Dr. Jain, please explain why you disputed another Dr.'s diagnosis of ADHD

[Anonymous]

geoduck, you saved me the time from reading all of that Advocacy is more complicated than a blanket defending all with x disorder. Giving public the idea that angry impulsive behavior= ADHD is harmful and ignorant. this could lead to: bad press worsening stigma for ADHD.. What if someone assumed that I am angry, destructive, and impulsive if I disclose ADD? I’m a little impulsive, but not in the violent destructive sense at all. what happens if a rash of angry impulsive people demand stimulants and ADHD diagnoses when they need anger management therapy etc therapy and/or treatment for other disorders such as substance abuse, PTSD, depression, bipolar disorder…etc? they will be receiving inappropriate treatment, higher risk of addictions, more anger with stimulants???

yay i like thinking…just not wanting to think about coursework..right now..

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[caper]

@pete: I suggest you read it again. Dr. Jain was hired by the bar to refute the diagnosis of ADHD. This is not a case of a patient contacting him for a second opinion.

I also suggest you consider the hippocracy of separate legal and medical diagnosis.

Would you then train doctors in law so when they diagnose a mental illness they can also diagnose the higher standard of a “legal” mental illness?

I also think this case falls into the category of using ADHD as an explanation, not an excuse (see Bill’s video on ADHD not an excuse).

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[caper]

From pg 2 of a 1997 paper by Barkley:

“Poor behavioral inhibition is specified as the central deficiency in ADHD. “

http://data.psych.udel.edu/abelcher/Shared%20Documents/4%20Developmental%20Psychopathology%20and%20Risk%20%2824%29/Barkley,%201997.pdf

In the CADDAC videos Barkley explains behavioral inhibition means impulse control.

I think it is nearly impossible that Dr. Jain would not be aware of this, yet earlier this year he goes on record in court to say that a man that was diagnosed with ADHD probably has impulsivity instead of ADHD. This is a man that was satisfied with the diagnosis, and did not go to Dr. Jain for a second opinion. I’ve also read through the DSM, and can’t find a disorder for impulsivity. The closest thing I can find is Intermittent Explosive Disorder, but that can only be diagnosed when ADHD has specifically been ruled out.

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[Geoduck]

But impulsiveness is also central to other diseases, as well. Just because it’s central to one, does not mean it can’t be central to others. Thus the DSM 4 criteria for ADD diagnosis. A diagnosis of ADD cannot be made on one symptom alone. It just can’t.

In my recollection of the document (and I can’t believe I read the whole thing), Jain did not say impulsiveness was a disease in and of itself, but rather could be an indicator of another disorder, which left untreated, would continue to plague the man. Jain actually agreed that it may be ADD, but without a proper diagnosis (even this guy’s own doc admitted that he did not complete the testing), if he had something else, treating for the wrong disease may make things worse.

Personally, as a person who has been treated for the wrong disease, based on the bad diagnosis of a lazy doctor, I appreciate the caution Jain showed. Turns out inattentiveness is also a sign of depression. My doc based her diagnosis on that ONE symptom and she was completely off the mark. It’s why she wasn’t my doc for very long. I appreciate that my current doctor used the DSM4 criteria and did a thorough diagnosis. Now I’m getting the proper treatment I needed all along.

This poor guy may or may not be getting the right treatment, but doesn’t he deserve a shot at a proper diagnosis, too? Accidentally getting it right is not a proper diagnostic tool. Sure, it may be ADD, but really how does one know for sure without proper diagnosis. What if his doc is missing something.

In his doc’s defense, the guy’s lawyer ordered a halt to the testing. However, he shouldn’t have jumped to a diagnosis without complete testing.

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[caper]

[24] Dr. Jain was retained by the Society to provide a critique of Dr. Blouin’s report and opinion. […] Mr. Lyle may well suffer from A.D.H.D. but Dr. Jain’s view was that some of the findings indicated a diagnosis of impulsivity…

So Dr. Jain suggests a DIAGNOSIS of impulsivity rather than ADHD. Can anyone find the criteria for diagnosing impulsivity in the DSM?

As I’ve said before, Dr. Jain knows impulsivity is one of the key criteria to diagnose ADHD in adults. Dr. Jain could have told the court that he agreed that one of the criteria for ADHD was met (impulsivity), and that a proper diagnosis required evidence of either hyperactivity or inattentiveness. Instead he attempted to mislead the court saying that some of the findings indicated a (different) diagnosis of impulsivity.

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[Geoduck]

Ah, I see your confusion. We’re reading that sentence differently (funny how people can read the sentence and come away from it so differently). Here’s the whole sentence:

“Dr. Jain cannot and will not provide a diagnosis. Mr. Lyle may well suffer from A.D.H.D. but Dr. Jain’s view was that some of the findings indicated a diagnosis of impulsivity which, if untreated, would get Mr. Lyle into trouble again. There is a standard (DSM 4) for the diagnosis that must be followed to achieve a reliable diagnosis and Dr. Blouin did not follow the standard. His diagnosis is, therefore, unreliable and his treatment may also be unreliable.”

The findings indicated that there was impulsivity. From Dr. Blouin’s findings, all that could be determined was a diagnosis of a symptom, which was Jain’s point. Without the full diagnosis, the standard was not met for ADD.

The writer of the document put the word “diagnosis” in front of impulsivity, and there aren’t any quotes around it, so it may have not even been used by Jain. Even if it were, it could be a less usual use of the word meaning “cause of his trouble,” not the disease itself (some docs use that word a bit interchangeably, some dictionaries allow for this usage for a symptom). Impulsivity was the cause, although not the disease itself. It’s hard to tell without being in the room and hearing the exact words used. Note that Jain said he would not provide a diagnosis, so I have a feeling it was not his choice to put “a diagnosis of impulsivity” in the document.

It is clear that the diagnosis standard for ADD was not met, which is what Jain was called in to testify about. Even using that rare usage of diagnosis, meeting the diagnostic standard of impulsivity as a symptom does not mean that the person has ADD. There are several other symptom requirements that need to be met. The point Jain was making is that the guy may not be getting the right treatment for the root cause, and if not, could run into trouble again. There are several other diseases that have impulsivity as a symptom.

But you are right, there is no disease of impulsivity, which is exactly the point.

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[Geoduck]

Oh, read Pete-Puma’s post. He’s right. These are lawyers writing and they may miss some of the nuances, which may be exactly the problem with that sentence. I really think it was a lawyer who used that word, not either of the doctors.

Still, it’s a rare and may be actually a proper use of the word, just not a great choice of words when arguing over whether a root diagnosis of a DSM4 condition has been met.

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[caper]

Good point about the summary of the evidence given. To know what was actually said we’d have to get the transcript ($$$) or Dr. Jain could clarify exactly what he said.

As for “several other symptom requirements that need to be met”, I’d disagree. Hyperactivity, Inattentiveness, and impulsivity are the three possible requirements, and only 2 are required for a diagnosis. As well hyperactivity as a requirement in adults is questionable.

I still think it is lying if Dr. Jain didn’t disclose that impulsivity was one of the requirements for a diagnosis of ADHD (and so he would need to see evidence of inattentiveness to concur with a diagnosis of ADHD).

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[Geoduck]

Well, several meaning more than one, but I actually thought it was something like six. I think I got that off one of the DSM tests I saw here and also on another site. Nice to know. Where did you find that, by the way. I ask because I’m researching for a friend whose child is being treated. Still, Jain did say that Impulsivity could be part of ADD, and that ADD was a possibility here, just not that he was sure this guy had ADD.

Lying really is a strong word (you are implying perjury, which is a criminal offense), and I just see no benefit for Jain, because he would be paid, either way (if he was subpoenaed by this committee, he may have been compelled to testify without pay. That’s how it works here in the US, in some cases). Also, the damage that would have been done to his own practice would far outweigh any monetary incentive, unless it was enough to set him up for the rest of his natural life. I just don’t see any doctor putting their practice on the line like that. Plus, there would be the jail time for perjury. He just doesn’t look like a guy aching to go to jail anytime soon.

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[billd]

While this is true:

>>Hyperactivity, Inattentiveness, and impulsivity are the three possible requirements<<

Trust me – it can also mean something else. I’ve been through multiple proverbial ringers lately for diagnosis of multiple things going on.

While yes, all do finally agree ADHD to the max, my research and questioning everyone I talk to say those three can ALSO be symptoms of some of the other stuff going on with me. Just that in my case, a lot of other indicators that don’t fit other problems all added up.

In short – ask a doctor – those three alone don’t guarantee an ADD diagnosis, but do prompt good doctors to do a full battery of tests to rule out other things that could be causing those exact same three.

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[caper]

Geoduck, there are more than 3 symptoms, which are grouped into the 3 symptom categories I referred to.

When I use the word lying I’m using Paul Ekman’s definition which is roughly an attempt to deceive.

http://www.paulekman.com/

Perjury has a higher threshold than lying; it’s intentionally giving false information.

It appears Jain lied by omission (by excluding the fact that impulsivity does not exclude a diagnosis of ADHD, rather it supports it).

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[trashman]

I don’t know why we are having this thread when we all know that it would be unethical for him to discuss this. it seems to me it does not matter what camp you are in this is a waste of time.not having read all the posts,but having formed this opinion in the past that Dr J did what he felt was right who do we think we are to have this thread here when we all know dam well he is not allowed to chime in according to the law. I will be first to admit that I have not read most of this tread ,but when I see that someones integrity is being questioned I have to wounder how someone can come to his web site and do that when we know he can not defend himself. i don’t know him personalty, all i see at totally. com is people trying to help us.so to Dr J I say thanks and to those that are just trying to make trouble, its time you move on. this is not the place for that. we all have enough trouble on our own we do not need that kind of help. ok i fell better now having said that.

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[dspicelady]

trashman-sending you a virtual “high-5”! Couldn’t have said it better.

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[caper]

trashman: Dr. Jain may remember exactly what he said or may have the official transcript. The judge’s summary of his evidence may not have accurately represented what Dr. Jain said. “We all know” that there is nothing unethical about disclosure of public information.

Your post seems argumentative & evasive. I used the same phrase as you (we all know) to emphasize this. An assertive form of communication would be to say, “I believe” or “I think”. Your use of the phrases “we all know” and “we know” is a form of communication that doesn’t leave an opportunity for different perspectives.

If you had said, “I think it would be unethical for him to discuss this”, then I could have responded with “I disagree” without prompting a fight. “We all know” is condescending, and likely to prompt an equally or more angry response.

dspicelady: shame on your for supporting this type of behavior.

Here’s a page I like that describes healthy communication styles:

http://www.cgstock.com/relationships/communication

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[billd]

WOW – that’s unbelievable…………………and I thought *I* tried to pick conflict……..

Coming to someone’s place and pounding on them without all the facts, only what has been read?

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