20 years
back we did not need talent identification because few athletes were doing
triathlon and there were resources available; those resources are not there
anymore neither the time to spend with so many athletes. We need to make fast decision about the level
of involvement with athletes depending on the degree of commitment they have
for the sport. We have spoken about it
previously (24 mai 2012 TALENT IDENTIFICACION ADDICTIONS).
Talent identification has to do with
education and secondary with our “soma.” It depends on the adaptive patterns. Somebody
has to live healthy in order to overcome addictions; so knowing the adaptive
patterns is important when we speak about talent. A practical and clever Ecological definition
of an addiction is given by Gregory Bateson, Mind and Nature, A Necessary Unity
(1979). Bateson puts adaptation vs.
addiction. I go by this definition because it gives me the opportunity to be a
better human being without “hard” addictions and it guides me to overcome my
addictions in a practical way:
Addiction is the name of the large class of changes induced by
environment and experience that are not adaptive and do not confer survival
value (193).
When we speak of psychiatric disorders we should think in the Batesonian
definition of an addiction. A
Psychiatric Disorder is equal to addiction according to Bateson. The thought/behavior/pattern is repetitive in
psychiatric disorders; Bateson calls the insane repetitiveness addiction. What we call disorder in psychiatry it is an
addiction in the Ecological Batesonian sense.
Let´s take a practical example now that you learned about clinical
trials in the previous post and practice how to read an article.
Comented by the one below:
Arch Gen Psychiatry.2012;69(12):1295-1303.
doi:10.1001/archgenpsychiatry.2012.271
Comented by the one below:
ADHD at age 41: Absent or antisocial or
moody/anxious
Nassir Ghaemi, MD, Psychiatry/Mental Health, 08:44PM Nov 1, 2012
There is an article: Clinical and Functional Outcome
of Childhood Attention-Deficit/Hyperactivity Disorder 33 Years Later.
Recent article available online first in the Archives of General
Psychiatry provides a fascinating and long-needed long-term prospective
follow-up of childhood ADHD into adulthood. This was a 33 year prospective
follow-up, which can finally tell us what ADHD is and becomes after childhood.
I've always thought that making childhood psychiatric
diagnoses was like taking a still picture of a runner in motion - everything's
blurry. You don't really know the anwer until the child becomes an adult (and
by then it's too late to do anything for the child).
So what does this study tell us?
At age 41, 135 men who had been diagnosed with
childhood ADHD around age 8 were compared to 136 age matched men with no prior
childhood ADHD. Some interesting results, based on my interpretation, not
necessarily those of the authors:
1. ADHD persisted in 22% of the adults. In other
words, consistent with a large older literature, ADHD goes away in 80% of
children by the time they become adults. This contrasts with the common
assumption these days that most children with ADHD should stay treated for it
into adulthood.
2. ADHD was diagnosed in 5% of the adult control
group, who had NOT had childhood ADHD. What does this mean, especially in
the context of the National Comorbidity Survey data showing a 3%
epidemiological prevalence of adult ADHD in the US? Maybe it means that
"adult ADHD" is not an illness, but rather represents the cognitive
baseline of the general population, whereby 95-97% of the population has normal
concentration, but a small percentage (3-5%) have decreased concentration -
just as some of us are somewhat more anxious than others, and some of us are
more shy than others, as part of normal personality traits. These are not
all disease, but normal variations in personality or cognition.
3. The most clear cut adult psychiatric
diagnosis in children with ADHD was antisocial personality disorder (16% vs 0%
of controls). Does this suggest that much "ADHD" in children is
not ADHD, but conduct disorder that later declares itself as antisocial
personality?
4. Not surprisingly, substance abuse was common
(14% in the ADHD group versus 5% in controls).
5. Mood and anxiety disorders (common causes of
impaired attention) were more common in the ADHD group than controls, contrary
to the interpretation of the authors (statistical nonsignificance is not equal
to nonexistence, a common statistical mistake). The results were 9%
versus 6% for mood disorders, and 13% versus 9% for anxiety disorders - in
other words, about a one-third increase rate for the ADHD group for both
conditions (p-values are irrelevant for this kind of study with multiple
comparisons, which was not statistically powered for this subgroup analysis).
(Diagnosis were based on standard research SCID interviews, but were conducted
by clinical psychology graduate students, not trained psychiatrists).
The authors conclude: "The multiple disadvantages predicted by childhood ADHD
well into adulthood began in adolescence, without increased onsets of new
disorders after 20 years of age".
What could we conclude (somewhat differently than the
authors)?
Almost 80% of children with ADHD do not continue to
have the condition into adulthood.
The epidemiological prevalence of "adult
ADHD" is consistent with the baseline normal variations of cognitive
function in adults who never had childhood ADHD.
A common adult outcome of childhood ADHD is antisocial
personality.
Mood and anxiety disorders are one-third more common
in adults who had childhood ADHD.
The authors don't tell us what percentage of adults
with ADHD did not have antisocial personality or mood and anxiety disorders,
which could themselves cause attentional impairment, but it would be
interesting to know if this group would exceed the 5% non-ADHD baseline of
ADHD-like cognitive impairment in adults. What strikes me the most is what I put in red:
The most clear cut adult psychiatric diagnosis in children with ADHD was antisocial personality disorder (16% vs 0% of controls).
The most clear cut adult psychiatric diagnosis in children with ADHD was antisocial personality disorder (16% vs 0% of controls).
The predictive power of
the childhood precursors of antisocial personality disorder provides ample
justification for early intervention. Greater understanding of subgroups
within the broad category of antisocial children and adults should assist
with devising and targeting interventions.
Some countries, as New
Zealand, go directly to make interventions to avoid the antisocial personality
in the future, when the adolescents become adults. They do it with the
aboriginal population mainly, because this behavior/diagnosis is related to
factors as poverty and degree of education.
In Mexico, we do not have
a way to deal with this kind of addictions and the society promotes this
antisocial behavior. Our talent
identification depends on the degree of antisocial behavior developed already
in the athlete. Our Nobel Prize
Winner, Octavio Paz recognized the main feature of this disorder and wrote a
book title: THE LABERITH OF SOLITUDE:
“Lying plays a decisive role in our daily life, in our politics, our
love-affairs and out friendships, and since we attempt to defeat ourselves as
other our lies are brilliant and fertile, not like the gross invention of other
people.”
In practice, most New
Zealand mental health programmes, broadly defined, in relationship to conduct
disorders is focused on tertiary prevention i.e. attempting to reduce the
impacts of the disorder made especially obvious by significant harm to others
such as assault with a deadly weapon, forced sex, and aggravated robbery. The
natural history of the disorder, however, is for an escalating pattern of
offending, often with roots in the first five years of life. Because tertiary
prevention of conduct disorders is expensive, often ineffective, and too late
to prevent irreparable damage to others, including family, there is
increasing interest in other types of prevention.
Now there
is also evidence that early intervention programmes that target aggressive
and non-compliant behaviour in children can reduce delinquency later in life.
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%20in%20conduct%20disorders.pdf
As I mentioned in previous posts, countries as New Zealand and Australia
have children that feel ashamed of their behavior at the age of five compared
to Mexico, where children get angry if they are confronted by an adult for
his/her behavior. An athlete mentioned
to me about knowing the existence of this research.
Delinquency is the target of these programs in New Zealand, but
non-compliance is a huge problem encounter in countries like Mexico. This lack of education is an insurmountable
handicap and, if we want to create champions, we should start at a very early
age training/educating kids.
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