Category Archives: ADD/ADHD and Bedwetting

ADD/ADHD and bedwetting

A.D.H.D – No Diagnosis Left Behind

Approximately 40% of our patients being treated for the symptom of bedwetting have been diagnosed or labeled ADD/ADHD. We found the following article written by Maggie Koerth-Baker and published in The New York Times Magazine informative and compelling.

By MAGGIE KOERTH-BAKER

Between the fall of 2011 and the spring of 2012, people across the United States suddenly found themselves unable to get their hands on A.D.H.D. medication. Low-dose generics were particularly in short supply. There were several factors contributing to the shortage, but the main cause was that supply was suddenly being outpaced by demand.

The number of diagnoses of Attention Deficit Hyperactivity Disorder has ballooned over the past few decades. Before the early 1990s, fewer than 5 percent of school-age kids were thought to have A.D.H.D. Earlier this year, data from the Centers for Disease Control and Prevention showed that 11 percent of children ages 4 to 17 had at some point received the diagnosis — and that doesn’t even include first-time diagnoses in adults. (Full disclosure: I’m one of them.)

That amounts to millions of extra people receiving regular doses of stimulant drugs to keep neurological symptoms in check. For a lot of us, the diagnosis and subsequent treatments — both behavioral and pharmaceutical — have proved helpful. But still: Where did we all come from? Were that many Americans always pathologically hyperactive and unable to focus, and only now are getting the treatment they need?

Probably not. Of the 6.4 million kids who have been given diagnoses of A.D.H.D., a large percentage are unlikely to have any kind of physiological difference that would make them more distractible than the average non-A.D.H.D. kid. It’s also doubtful that biological or environmental changes are making physiological differences more prevalent. Instead, the rapid increase in people with A.D.H.D. probably has more to do with sociological factors — changes in the way we school our children, in the way we interact with doctors and in what we expect from our kids.

Which is not to say that A.D.H.D. is a made-up disorder. In fact, there’s compelling evidence that it has a strong genetic basis. Scientists often study twins to examine whether certain behaviors and traits are inborn. They do this by comparing identical twins (who share almost 100 percent of the same genes) with fraternal twins (who share about half their genes). If a disorder has a genetic basis, then identical twins will be more likely to share it than fraternal twins. In 2010, researchers at Michigan State University analyzed 22 different studies of twins and found that the traits of hyperactivity and inattentiveness were highly inheritable. Numerous brain-imaging studies have also shown distinct differences between the brains of people given diagnoses of A.D.H.D. and those not — including evidence that some with A.D.H.D. may have fewer receptors in certain regions for the chemical messenger dopamine, which would impair the brain’s ability to function in top form.

None of that research yet translates into an objective diagnostic approach, however. Before I received my diagnosis, I spent multiple sessions with a psychologist who interviewed me and my husband, took a health history from my doctor and administered several intelligence tests. That’s not the norm, though, and not only because I was given my diagnosis as an adult. Most children are given the diagnosis on the basis of a short visit with their pediatrician. In fact, the diagnosis can be as simple as prescribing Ritalin to a child and telling the parents to see if it helps improve their school performance.

This lack of rigor leaves room for plenty of diagnoses that are based on something other than biology. Case in point: The beginning of A.D.H.D. as an “epidemic” corresponds with a couple of important policy changes that incentivized diagnosis. The incorporation of A.D.H.D. under the Individuals With Disabilities Education Act in 1991 — and a subsequent overhaul of the Food and Drug Administration in 1997 that allowed drug companies to more easily market directly to the public — were hugely influential, according to Adam Rafalovich, a sociologist at Pacific University in Oregon. For the first time, the diagnosis came with an upside — access to tutors, for instance, and time allowances on standardized tests. By the late 1990s, as more parents and teachers became aware that A.D.H.D. existed, and that there were drugs to treat it, the diagnosis became increasingly normalized, until it was viewed by many as just another part of the experience of childhood.

Stephen Hinshaw, a professor of psychology at University of California, Berkeley, has found another telling correlation. Hinshaw was struck by the disorder’s uneven geographical distribution. In 2007, 15.6 percent of kids between the ages of 4 and 17 in North Carolina had at some point received an A.D.H.D. diagnosis. In California, that number was 6.2 percent. This disparity between the two states is representative of big differences, generally speaking, in the rates of diagnosis between the South and West. Even after Hinshaw’s team accounted for differences like race and income, they still found that kids in North Carolina were nearly twice as likely to be given diagnoses of A.D.H.D. as those in California.

 

Hinshaw, as well as sociologists like Rafalovich and Peter Conrad of Brandeis University, argues that such numbers are evidence of sociological influences on the rise in A.D.H.D. diagnoses. In trying to narrow down what those influences might be, Hinshaw evaluated differences between diagnostic tools, types of health insurance, cultural values and public perceptions of mental illness. Nothing seemed to explain the difference — until he looked at educational policies.

The No Child Left Behind Act, signed into law by President George W. Bush, was the first federal effort to link school financing to standardized-test performance. But various states had been slowly rolling out similar policies for the last three decades. North Carolina was one of the first to adopt such a program; California was one of the last. The correlations between the implementation of these laws and the rates of A.D.H.D. diagnosis matched on a regional scale as well. When Hinshaw compared the rollout of these school policies with incidences of A.D.H.D., he found that when a state passed laws punishing or rewarding schools for their standardized-test scores, A.D.H.D. diagnoses in that state would increase not long afterward. Nationwide, the rates of A.D.H.D. diagnosis increased by 22 percent in the first four years after No Child Left Behind was implemented.

To be clear: Those are correlations, not causal links. But A.D.H.D., education policies, disability protections and advertising freedoms all appear to wink suggestively at one another. From parents’ and teachers’ perspectives, the diagnosis is considered a success if the medication improves kids’ ability to perform on tests and calms them down enough so that they’re not a distraction to others. (In some school districts, an A.D.H.D. diagnosis also results in that child’s test score being removed from the school’s official average.) Writ large, Hinshaw says, these incentives conspire to boost the diagnosis of the disorder, regardless of its biological prevalence.

Rates of A.D.H.D. diagnosis also vary widely from country to country. In 2003, when nearly 8 percent of American kids had been given a diagnosis of A.D.H.D., only about 2 percent of children in Britain had. According to the British National Health Service, the estimate of kids affected by A.D.H.D. there is now as high as 5 percent. Why would Britain have such a comparatively low incidence of the disorder? But also, why is that incidence on the rise?

Conrad says both questions are linked to the different ways our societies define disorders. In the United States, we base those definitions on the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), while Europeans have historically used the International Classification of Diseases (I.C.D.). “The I.C.D. has much stricter guidelines for diagnosis,” Conrad says. “But, for a variety of reasons, the D.S.M. has become more widely used in more places.” Conrad, who’s currently researching the spread of A.D.H.D. diagnosis rates, believes that America is essentially exporting the D.S.M. definition and the medicalized response to it. A result, he says, is that “now we see higher and higher prevalence rates outside the United States.”

According to Joel Nigg, professor of psychiatry at Oregon Health and Science University, this is part of a broader trend in America: the medicalization of traits that previous generations might have dealt with in other ways. Schools used to punish kids who wouldn’t sit still. Today we tend to see those kids as needing therapy and medicine. When people don’t fit in, we react by giving their behavior a label, either medicalizing it, criminalizing it or moralizing it, Nigg says.

According to Joel Nigg, professor of psychiatry at Oregon Health and Science University, this is part of a broader trend in America: the medicalization of traits that previous generations might have dealt with in other ways. Schools used to punish kids who wouldn’t sit still. Today we tend to see those kids as needing therapy and medicine. When people don’t fit in, we react by giving their behavior a label, either medicalizing it, criminalizing it or moralizing it, Nigg says.

By MAGGIE KOERTH-BAKER

Source:  http://www.nytimes.com/2013/10/20/magazine/the-not-so-hidden-cause-behind-the-adhd-epidemic.html?pagewanted=3&_r=0

 

Jennifer Lawrence Discusses Her Bed-Wetting

The newest face of bedwetting:  Jennifer Lawrence was the latest celebrity with a late-night sharing with Conan O’Brian that she wet the bed even at 13.  More intriguing, were her comments about hyperactivity.

40% of our patients at the Center for Bedwetting Treatment present with both bedwetting and ADD/ADHD symptoms.  Beyond the developmental years we know the leading cause of bedwetting is the sleep condition that keeps the individual in a deep state of sleep rather than five stage gradual cycling every 90 minutes.  They wet the bed in the deepest sleep  and wake up sleep deprived!  Chronic bedwetting takes a toll on the individual.  When the brain is tired it can take on many symptoms including distractibility, hyperactivity, and difficulty focusing. Lawrence revealed her rather hyperactive youth, which included medication at one point. She says she looked at every day as a way to start fresh, cool, calm and collected. It just never worked out that way.

Jennifer Lawrence seem to take her bedwetting experience in stride.  “I wet the bed when I was sleeping, and I just thought, ‘Who wets the bed when they’re 13?’ And so I couldn’t wait to get to school and tell everybody, then I went into the bleachers and was like, ‘Everybody, I wet the bed last night,’ thinking everybody was going to think I was so funny and cool, and it was just silent.”

It was generous of Miss Lawrence to be so honest about this very private matter.  Millions of teenagers and young adults who continue to wet the bed can know they are not alone.

Jennifer+Lawrence+Short+Hairstyles+Messy+Cut+F7DYuKMVNr1x

http://teamcoco.com/video/jennifer-lawrence-wet-the-bed

 

 

 

Bedwetting and ADD/ADHD

I have read your post, and I would like to offer some insight.  I am a psychologist, and I have an in-depth understanding about bedwetting and ADD.  Many bedwetters are misdiagnosed with ADD.  Symptoms of a bedwetter’s deep sleep disorder, such as the inability to stay focused or to concentrate, are almost identical to those of ADD.

Bed-wetting is not anyone’s fault; our findings point to a deep sleep that prevents the brain from responding to the bladder’s signal.   According to  the American Pediatric Association, less than 1% of bed-wetting cases are caused by a physical problem.

The only way to end bed-wetting successfully is to recognize that the problem is a SYMPTOM resulting from a genetically determined and transferred deep sleep disorder.  Until the underlying sleep disorder is addressed, a child will continue to wet the bed, frequently have daytime “accidents” and suffer from the psychological distress that the disorder can cause.

Parents naturally turn to their pediatrician seeking information regarding their child’s bed-wetting problem around five or six.  Often the “Medical Advice” is to wait:  Hearing “do worry, they will outgrow it“.  This is the worst advice you can get. While the child waits, the enuresis can remain and additional symptoms can result.

According to Harvard Medical School, sleep disorders are commonly encountered problems in pediatric practice, yet under recognized to a large extent. The consequences of under-diagnosed and untreated sleep disorders may include significant emotional, behavioral, cardiovascular and neurocognitive dysfunction.

Dr. Meltzer, Ph.D., from The Children’s Hospital of Philadelphia, and associates conducted a chart review for all well-child visits at the 32 primary care pediatric practices affiliated with this hospital.  Included were records for nearly 155,000 patients from birth to 18 years.

Dr. Meltzer stated “We found that all sleep disorders, including those that are less of a concern, such as bedwetting and sleepwalking, and those that are more serious, including obstructive sleep apnea, insomnia and narcolepsy, are being under diagnosed in primary care practice,” the researcher noted.”

“Untreated sleep problems can impact every aspect of children’s lives, including growth, learning, attention, mood, and family functioning.”

For over three decades, the Center for Bedwetting Treatment has successfully treated thousands of people from around the world who thought there was no hope for their child’s bed-wetting.  Their unique approach to treating children and teenagers around the world, eliminates the bed-wetter’s sleep disorder. If a child does not have true learning disability, the symptoms will disappear.

I always encourage parents to visit our website and take advantage of the extensive knowledge on treating this issue.

Time is of the essence.

Lyle Danuloff, Ph.D.

www.NoBedwetting.com