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Comment by adamrights | Hacker News Reader

Yes, impulsive, creative, wild, dangerous, bored people doing riskier things have 2x mortality. There's a lot of things that'll increase it a lot more -- like different geolocations.

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I agree that this shouldn't be a surprise. What I'm more interested in is whether the medication used to treat ADD/ADHD could have an adverse health effect that would reduce lifespan, i.e. if they ignore accidental deaths completely, will those on ADD/ADHD meds live just as long as those that do not take those meds?

For stimulants: increased blood pressure. I've had to switch several times because I wasn't able to get to an effective dose without sitting firmly in prehypertension bp levels.

True, although--if this isn't obvious--this won't necessarily matter if you're not prone to high blood pressure. I've got several risk factors as well as ADHD, but even with daily stimulants my blood pressure is comfortably within the healthy range.

Right, and even then.... I now don't have the impulse to go get soda and snack food at the convenience store nearby to kill time. I also find it easier to plan meals and follow through. So, net positive as far as lifespan.

I think I probably have ADHD, and this didn't surprise me. One of the symptoms appears to be a problem with executive function where there's a disconnect between recognizing risk and taking appropriate action to mitigate it. So many times I find myself cursing my stupidity when some foreseen accident actually ends up happening. Fortunately, as you might have already assumed, it hasn't been fatal yet.

> I think I probably have ADHD

Do not think, know. Get checked and officially diagnosed. Otherwise, you are doing yourself and others harm. We test code, we should test ourselves.

I've been looking into it, but it looks like it's going to cost several hundred dollars, which would be fine if I knew I was getting something out of that, but it's a lot of money just to be told, "No, it must be something else."

You will.

Well, true, any information is useful, I guess.

Note that all a psychiatrist does for adults to determine whether they have ADHD is give them a self-reporting questionnaire. You can find sample questionnaires and diagnostic criteria for interpreting them in a couple of places online. In other words, if you're honest with yourself when you answer, you can know exactly what a psychiatrist will say without having to go.

The one thing that might not be mentioned on such sites is that people being tested for ADHD are also given an inventory for anxiety disorders, sometimes mixed into the ADHD questions. Anxiety looks like ADHD in some ways but is treated differently; effectively, in order for an ADHD diagnosis to "count", you have to be not-overly-anxious.

You sure on that? It's extremely common for ADHD to be comorbid with anxiety. There's a challenge in figuring out which is secondary to which, sure (same with depression and ADHD or depression and anxiety--they all confound each other) but I've never heard of apparent anxiety being a disqualification.

Not a disqualification, no; it's more, like you said, that they confound one-another, but usually it's the anxiety doing more of the confounding. It's very hard to determine whether the ADHD really "exists" as its own thing or not until you've treated for the anxiety. (In neurochemical terms, since adrenaline production consumes dopamine, there's no way to know what the person's "normal" dopamine flow is like until you can get them to stop being so stressed out.)

Couple this with the fact that a good few of the psychiatrists I know basically only treat adult ADHD cases—they're easy, no long-term maintenance therapy needed!—and it starts to look more like having anxiety is a "disqualifier". What it really means, though, is that the patient will have to get the anxiety under control before a sensible psychiatrist will trust the calibration of the ADHD self-assessment criteria.

In my case I had to take two questionnaires (one was 100+ questions for general mental disorder evaluation), a subset of an IQ test, and a computer test. The computer test was interesting... it was along the lines of left click when you see the number 2, right click when you hear a sound. No other distractions trying to trick you into clicking, but it is a 15 minute test. Excruciatingly boring, but even trying as hard as I could, the psychiatrist wondered if I had cheated/fudged the test because my results were so far out of whack compared to the IQ test.

It's a muddy situation but your insurance may cover the cost. I explicitly called my insurance provider and asked if they cover the testing required and they said learning disorders weren't covered for adults at all. It was getting to be a big enough issue that I was willing to part with the money out of pocket so I got tested anyways. Insurance ended up paying 100% :/

> Get checked and officially diagnosed.

That can be a surprisingly difficult process.

For example the NHS isn't entirely sure how to diagnose ADHD in adults. My GP didn't even know it was possible, and had to go and make phone calls to find out where the nearest specialist was. Unfortunately if your answer to "Did you get bad grades at school?" is "Not really" then hard luck, as they want evidence of underachievement as a kid to confirm the diagnosis. And there really is no way to complain your above average grades were underachievement without sounding like a dick.

It wasn't until I was in the final stage of my degree that somebody noticed that I had problems, and luckily the University helped me get a private diagnosis for some of my issues.

There are standard batteries of tests now. I'd be surprised if they were completely unknown. The need for evidence back into childhood does probably remain, but I think most pros who understand ADHD know that grades are only one possible indicator.

That's especially true for gifted people (guessing from your "sounding like a dick" sentence), where "twice exceptionality" can be tough to recognize due to smarter people being able to find better coping mechanisms. That particular issue is not unique to ADHD, comes up with dyslexia and other learning difficulties too.

Admittedly my last interaction with the NHS was three years ago, but the GP had to go away and research what to do. I have no problem with that, they can't be expected to know everything offhand! The human mind is a complex thing.

My own hangups make it difficult as I find the whole thing hard to talk about. I have no reason to complain in the grand scheme of things, "Some people have real problems!"

I agree that getting an assessment for ADHD in the NHS is frustrating and too hit or miss.

NICE is aware of that, and they're pretty clear about what should happen.

For anyone living in England: https://www.nice.org.uk/guidance/cg72

I started with the process of getting a diagnose less than a year ago, and am next month meeting up with doctor nr 4 and 5. It is a long and painful process.

A thing with this study is that they measure survival mostly in an age bracket with relatively low chance of death, but also in a bracket where chances of death by accidents due to lifestyle are relatively high.

A base death rate of 2.2 per 10k years is one per 4500 years. Since you live about 80 years, the sample is skewed towards the not-so-likely to die. Perfectly acceptable btw, but it makes inferences to what happens to the life expectancy Curve harder.

My prior would be: the cumulative survival curve for ADHD is markedly lower in the ages 5-30s (one dies more often when at risk due to accidents), and then converging to the curve UNLESS the medicines are harmful as well.

My point in other words: aMRR is a fine measure, but you really want to identify causes to shifts in (parts of) the survival function. For now it's a finding that just confirms prior beliefs.

[edit] Confirmation by the same author [1]. All that would be cool now is estimates of survival functions. They must have some people in their dataset dying of old age.

"Children with ADHD had an increased risk of injuries compared with other children. Treatment with ADHD drugs reduced the risk of injuries by up to 43% and emergency ward visits by up to 45% in children with ADHD. Taken together with previous findings of accidents being the most common cause of death in individuals with ADHD, these results are of major public health importance."

[1] http://pure.au.dk/portal/en/persons/soeren-dalsgaard(9da0473...

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