptions of enlightenment ( Roshi Philip Kapleau is one that comes to mind.). Now it is clear that I have gone through all of my life feeling like shit- and much of my restlessness has come from discomfort. The current situation is a huge improvement and the improvement continues to deepen.

Now I think that this is a major key to understanding psychiatric illnesses because all this felt experience does have an impact about what we think about ourselves and others. There are all kind of feedback loops there. The question of mental illness is dogged by linguistic imprecision- and really the Western field of psychiatry does not have a proper definition of mind. As “mental” is “of the mind”– we have a problem here.

So what I missed is 2 comments from the Zen master Dogen (do yourself a favour- look him up). 1) That the Buddhas entire dharma (ie the enlightenment experience can be fully apprehended by sitting in lotus. (Interesting, and neurologically plausible too) 2) just the other day– that enlightenment is an experience of the body. Enlightenment is also sometimes referred to as cessation or extinction- which is intriguing in terms of the cessation of unpleasant feeling I am noting.  I’m not making any claims about me here- just looking for ways to understand complex concepts.

One issue which interests me greatly is bipolar- as I have had several episodes (and when this event started with the laser I was very careful to exclude another episode). The first episode was triggered by a serious whiplash (from which I thought I had got off unscathed!!!). However within days the change started- I was more energetic, I was happier, I was really seeing the beauty of nature in an amazing way. I felt good, (like Jame Brown!) whereas I had been feeling physically terrible probably since early adolescence when I first developed dysautonomia.) That good feeling felt right- it felt like our birthright. — and it is.

However there was too much to see too much to respond to, and it was difficult to not go with that and get carried away into silliness.  Equally the intensity of my experience made it difficult sync well with others in conversation, and caused a good deal of aggravation. I would also say that there was too much sympathetic stimulation (leading to restlessness, whereas now, I am feeling very restful and can drop off in bed in a couple of minutes). All other episodes have been associated with increased sun exposure in spring or summer.

So lets advance a little hypothesis here- the whiplash that started this off actually improved circulation to and neuronal metabolism within the brainstem  (which was functioning poorly and causing me to feel poorly (though I thought that was normal) and I suddenly felt amazingly happy and positive. Increased sun exposure in the other episodes was the equivalent of the low level laser and set the process going again- because we did not understand it.

So that glimpse of positivity at the start of of the manic episode is very interesting. Many bipolar people actually grow out of it and mature into serious spiritual practitioners. ( ie the Jungian Therapist and Tibetan Buddhist practitioner Paul Levy: https://www.awakeninthedream.com/ They have all recognised their manic episodes as part of their awakening.
I’m inclined to think that the more positive feeling at the start of a manic episode is actually truly a feeling of better functioning. Its interoceptive signature is actually one of absence of unsatisfactoriness- you feel less of your body unless you choose to observe it.
That is the danger though, a full blown episode is very destructive and we tend to try and deny the whole experience, throwing the baby out with the bathwater.

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Towards a mechanism for some ADHD symptoms relating especially to alertness.

Since the first low level laser treatment to the brainstem via the back of my neck, five days ago I have been very different. No brain fog, able to see multiple interactions between simultaneous streams of data, elbowing quick choices of the shortest, easiest way through, I’m more concise, far more coordinated, more able to sleep or wake as needed, and getting far more precise instructions from my body about what food it wants, and how much.

A zen master was one asked about the experience of enlightenment, and he said that when enlightened, one eats, when hungry, and sleeps when tired.

Well that’s what is happening and it was brought about by light therapy.

Does that mean that I am “ enlightened” , or “enlasered”, or just that I seen the light? Maybe even just good at bad puns

However, all jokes aside, I realised after I wrote the above last night that I have had this experience once before- in 2008, just after I started dexamphetamine.

The result then was staggering. All of the above, the weight just fell off, my body decided what it wanted to eat. I had always been shy, but now was able to talk fluidly and be sociable.

So- why the similarity?
This is interesting, very interesting.

Now alertness is largely regulated through the locus coeruleus, a pontine brainstem nucleus.
The LC uses norepinephrine as its effector neurotransmitter.
Stimulation of the LC causes an increase in vigilance/ sensory sensitivity, it somewhat increases metabolic rate (good for running away, and also for thinking as low metabolic rate is associated with a functional drop in intelligence). and it also causes some sympathetic activity,

Additionally the LC is involved in posture regulation and higher alertness is associated with more upright posture (think meerkat on guard). As an aside- deliberately shifting to an upright posture will help alertness- hence the meditation instructions we are given if we have a good teacher).

Finally a more upright posture will improve hydrodynamics and neural compression around the craniocervical junction associated with malalignments.

Now we usually think of ADHD as being associated with dopamine, but the stimulants also affect norepinephrine, and improve norepinephrine neurotransmission.

So it is very clear to me that there is at least a norepinephrine driven effect on the locus coeruleus that improves alertness and attention at least by improving neck posture and the function of the craniocervical junction and probably also by more direct neural effects.

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Breakthrough, at last.

Ive had some level of symptoms from what looks like a birth injury to my neck in 1962- mostly along the lines of ADHD, and dyspraxia,low grade dyslexia. That worsened in 1985 with the onset of what was to be 2 years of sever R sciatica

It seems that I was set up for more trouble in 1987 by a whiplash injury, which within a week was followed by the abrupt onset of my first ever manic episode. In due course that was controlled with Lithium, and the problem seemed to be over.

However my work involves much home visiting and much paper work.
From abut 1993 I experienced (as well as the declining episodes of sciatica) gradually increasing neck stiffness- becoming unable to turn around properly, misjudging distances, having minor car accidents (ie reversing into other cars in car parks) becoming intolerably vague ( I will write for you all one day the full list of types of inattentive episodes leading to my diagnosis of ADHD), and also a good number of other odd symptoms- increasing sleep dysregulation, episodes of nausea, episodes of sensory processing disorder. One symptom of the ADHD in particular was losing track- once I was doing something I had to lock on to it to the exclusion of everything else.

“Please don’t interrupt me while I am ignoring you” reads the coffee cup my partner gave me– but it was not in jest.

ADHD diagnosis and stimulant medication was a live saver, and to this day I remain of the opinion that even though they only symptom relievers, stimulants are the most effective medications and predictable I have ever had or prescribed. So much for all the bad publicity they get.

However like virtually everything else in Internal Medicine (barring antibiotics)- symptom relief is all they offer.

The ADHD diagnosis was on 4 October 2008, and by that time the pain was worsening, but it seemed unrelated.

Soon after that I realised that meditation can be regarded as a form of attention training- and started investigating.

By chance, in December 2009, while in dire straits I encountered a brochure for Atlas Profilax, and I had treatment within days.  That was puzzling– how could those”quack chiropractors” who treated a non existent subluxation, be right. However they were, and I started seeing many other people with the same problem, particularly chronic orthopedic issues like frozen shoulder. Diagnosing and referring these patients was an imperative, because they were in great trouble. However the attitude of the profession, the health regulation authority and my professional defence organisation was hostile– so this was very stressful. However I did not do this job to  curry favour, I did it to help people, and to dishonestly conceal useful information. thatwould have been a breach of mBuddhist vows. So after finding and reading some textbooks I started referring.  Yes, it was devastatingly stressful, but I will say no more as there is a good chance i will pursue legal action.

The outcome of Atlas Profilax in terms of mental clarity and reduction of pain was staggering- far stronger than the stimulants, and very fast, within 24 hours. However I still had a very crooked spine and that kept stirring the issue up. You will not keep your neck straight if it is not sitting straight on your body. That’s not rocket science.

I learned mindfulness integrated CBT- (body scanning) to use as a psychotherapy with my patients. It also proved useful for me and helped me be more precise in localsing remaining issues. That + the outcome of the Atlas issue was enough from me to taper from 50g dexamphetamine to zero from 15April to 15 June 2010. (I had to resume a lower dose later- April 2012 to now).

In June 2010 I had a further stroke of luck- a chance meeting with a chiropractic neurologist and we started work on my dysfunctional movement patterns, eye movements etc that were maintaining the pain and postural issues.

That proved very resistant to treatment and despite steady progress there were setbacks related to my marriage breakdown, and a further severe manic episode due to a change of medications. However, by May this year the pain and subluxation feelings were largely gone and the return to work process for me was initiated.

However there were still ongoing issues with irregular sleep pattern (sometimes as much as 5 days straight with no sleep) with bizarre right sided sweats, with mental fog, and terrible issues staying on track in tasks. I would get ice cold fingers, upset gut, postural hypotension, alternating with skyrocketing blood pressure episodes (up to 240/160), frequency of urine all night, strange skin discomfort (dysaesthesiae). I was not having a good time. I was also not my best- though I was actually much better than an entire profession whose prejdices prevented them from seeing what was needed to get me well. Ie I was that sick and STILL a better diagnostician and researcher.

I found the functional neurology profoundly interested and have studied as much as I could given my illnesses. The quality of the information and its obvious applicability have caught my interest. It is worthy of my attention. The sort of articles we so often see in medical magazines about various tedious demographic studies of the incidence of championship level tiddlywinks playing amongst Aboriginal and Torres Strait islanders are not worth my attention.

The functional neurologists have also been incredibly kind, making time to answer my incessant questions and handle my endless theorising. Several have directly reached out from the far side of the world and guided me in the study that I needed to do to understand my chronic pain. That is generous on a scale usually only seen in bodhisattvas. Thankyou George, and Amy, Brandon, and Lynn, the queen of photobiomodulation.

In the last few months though the information has started flowing in much faster.
I found on You Tube several excellent short presentation on dysautonomia in ADHD (I have been observing this and clinically confirming it for some years)

-then a huge cache of information on the recent discoveries made around the cervicocranial dysfunction following the advent of upright MRI.
https://atlassubluxation.wordpress.com/2018/07/09/significant-lectures-and-video-presentations/

Now closer inspection of all that and my new book “The Cervicocranial Syndrome and MRI)
made several things clear. The symptoms troubling me fit neatly in to “cervicomedullary syndrome”. In the context of a neck issue the causative chain is

Whiplash- ruptured alar +/or transverse ligaments between the peg of C2 and  C1 and the base of the skull

leading to minor lateral instability of the odontoid peg (C2)— leading to mild inflammation over the odontoid peg, which, on neck flexion compresses the upper spinal cord /lower medulla

That causes a low grade inflammation and localized energy deficiency in the brain stem which can lead to neuronal deaths (apoptosis) but certainly leads to dysfunction.

There are other likely issues such as lateral stretch of the cervical spinal canal irritating the lateral spinothalamic tract. That could have huge ramifications for chronic pain.

The instability in my spine at that level is obvious and I am strangely unenthusiastic about getting parts of my neck bolted together.

I had heard about photobiomodulation- low level laser therapy (frequencies 640, 808 and 904 and thought it worth a try. I had my first dose last Thursday 13th September.
Essentially the target is the front of the spine- going through the gaps between the back of the skull, the back of C1 and the back of C2.

It worked.
20minutes later ALL symptoms apart from a little local instability are gone.
It actually feels really good to be alive- and not imprisoned in a body that feels like a torture chamber.

This has enormous implications though. The neurosurgeon Joel Franck lists global neuropsychological, multifocal brainstem, spinal pain, and radiculomyelopathic clusters of conditions. That’s all of my problems.

Now I believe there is real work to be done optimising treatment. With the work I have had has straightened my spine up I think that the minor instability I do have at C1/C2 will require not much more than basic fitness and postural care- but for people earlier in that process, that might be harder and they will need to work with their therapists.

On the matter of neuropsychological problems it should not be lost on any psychopharmacologist that the neurones carrying those important neurotransmitters dopamine, norepinephrine, serotonin are all neurones that originate in the brainstem. Given time I hope that we shall see the “neurotransmitter model of psychiatric illness dead and buried. The symptoms of all these conditions can mostly be understood as variants of cervicomedullary syndrome.

Another small point on self care involves walking in the sun before 9 and after 3 and getting it to shine on the back of the neck. That is the same wavelengths. It also occurs to me that the old yogic practice of sun eating would shine sunlight on the rear pharyngeal wall and would also help.

The current situation in medicine has been incredibly wasteful and destructive.
I have had a great deal of psychotherapy over all this time (he is a lovely man and he actually learned quite a lot from me. it was nice having a specialist who did not think you a nut case.  However looked at one way– we spent $90,000 trying to talk my alar and transverse ligaments to grow back together!

To me this post seems more brief and to the point than my early efforts– I suppose better energy supply will do that. As always I am happy to clarify any questions. I am learning more every day.

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What’s In A Name? Pt 2. ADHD as a model of the flaws in DSM and in psychiatric thought processes.

Before I commence this critique, lets be totally clear that I have been diagnosed with ADHD, and am happy with the positive effects of the treatment with stimulants that I have received from my doctors. I am also aware, however, that that treatment has been inadequate,  no more than a band aid covering a bigger problem.

Many commentators have drawn attention to their concerns about the DSM (Diagnostic and Statistical Manual of Psychiatry, but it seems to me that none have hit the mark.

ADHD is a particularly apt example of the defects at the core of the DSM system.

ADHD is said to be a “neurodevelopmental condition”, but, remarkably, it is defined entirely by a list of behavioral abnormalities. Despite being conceived as a “neuro-developmental condition” no mention is made in the symptom profile of neurological symptoms, and no mention is made any where of examination findings. That is curious, to say the least.  The only significant figure looking at this is Prof Martha Denckla, working with her classification of “Deficits of Attention, Motor Control and Perception”. Her work seems to have disappeared almost without trace into a deep pit of intellectual conformity.  It seems to me that only a handful of individuals or groups have chosen to investigate the neurological basis of ADHD ( the one that all the academics and clinicians on the speakers circuit reference), and when they have done so they have been systematically ignored.

ADHD is defined as a neurodevelopmental disorder, but its defining features as listed in DSM are all behavioural. However, everyone acknowledges that it is strongly co-morbid with dyspraxia, dyslexia, ocular convergence issues and sensory processing disorder.

In fact, all of these disorders have demonstrable neurological deficits, even if many of them can only be reliably demonstrated clinically through what are described as “soft signs”. These soft signs can actually be demonstrated in ADHD as well, but few if us ADHD individuals can find practitioners competent to either elicit these signs or understand their relevance.

Now here is the trap- correctly understood, all these conditions are part of the same problem, but due to the thinking deficits underpinning modern medicine conditions like dyspraxia (Developmental Coordination Disorder- present at full syndromal levels in at least 50% of ADHD individuals) are regarded as being co-morbid with ADHD rather than a different manifestation of the same problem.

Furthermore the great consensus of opinion in the world of neurology now is that cognition is an internalisation of movement, and involves planning the next movement. This position has very substantial support through fMRI studies of individuals planning a response to a stimulus. (more on that in later posts).

If we choose to separate out the group that has convergence insufficiency or another related ocular coordination problem, we can immediately note a very large overlap between ADHD symptoms and convergence insufficiency disorders.
While convergence insufficiency is not considered an exclusion for the diagnosis of ADHD, the 2 conditions share 5 overlapping symptoms, and if CI was treated in patients with the 2 conditions co-morbid, it is likely that most patients post treatment would fall below ADHD diagnostic criteria. This is not a causal or careless observation, as most of us who have been treated for ADHD can attest to the fact that the effect of ADHD medications diminishes with time.

Now it does not take a lot of thought to understand that a movement disorder or an issue with filtration of irrelevant sensory stimuli might just reduce the capacity to pay attention, and that reduction of these issues might just significantly and positively affect the performance of the “attention impaired individual”, but for the life of me I can’t understand why most individuals interested in this area cannot immediately grasp that we are actually working with different ways of viewing the same problem.

So, depending on which way you choose to look at it your ADHD individual could fit in to any one of the categories already mentioned. Hence–“To a man with a hammer…..”.

The truth is, that as patients we are entitled to expect a better class of thinking from the professionals charged with our care.

Dream on.

Now this question of the way syndromes arise from our model of thinking. the next post is going to be more challenging, discussing the neurological underpinnings of pathological emotional processes. I suspect that cervico-medullary syndrome underpins the majority of psychiatric presentations, but I want to have my arguments reasonably well buttressed before I go there.

 

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What’s In A Name? Pt 1.

Each profession tends to see the material before them in terms of their own cognitive framework, and, conversely, is blinded to anything lying outside that framework.

“To the man with a hammer, the whole world is a nail”

For many years the chiropractors have been attempting to draw our attention to the issue of upper cervical subluxation (aka, in their language, atlas subluxations) and their wider significance. Generally their comments have been ignored or dismissed out of hand, as no doctor could believe how such a tiny abnormality could cause such severe symptoms. However, in the world of medicine, attention to detail (even tiny details)  is the necessary distinction between success and failure.

We had a hint that things were changing when Dr Michael Flanagan brought out his book “The Downside of Upright Posture”, and more recently we have seen significant work done by chiropractors, radiographers and neurosurgeons.

Now the following comments are referenced to links previously provided here:
https://atlassubluxation.wordpress.com/2018/07/09/significant-lectures-and-video-presentations/

In particular the work done by Scott Rosa DC and colleagues has established a link between whiplash injury and craniocervical instability, that link having been confirmed by the neurosurgeon Dr Joel Franck MD, who employs his own technique of “minimally invasive C1-C2 fixation”.

There has also been significant overlap with the work done over the past 30 years by Dr Fraser Henderson MD (Neurosurgeon) who has been involved in the management of Chiari malformations, notably in Ehlers Danlos Syndrome. (See the previous post on this blog:
https://atlassubluxation.wordpress.com/2018/07/09/significant-lectures-and-video-presentations/
He describes some of the symptoms associated with these problems as cervicomedullary syndrome- highlighting the issue of impingement on the medulla (lower brainstem) as a generator of symptoms.

I further suggest (and will discuss in a subsequent post) that the majority of symptoms in many psychiatrically defined syndromes can be subsumed under the headline of “cervico-medullary syndrome”.

Cervico-medullary syndrome:

(Bear in mind that these symptoms are described in a quite coarse, broad-brush manner, and a detailed history would find them being described in a much more complex individualised way, generating a good number of sub-symptoms).

Symptoms:

Double vision

Memory Loss

Cognitive Changes

Anxiety/Depression

Dizziness/Vertigo

POTS

Tinnitus

Difficulty swallowing

Sleep apnoea

Respiratory abnormalities

Blue hands in the cold weather

Sensory loss

Fatigue

Unsteady walking

Clumsiness/ incoordination

Urinary dysfunction

Irritable bowel syndrome

Gastro oesophageal reflux

Speech difficulties

In fact this list includes most,  if not all of the visceral symptoms (heart, lung, gut, skin, unsteadiness) associated with most psychiatric symptoms.

It seems to me that the reason we have such desperately poor results in managing psychiatric conditions is that we do not understand why or how symptoms are generated, and we foolishly attribute the genesis of all psychiatric symptoms to cognition.

This is a serious defect in thinking and I will cover its ramifications in greater detail later. The more serious point here is that we have to start looking at the idea that there is enormous overlap between these conditions, and that the underlying assumptions which direct us to choosing a particular cluster of signs and symptoms to define a syndrome may be flawed.

To the man with a hammer etc….

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