[HN Gopher] Longitudinal study on the relationship between child...
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Longitudinal study on the relationship between childhood
maltreatment and ADHD
Author : geox
Score : 54 points
Date : 2023-07-21 17:05 UTC (5 hours ago)
(HTM) web link (www.psypost.org)
(TXT) w3m dump (www.psypost.org)
| voisin wrote:
| Dr Gabor Mate has a book on ADHD that is very readable and covers
| this well.
| bartchamdo wrote:
| What is the title?
| tremon wrote:
| The GP is referring to Scattered Minds, I guess. But The Myth
| of Normal might also apply (I haven't read the latter).
| boomskats wrote:
| Among other things, Dr. Gabor Mate insists that ADHD is not a
| hereditary condition, something which is commonly accepted at
| this point. This article also mentions it as accepted fact
| towards the end ("Given the high heritability of ADHD...").
|
| In my opinion, Dr. Gabor Mate is much more interested in being
| a contrarian populist / sensationalist figure than he is in
| science or scientific proof. His tendency to do things like
| diagnose Prince Harry with ADHD via a 90 minute livestream
| doesn't do much to change my mind.
| lo_zamoyski wrote:
| Virtually every other condition described by and
| psychology/psychiatry is descriptive, rather than
| explanatory, i.e., an appeal to causes (by which I mean
| explanatory in a manner worthy of the name, and not woolly
| and dubious notions like "chemical imbalance"). That is, we
| are describing some collection of symptoms, taken to be
| symptoms, which are grouped together for often tacit reasons
| and pathologized based on some pre-exiting intuition of the
| normative. (This intuition can be correct, but it need not
| be. I am merely making these things explicit.)
|
| In the case of what we call ADHD, you are effectively saying,
| that the symptoms most commonly labeled as ADHD have a
| hereditary cause. I wonder what the environmental angle is
| here. That is, can what we call ADHD be a response to an
| environment that is novel or taken as normative, when it is
| not? If an environment (and I include parents in this) is
| poorly suited to the child and does not response to the
| child's objective needs, it would not surprise me if the
| result is some of the behavior described.
|
| Take alcoholism. It is accepted that alcoholism can have a
| hereditary component. However, that doesn't mean everyone
| with this disposition becomes one. Environmental factors play
| a role in making alcoholism more likely. If your parents
| drink, or you fall in with a bad crowd that abuses alcohol,
| the chances that you will succumb to alcoholism increase.
| That doesn't mean it is deterministic, but if you have a
| predisposition, then it becomes more difficult to resist the
| temptation to abuse alcohol when put in a near occasion of
| sin. And culture can encourage or discourage such near
| occasions, or valorize or stigmatize the behavior in
| question. Obesity is another example.
|
| In the case of ADHD, I can imagine several potential factors.
| An environment that is biased toward a sedentary lifestyle
| (kids have tons of energy that needs to go somewhere). A
| hostile school environment that produces a sense of anxiety
| and alienation, perhaps though the methods of 'school
| management' and pedagogy employed. A school environment that
| is abusive, e.g., through bullying, or by punishing
| reasonable acts of self-defense. Rigidity of the education
| system (prioritizing following some program above responding
| to a child's actual particular needs). Indulgence and
| softness and a lack of reasonable and age-appropriate
| discipline as a corrective measure. (We are squeamish about
| it today, but children have not yet developed their reasoning
| faculties well, and they haven't learned impulse control or
| disciplining their desires. This means punishment for
| obstinate _bona fide_ bad behavior must rely on licit means
| of producing unpleasantness, as these are readily perceived
| by children and taken to counteract indulgence.) I can
| imagine some cocktail of these things playing a role. That
| rates seem to vary by country (for children <6 years of age,
| compare the US with Poland; for adults, Australia with China)
| means it is worth considering cultural factors, or else
| assume the genetic differences across populations play a
| significant role, and if so, what affected countries could do
| about it.
| PaulKeeble wrote:
| Like almost all psychology studies I doubt this survives its
| first attempt at replication. At most this will survive 20 years,
| someone else will do a similar study and fail. Either that or a
| reviewer will determine this study was clearly flawed or
| biological research will show more likely causes. There is too
| much evidence pointing to other causes of ADHD at this point on
| biological grounds to take psychological explanations seriously.
| AlexanderNull wrote:
| This research doesn't claim to show any _cause_ of ADHD, it 's
| only showing potential exacerbating influences on, or at least
| confounding factors of, the severity of symptoms those with
| ADHD present later in life. Children who expressed more
| negative emotional outbursts were more likely to be mistreated
| later, and those that were mistreated were more likely to
| express ADHD symptoms, and those those expressed more ADHD
| symptoms were more likely to be mistreated. There's no causal
| explanation expressed there, simply correlations that could be
| used to identify at risk factors earlier on in life. Everyone
| expresses their ADHD differently and identifying patterns in
| life that may either aggravate or alleviate the difficulties of
| the condition can potentially be helpful in the long run.
| kstrauser wrote:
| Obligatory counter-anecdote: by all accounts, I was a cheerful,
| happy little baby. My parents are wonderful people and we're a
| tight-knit family. And yet, I was recently diagnosed with ADHD by
| a doctor who, after finishing the diagnostic screening, asked
| "how are you not homeless?"
|
| I also have a kid who was diagnosed at a young age. Said kid was
| also a cheerful, happy little baby that we love dearly and did
| our best to raise into an amazing young adult.
|
| Which is to say that I'm not arguing against the study, but ADHD
| doesn't automatically mean neglect, or vice versa.
| tremon wrote:
| _" how are you not homeless?"_
|
| Wouldn't the obvious (and slightly glib, but I hope you can see
| my point) reply to that be "because my parents are wonderful
| people and we're a tight-knit family"?
|
| Note that they say ADHD _symptoms_ , not necessarily ADHD
| _prevalence_. So it could very well be that the only thing they
| 're saying is that ADHD is much more manageable if you have
| (enjoyed) a good, stable upbringing.
| theGnuMe wrote:
| Interesting comment that untreated ADHD is a cause of
| homelessness. Medication for ADHD is low dose stimulants. I
| wonder if the meth epidemic stems from untreated ADHD. Then
| maybe the government regulates ADHD meds to keep people
| homeless. Or if we treated the homeless for ADHD they wouldn't
| be homeless.
| jowea wrote:
| > Then maybe the government regulates ADHD meds to keep
| people homeless
|
| What for?
| Paul-Craft wrote:
| I've worked with homeless people in a shelter environment
| before, and my experience was that the most prevalent
| psychiatric issues among that population were schizophrenia,
| bipolar disease, and various addictions (especially
| alcoholism). There were a few who I thought had some ADHD
| issues, but I don't know if that led directly to them
| becoming homeless or not. Granted this does not constitute
| anything like a research study, but it does suggest that just
| treating people for ADHD might not have a lot of impact.
|
| I did a quick search and was only able to come up with the
| abstract for a study that claimed ADHD had a ~4-5x higher
| prevalence among homeless individuals than non-homeless
| individuals. The abstract alone indicates a couple potential
| issues with the study ( _e.g._ subjects were only white men,
| and they used a population sourced from people who had gotten
| treatment at a particular medical center), and it doesn 't
| indicate any causation.
|
| I don't really think ADHD meds are regulated to keep people
| homeless, and I'm not sure about the meth epidemic being
| related to ADHD, but I don't think it would hurt to get
| people the treatment they need, whether they can pay for it
| or not.
| bamfly wrote:
| Ours were cheerful happy babies until they turned into moody,
| constantly-bonkers late-toddlers/preschoolers/lower-grade-
| elementary-kids on whom _zero_ disciplinary or behavior-
| correction approaches worked, whatsoever. None. Even a bit.
|
| Both were eventually diagnosed with ADHD. Both got on meds. Now
| we're not constantly stressed every waking second with a
| chaotic house full of screaming and shit flying everywhere.
|
| We'd have thought we were just the world's worst parents, if we
| hadn't had a third on whom _every_ approach worked, exactly the
| way the experts say they should. That 's when we were like,
| "oh, maybe it's not _entirely_ our fault, maybe we should take
| these kids to a shrink ".
|
| We'd read these books on various parenting approaches, try each
| very earnestly and consistently for months at a time, and not
| once would any of it look like it did in the book. Nothing
| worked. Third kid, no ADHD? It all went exactly the way the
| made-up examples in the books said it should. It was a
| revelation. "Oh, _this_ is what this stuff 's like for most
| people! Holy shit, this is so easy!"
| travisjungroth wrote:
| So your anecdote actually does go against the bidirectional
| relationship in the study. I'm not saying it disproves it or
| anything, just that this is things going the other way.
|
| The model is that there's a loop of bad behavior -> worse
| treatment -> worse symptoms -> worse behavior. Taking the
| kids to a therapist interrupts that cycle. Bad behavior ->
| more appropriate treatment -> better symptoms -> better
| behavior.
| bamfly wrote:
| We noticed a correlation between worse treatment and worse
| behavior, and course-corrected. The trouble was that even
| going wildly the _opposite_ direction made things better...
| but just a somewhat-nicer circle of hell, and achieved only
| at immense time-cost ( _consistent_ long stretches of
| positive 1-on-1 attention, regardless of behavior,
| amounting to hours a day per kid, were necessary to have
| any notable effect) that wasn 't going to be tenable long-
| term while keeping all the other plates of life (and we've
| got a pretty damn easy one, otherwise) spinning--plus, you
| can't really do that when they're in school, and neither
| can the teachers. And that still wasn't enough to get us
| out of hell, it was still _really_ bad.
|
| Meds (& therapy--but if this miss that for a couple weeks,
| nothing bad immediately happens, while if they miss the
| meds even one day...) did the trick. Amazing. We can just
| _tell them stuff_ , and they mostly listen. We can talk to
| them about something they just, moments ago, did that was
| wrong, and they _know what we 're talking about_ rather
| than being genuinely confused, and will not just commit to
| do better, but will actually _try_ and maybe not
| immediately repeat the behavior, even entire minutes (LOL)
| later, and almost never start to just absentmindedly _do it
| again while we 're still talking to them about it_.
| Punishments or harsh reprimands are (and were, after we
| caught on to those being not just ineffective, but counter-
| productive, even in very mild forms) reserved for immediate
| safety problems that can't wait for a touchy-feely
| approach, or many-times-repeated bad behavior, and don't
| usually result in hours of backlash-behavior later, as they
| used to, and _do_ usually have an overall-positive effect.
| They _notice_ straightforward natural-consequence-type
| correction and respond to it, rather than its having zero
| effect whatsoever.
|
| But, yes, we can add 2 to N for worsening treatment being
| the _opposite_ of helpful for (at least our) unmedicated
| very-ADHD kids, for sure. That was definitely something we
| saw.
| mrguyorama wrote:
| >Which is to say that I'm not arguing against the study, but
| ADHD doesn't automatically mean neglect, or vice versa.
|
| Yes that's _how statistics work_
| emptysongglass wrote:
| > Obligatory counter-anecdote: by all accounts, I was a
| cheerful, happy little baby. My parents are wonderful people
| and we're a tight-knit family. And yet, I was recently
| diagnosed with ADHD by a doctor who, after finishing the
| diagnostic screening, asked "how are you not homeless?"
|
| The doctor's question doesn't make sense given the context
| you've provided. Do you have a career? The fact that you're on
| Hacker News and can afford to care for a family indicates
| you've _at least_ managed your symptoms with any number of
| tools or methods.
|
| So, "why aren't you homeless?" The question answers itself,
| from all appearances. But if there's something you've left out
| that could provide missing context, I'd be curious to know.
| kstrauser wrote:
| Short version: despite some fairly severe symptoms, I've
| managed to develop tools and coping mechanisms that let me do
| OK in spite of myself. A lot of it was from brute force,
| though. We went on to discuss some of them to see if there
| were any practical tools he could pass along to other people
| in the same boat.
|
| I largely made an appointment in the first place because I
| was weary of using all my mental energy to stay afloat. Not
| drowning isn't the same as thriving, and I wondered what I
| could accomplish if I could spend some of those mental cycles
| on more productive goals. We found some meds that work well
| for me, and I'm still astonished at the ability to, you know,
| choose work on the things I _want_ and _need_ to work on.
| What a different world that is!
| schaefer wrote:
| >Not drowning isn't the same as thriving, and I wondered
| what I could accomplish if I could spend some of those
| mental cycles on more productive goals. We found some meds
| that work well for me, and I'm still astonished at the
| ability to, you know, choose work on the things I want and
| need to work on. What a different world that is!
|
| writing as someone that might be undiagnosed... thank you
| for writing this. More encouragement to take action myself.
|
| Can I ask, did you start with your primary care physician
| and work your way through the system, or did you start with
| a psychiatrist?
| operatingthetan wrote:
| "why aren't you homeless?"
|
| Also sounds pretty unprofessional for a doctor to say and
| really strange in that context to the point that I don't
| really believe the poster's story.
| kstrauser wrote:
| Eh, believe it or not. It's no skin off my back either way.
|
| But doctors are people, too, and he and I built an easy,
| informal rapport. I'm certain he wouldn't have said it if
| he wasn't sure I'd laugh in response.
| operatingthetan wrote:
| Something is off here. Now you're presenting it as a
| joke, and previously you offered it as a literal
| "counter-anecdote" to the OP. If it was actually a joke
| then it's meaningless in the context of the thread.
| kstrauser wrote:
| I think you're reading too much into this.
|
| The anecdote is true. It really happened. The doctor's
| comment, while deliberately phrased humorously, was
| serious. He identified some quite significant symptoms,
| and was happy for me that I'd managed to do OK in life in
| spite of them.
| travisjungroth wrote:
| > But Golm noted that "it is important to highlight that the
| findings of the study are not deterministic. What this means is
| that the presence of negative emotionality or ADHD symptoms in
| a child does not mean that they will be maltreated. It only
| increases the likelihood to experience maltreatment."
|
| Your story isn't really a counter-antidote all. The study is
| saying that a feedback loop exists, not that it's the only
| variable.
|
| If anything, your anecdote _supports_ the study. A baby had a
| positive disposition and was treated well, avoiding the
| feedback loop so much that the management of the symptoms stood
| out to your doctor.
| ithkuil wrote:
| This study links ADHD children that are not cheerful and happy
| with them being mistreated. It probably tells something about
| the link of the behaviour of the child and the likelihood of it
| being mistreated.
|
| After all parents are human too and many don't live up to the
| task, which is a very hard task especially if the child is
| difficult.
|
| The study doesn't necessarily imply that all ADHD children
| exhibit those behaviours. The fact that both you and your child
| don't perhaps is an indication that there may be other
| confounding genetic factors beyond the main ADHD traits
| daniel-cussen wrote:
| For sure if that maltreatment is forcing children to take
| fluorine pill for their teeth, or flourination in general. Cause
| n effect. N then it comes down to intent, too, who wants children
| fluorinated? Why should they be flourinated? Allegedly it is
| critical to fluorinate water n in addition to give huge doses of
| _fluor_ at the dentist ev single time because that allays the
| alleged greatest medical problem children face, cavities. What a
| crock of shit, by lowering my defenses against bullying, in
| particular by slowing my brain clock speed, i had much more to
| worry about from _matonaje_ (this was in Chile, in USA when i
| visited i loved America because i faced no _matonaje_ whatsoever,
| prefix _maton_ meaning bully or hitman, n _aje_ meaning process
| or syndrome, j like _sabot_ , shoe, _aje_ , process, process of
| putting shoes in the windmills, sabotaje, a Spanish word like
| cabotaje, cape process, rendered as sabotage n cabotage in
| English.
|
| Not exactly like bullying, that's the soft form of it, we're
| talking spitting at the smaller n weaker n more studious
| students, like myself at the time; running away from me all
| recess to communicate to me i was a pariah (but which upon
| reflection also meant they were afraid of me in cowardice) so
| much more, but don't want to ruin your day.
|
| Cavities were no big deal.
|
| Now, as for the childhood maltreatment in the schoolyard causing
| ADD (Adult ADD), i would say not, i got this down to a science,
| have the whole chemistry down, including a homemade mouthwash
| that means no cavities practically ever, n great breath all day
| but for real, like the ads purport you'll get from their
| products, they are lying about that but it would be true if said
| about this mouthwash. Got it from a Dr. Frei, a dentist, online.
| So in fact at this point have ADD by choice, when i drank from a
| well for a few months i was capable of paying attention for the
| first time in my life, which is this really crappy activity i
| thoroughly hated. So now i titrate my fluorine for the time
| steroids to keep working, much rather they pay attention for me,
| i never want to pay attention agains as long as i live, it's like
| a marathon w your head waking itself up right before it loses
| track of what's going on, over and over and over again, which i
| was never capable of due to fluorine, n am not capable of
| organically now, again. Not that spacey, either; most ADD
| patients have no idea what it means to pay attention any more
| than the colorblind see the color of their missing cones.
| empressplay wrote:
| I know a number of people who grew up in areas where the water
| was never fluoridated and where the toothpaste had a very low /
| nonexistent level of fluoridation (rural Australia) and they
| have ADHD. There's no link.
| dommer wrote:
| The title could have been worded better.
| dzink wrote:
| What if you look at it from a different perspective. The body and
| brain are two roommates with different needs and if you treat one
| poorly it acts it on the other.
|
| If a child has a fast processing brain eager to learn and crunch
| problems and a body full of energy, then when one or both of
| those has nowhere to go, they will act out.
|
| Families have an abundance of mental stimulation cheap right on
| their phones, TV, etc. That likely makes both parents and kids
| less likely to move their bodies as much as the body required to
| generate natural endorphins and balance the needs of the brain.
| AKA: staring at screens or people all day and not moving as much
| as your body needs to will make you miserable, regardless of how
| successful your mental tasks were.
|
| Carbs create more energy for the body and proteins with fat make
| more food for the brain, if one consumes more of one than they
| need and less of the other, they will also suffer. If you eat a
| bunch of carbs you will want to move more and think less.
|
| A child or adult who gets to vary physical and mental exertion
| will be more focused and able to work. Test that. ADHD symptoms
| may not show as much in tired bodies telling you if the issue is
| that or an actual pathology in each person.
| theGnuMe wrote:
| I mean ADHD is executive function dysregulation. An overtired
| kid can have a lot of behaviors and be able too tired to work.
| I don't find myself focused after a long day of work.
|
| I think what you mean is that what physical and mental exertion
| may do is train your body and increase your stamina which
| improves your focus long term. Sure it may help develop the
| neural pathways. Much like learning to read is hard at first
| but then becomes easy.
|
| Also people with ADHD can hyper-focus on the things that
| interest them.
|
| I am not sure what you mean by or how you would test varying
| physical and mental exertion in any reliable way. If we make
| kids run a mile and then rest and give them a math test what
| does mean?
| krabizzwainch wrote:
| I want to disagree with how you got to this conclusion, but in
| the end anecdotally this is 100% me. I'm a runner with ADHD and
| if I don't run for a couple days I go crazy. Exercise in
| generally has made me feel infinitely better as an adult.
|
| But I don't think effects of ADHD should be limited to "acting
| out". And there wasn't the same abundance of cheap stimulation
| 30 years ago for me.
| tetrep wrote:
| I might be reading a bit too deep into this, but the source of
| data for the study self-titled it as "Fragile Families" (since
| renamed to "Future of Families") and it really makes it sound to
| me, as a laymen, that the data is skewed towards families that
| might not be representative of an average family / we might not
| be able to take much away from this beyond the groups that were
| actually studied.
|
| This is a study about a relationship between mental development
| and abuse, and it's done with a data source skewed towards low-
| income families with unmarried parents in large cities. Are these
| families more likely to be abusive or have ADHD in the first
| place? Less likely?
|
| There's a relevant joke that the results of most psychology
| studies should have "for college students" appended to it. I
| think this study needs a similar caveat appended, "Longitudinal
| study on the relationship between childhood maltreatment and ADHD
| in low-income unmarried families in large cities."
|
| From https://ffcws.princeton.edu/about
|
| The Future of Families and Child Wellbeing Study (FFCWS) is based
| on a stratified, multistage sample of 4898 children born in large
| U.S. cities (population over 200,000) between 1998 and 2000,
| where births to unmarried mothers were oversampled by a ratio of
| 3 to 1. This sampling strategy resulted in the inclusion of a
| large number of Black, Hispanic, and low-income families. Mothers
| were interviewed shortly after birth and fathers were interviewed
| at the hospital or by phone. Follow-up interviews were conducted
| when children were approximately ages 1, 3, 5, 9, 15, and 22
| (began late 2020). When weighted, the data are representative of
| births in large US cities.
|
| Beginning with the baseline interviews in 1998-2000, the core
| study was originally designed to primarily address four questions
| of great interest to researchers and policy makers: (1) What are
| the conditions and capabilities of unmarried parents, especially
| fathers?; (2) What is the nature of the relationships between
| unmarried parents?; (3) How do children born into these families
| fare?; and (4) How do policies and environmental conditions
| affect families and children?
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