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Overselling A.D.H.D.

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133 pointsokket218 comments

As someone in my 5th decade, with lifelong ADHD (though given my age it did not exist in my youth, and was only diagnosed relatively recently), I'm wary of backing away from treatments until we actually do have real viable alternatives.

It took far too long to get ADHD widely recognised, and even now it's often more likely to be received with humour than real recognition. Much more research, especially on other possible treatments and therapies, is needed before we turn too zealously against the only treatment actually shown to work. We have a long history of over diagnosing and overdoing pretty much everything.

I've only ever managed it with limited success. There's little doubt that the drugs can work. Despite some evidence of over-diagnosis and over-prescription there are many people who have had their prospects transformed as a result. I suggest the ADHD label is being significantly over applied because real awareness, even in the medical profession, is still abysmal. Doctors don't have time to look at home circumstances, or parents and other factors that might affect behaviour. Awareness coming from some TV comedy skit however is high.

I don't actually care that we don't yet have full understanding of how the drugs work, or that OMG they're amphetamines. I often wonder how things may have turned out differently for me had I encountered more GP awareness and less ridicule, or even earlier self-awareness or teen diagnosis and treatment.

If we are too successful "exposing big pharma" and overdiagnosis in the minds of GPs and the public, lives will be ruined once again. Let's not throw the baby out with the bathwater here rather than seek wider understanding.

The thing is, diagnosis rates in the U.S. are something like 3-4 times as high as in most countries in Europe, which are themselves 3-4 times as high as a country like France, which is averse to ADHD diagnoses. The main treatment for ADHD is lifelong maintenance of powerful amphetamines, when we have no idea what the long-term consequences of that would be, nor what proportion of children would normally develop out of the ADHD spectrum with time.

Overdiagnosis at that rate means that millions of children are being given amphetamines, when they shouldn't be!

I looked, and it seems to be about double (though figures disagree). And I wonder if this isn't simply a difference in educational systems and expectations of children.

I'm in Norway, and children play quite a bit, even in school. They take frequent breaks, have outdoor recess (in nearly all weather), and have no homework. The general attitude is that kids should be kids and not have to worry about stuff. Sure, there is more pressure as the child grows up, but it isn't comparable. School days are shorter as well. Far cry from what I remember as a kid in the US or what I see now. Little in the way of recess, homework starts early. I had a few hours every night at age 11. Sit still, be quiet for hours, do all the worksheets.

I'm guessing there are kids with ADHD that might not need medication, merely time to learn and develop coping mechanisms. Perhaps some children wouldn't have such a problem in the one system whereas in the other would be quite a disruption.

I have nothing to back this up, just a theory.

This is pretty important stuff, thank you for posting.

Often times, 'a problem' exists largely because a person's behaviour and/or performance exists outside of the local norm.

Given this, then by definition the amount and types of such problems are largely driven by the norm.

As you said, I don't have anything at hand to back this up, but this seems like a very reasonable way to explain some of these big diagnosis deltas.

I think you are right.

I would really prefer to change the world, than take medication. I say this without sarcasm and a little bit of sadness.

>we have no idea what the long-term consequences of that would be

Perhaps you have no idea, but we actually have a pretty good idea from 80 years of stimulant medication usage.

Do you have data suggesting negative consequences of decades of stimulant usage?

No? Then it's surely the best decision to ignore this FUD and continue treating people of all ages with stimulants which have been shown to be safe in such low doses.

Particularly when we have evidence suggesting not medicating is dangerous, as I mentioned in my other comments.

The main question is whether medication-based treatment encourages ADHD to persist past adolescence. Non-medication-based treatment, of course, does not necessarily imply non-treatment or non-intervention.

> Overdiagnosis at that rate means that millions of children are being given amphetamines, when they shouldn't be!

Only if you define overdiagnosis as "diagnosis relative to other countries" and not "diagnosis relative to the percentage of people with the ailment". If you use the first, we probably overdiagnose cancer, since countries like Mali have a much lower diagnosis rate...

> children would normally develop out of the ADHD spectrum with time.

And until they normally develop out, they would be behind in every measurable attribute as what we expect in their growth through school. Avoiding administrating a treatment which works because of our fear of the treatment is measurably bad for those affected. See, again, cancer and chemotherapy.

When similar standards of diagnosis are used across countries, they find similar rates of ailment. The difference is that the criteria for diagnosis in the US catches a much larger percentage of the population. Moreover, the US is also much more likely to use pharmaceuticals as the front-line treatment to any ADHD diagnosis.

Really, my concern isn't about children who would be diagnosed either way, or who unambiguously need pharmaceutical treatment (who exist in all areas). It's about the marginal cases where pharmaceuticals may not be warranted.

It would be dreadful to administer chemotherapy drugs to patients who got a false-positive on a cancer screening (cancer is not a spectrum, but I'll run with your analogy).

And as I said in another comment, skepticism of the long-term use of this medication in young children does not at all mean advocacy of non-treatment, non-intervention, or lack of support for children at the margins of the ADHD spectrum.

We don't yet know how many of those are being overdiagnosed - we don't yet know the limits of the spectrum. There's a lot of opinion on both sides, which is never helpful.

I can say that I wish I had had 30 more years on amphetamines, the difference has been marked. For the first time in my life the engine wasn't misfiring. If it were certain to take a decade or more of my remaining life, I'd continue fully aware. I still drift, but I think that's more because I have the habits. For me it'll still be a lifelong process to try and correct the bad habits and thought patterns reinforced throughout the first half of my life. Others will be less clear beneficiaries of treatment or better served in other ways.

I think diagnosing and treating toddlers and 7 year olds is appalling - better to try and manage it, or look into causative factors like poor home environment and such. A more Scandinavian approach to school may help more (The UK would benefit from this too). A good proportion will grow out of it. That comes back to wider real awareness though especially with first contact - teachers and GPs etc.

Some of these questions have been studied. When the same criteria are used, prevalence is comparable in Germany, Brazil and other locations. The recognition of the condition is affected by cultural factors but that's true for many conditions.

ADHD by definition is a condition that originates in childhood and persists into adulthood in about 1/2 or more of cases. In adults ADHD is indeed a chronic condition that often responds to amphetamine or methylphenidate treatment. At therapeutic doses, long-term treatment with such agents is generally well-tolerated, but careful monitoring is necessary to assure medication use remains effective and tolerable.

Interestingly, amphetamine has been used for this purpose for nearly 80 years, and methylphenidate for >50 years. Despite the several decades these agents have been employed, nothing more effective has yet been developed.

As I pointed out in my other comment, among adults anyway, the issue is that ADHD is vastly undertreated to the severe detriment of individuals, their families, communities and nation as a whole.

> ADHD by definition is a condition that originates in childhood and persists into adulthood in about 1/2 or more of cases.

Right, and all of this is a question about under what conditions it persists or fails to persist. Does ADHD medication, relative to say behavioral therapy or nontreatment/nonintervention, make it more or less likely that ADHD will persist in adulthood? This is a very important question of those who fear ADHD medication is overused, and may be encouraging ADHD to persist past adolescence.

Very important questions indeed, while there's no complete answer some data is encouraging. Imaging studies, for example, have shown children treated continuously to early adulthood show more robust brain development (white fiber tracts) vs. untreated subjects. Medication treatment is certainly not harmful in that respect and probably helpful.

The role of behavioral therapies is unclear, though practitioners point to instances where that makes a big difference in the outcome. Admittedly it is a hard subject to study systematically given the individualized nature of behavioral treatments.

However research is hardly saying that medication is the only factor. Lately, there is a great deal of attention in the field directed to findings that childhood adversity, e.g., abuse, malnutrition, environmental impoverishment contributes greatly to conditions that resemble ADHD. The implication is clear that reducing the negative impacts of inner-city poverty, etc., would have salutary effects on reducing incidence of psychiatric disorders including ADHD.

In adults, ADHD sufferers with long-term medication treatment show better functioning than untreated peers (matched for age, sex, education, etc.) if less well than unaffected individuals.

Most such studies have used medication therapy as the marker of treatment. So far the contribution of behavioral therapies has been hard to pin down. However, clinical experience is that medication alone is inadequate for adults to improve.

The saying is "pills don't build skills". Indeed, guided behavioral practicing is an essential element of ADHD treatment, though optimized medication treatment can be very useful to enhance neurophysiological infrastructure necessary for normalizing functioning. An individually optimized combination of treatment approaches is most likely to be successful, but hard to determine a priori, thus hard to study experimentally.

I don't believe my response truly satisfies your excellent question, but I'm very glad to know there are people like you who are thinking intelligently about these problems that affect all of us directly or indirectly.

Thanks for the great response, btw.

> The thing is, diagnosis rates in the U.S. are something like 3-4 times as high as in most countries in Europe, which are themselves 3-4 times as high as a country like France, which is averse to ADHD diagnoses.

I've heard people from France say that many French doctors absolutely will not diagnose ADHD in anyone, no matter what their symptoms, preferring to tell sufferers that they're lazy. It may be possible that the US overprescribes and Europe in general is a happy medium. France is systemically failing to treat people with a genuine medical need, and it ruins lives. If it has to be one or the other, I'd prefer to err on the side of helping people in need.

Please see my other post on the effects of ADD: https://news.ycombinator.com/item?id=12345969

I identify with a lot of what you say. I was not formally diagnosed with ADD (now properly called ADHD-PI, the non-hyperactive variant) until a few years ago, in my 50s. I did well in school but ADD has been the bane of my career. I get bored easily with uninteresting tasks and the mental effort to complete them is exhausting. If I slip, and find something more interesting to do, it can annoy my boss, to say the least. I'd like at job that fits my brain better, but at my age, opportunities are rare. I'm now taking a mild dose of an amphetamine (Vyvanse) and it does help, but I still have to maintain a lot of self awareness so I don't wander off into the weeds.

I'm glad amphetamine treatment is effective for you. I hope you can recognize that your situation (an adult, in full control of your own care, with informed consent at all stages) is very very very very very different than putting 6 year olds on ritalin because they're fidgetting at their desk in class. This is really done in America.

No, it's not done that way - there are more factors than "fidgeting in class" that psychiatrists take into account when diagnosing ADHD.

And frankly, if they're put on Ritalin and stop fidgeting and start paying attention, then it's probably a valid diagnosis in the first place. People without ADHD would end up fidgeting more, not less, if given amphetamines.

It is done this way and it happened to me. The public school I was attending told my parents in 2nd grade put him on Ritalin or we are going to expel him.

these are children we're talking about. you're endorsing drugging children.

Yes, so what? My son had a bladder infection, and I certainly endorsed the use of drugs to treat that. If there is a real and identifiable condition interfering with a child's quality of life for which there is concrete reason to think that a drug is an effective and remedy for which the risk of other side effects is mild compared to the expected benefit, why shouldn't responsible adults endorse drugging children in that circumstance?

bladder infection is an infection by a microbial disease. it's a pathogen caused by another organism that shouldn't be present in a healthy body. what exactly is ADHD? what is being treated, anyway?

this is medicating for "normality", which is another way of saying our society is defining and enforcing (with mind-altering drugs) a very narrow band of acceptable personalities and behavioral responses to environmental situations.

if chemical enforcement of "normal" is ok with you, then go ahead and drug your kids.

> this is medicating for "normality"

No, it really isn't. There's nothing normal about having ADHD. It's debilitating: it makes it very hard to hold a job. It makes it nearly impossible to plan for the future.

Imagine having a horn blowing in your ear at a random interval between a second and an hour, completely disrupting your train of thought, as if you just did a complete mental context switch. How big of a mental stack could you create, knowing that the horn will blow at any moment, completely destroying it.

Your friends get tired of talking to you, because you constantly lose track of what they're saying; you are constantly looking around for the source of that damned horn.

You try and read a book, but then the horn blows and you forget where on the page you were. You struggle on, and find that you can get back on track more quickly if you leave you finger where you were. The horn blows, and you spend a few moments lamenting that damned horn, and have to re-read the last few sentences to pick the context back up. The horn blows.

You try and walk down a hallway and through a door. The horn blows, disorientating you a bit, causing you to hit the doorframe on your way through.

You can't write code. You can't hold deep conversations. You can't read deep, technical books. You can't handle the college workload. You can't put together a plan for your future. All because of that f*cking horn.

But it's OK, everyone who doesn't hear the horn tells you - you're just living in the wrong time in history. You'd make a great hunter.

If someone offered you some earmuffs quiet that horn, would you take them? Would you then advocate them for others who have that same horn blaring in their ears?

I would. I do.

This description is right out of Vonnegut's Harrison Bergeron, written in the context of opposite effect of handicapping those of extreme skill/means rather than the debilitating effect of those trying to live a "normal" life.

https://en.wikipedia.org/wiki/Harrison_Bergeron

Yes, it is. However the effects of the sounds on cognition as described in that short story are remarkably spot on for how ADHD affects my ability to concentrate and think.

He even got the ability to "ignore the sound" down pat - it can be done if something novel really grabs hold of your attention... and that it doesn't last.

People aren't treating ADHD to make children "normal".

They're treating ADHD to reduce the risk of accidental death; homicide; suicide; and drug or alcohol dependency.

Perhaps you have a point. But in most cases when medication is prescribed it's because the condition is debilitating. I can speak from experience that when a child is incapable of sustained play, overwhelmed by the interactions, and has trouble with going to the bathroom that we aren't talking about a narrow band of acceptability. Your comment, like so many others here, demonstrates a complete lack of understanding of the real problem.

I've seen the absolutely amazing affects of non-stimulant ADD medication and it's not chemical enforcement of normal, it is treatment of a disease.

As a parent it's very hard. Our governess mentioned our one daughter was having difficulty focusing. So I did a trial with just 5mg/day Ritalin. Week on, week off. The difference is huge.

It's a really hard call. I'm worried about the effects long term, but she does so much better with it. If she was in a school instead of with a private tutor, I'm guessing she'd be way worse off.

FWIW I used to think giving meds to an 8yr old was horrible. It's not so clear anymore.

school is so boring we give children focus drugs and are surprised when they are able to focus? and we dont talk about fixing school, because the short term pragmatic decision is to adapt the brilliant kid to the shitty environment, instead of the inverse.

I don't think her school is too boring. It's her and her sister and a full time teacher just for them. They have near unlimited flexibility in scheduling and approaching things. She goes on about how fun it is; they both love it. It's just she can't seem to focus on any task without the meds. She really likes taking them, hence making me more conflicted.

that is because the task is boring, if it was engaging kids would focus on their own. its not more enthralling than the thing her attention diverts to. with screens, we have trained kids to always have ever changing dopamine bursts and excitement. school hasnt adapted to the chaoticness of our desires (and maybe ti shouldnt, maybe focus is a skill we should hone, instead of obtain through cheating.)

> you're endorsing drugging children.

Not just any children, I'm endorsing providing drugs to children who need those drugs. Just as I would endorse giving a child with a headache an appropriate amount of acetaminophen or ibuprofen. Or steroids to a child with severe MS. Or opioids to a child with chronic pain.

Just because the defect is in the brain and not the muscles or nerves or elsewhere doesn't make it less of a treatable defect. Or less worthy of treatment.

Do you say that about chemotherapy? Or insulin for T1 diabetic children?

Why do people on meth enjoy cleaning? There is little difference between meth and Adderall. Taking any type of stimulant even coffee helps people do menial tasks and be more optimistic while doing them.

Maybe millions of people are effected by some problem of distraction and lack of focus. But to suggest there's some biochemical reason for this that's cured by amphetamines seems like pseudoscience to me.

Drugs do work. If you want to take amphetamines to improve your work performance, go for it. But to suggest that it's a disease seems disingenuous.

There's something like 16 million Americans who take Adderall, which has drastically increased in used (300%+ from 2008-2012). Another poll said 35% of college students had said they'd tried Adderall.

The science of ADHD is ambiguous. The science of moderate uses of amphetamine or methamphetamines for improving work performance is easier to understand.

> But to suggest that it's a disease seems disingenuous.

That allows (at least) two things: pressuring insurance companies to pay for treatment, and pressuring students to undergo treatment.

> There is little difference between meth and Adderall.

I posit that you don't yet know enough about neuropharmacology to have beneficial opinions on this topic.

There is little difference between water and hydrogen peroxide.

Imagine this: you're an adult professional, sitting at your desk looking at a freelance work assignment that needs to be done by tomorrow, weeping with frustration because you've been staring at it for eight solid hours, trying and trying to begin, and you can't because focusing on anything important is like trying to grip a handful of water.

Because you ran out of your meds.

This is what my life is like. If that doesn't sound like a medical condition to you, then I don't know what you're thinking. If you think I haven't tried everything else imaginable to deal with it, you're mistaken. The only thing that works is amphetamines. There's definitely downsides, and if someone showed me a better solution I'd love to try it. But, so far, there isn't one.

Maybe some people take the meds who don't really need them. That's a shame. You don't get to sacrifice my career just to keep some people from getting high.

three things:

1. You do not enjoy your work, and thus have no motivation.

2. Maybe you should not do the work and suffer the consequences.

3. You have built a mental dependency that you must take amphetamines to "focus", and this hinders your real ability to focus.

All of those things ^^^ I have experienced at one point or another in my life. You can focus, you have to make yourself. There is no other way. You do not need medication... But maybe you do, I highly doubt it though.

> Maybe you should not do the work and suffer the consequences.

I've done that. A lot. It sucks. That's why I take medication.

> You can focus, you have to make yourself. There is no other way. You do not need medication...

I don't understand why people can't quite believe that mental illness is real. You would never tell a diabetic or an asthmatic that they shouldn't have to take medicine every day. But if someone's clinically depressed, or has ADD, or any of a hundred other mental conditions, people just assume you're imagining things or being lazy.

It is hereditary too. I've seen how in past generations, children with these kind of conditions were just labeled as trouble makers and got no help and eventually failed out the system.

Just simple understanding and acceptance that this is a condition, medication or not, makes a huge difference. And yet here we are still arguing it.

I have struggled with ADHD for my entire life. I don't think you realize how it can affect you.

I started to take medication after nearly failing out of college. It was physically impossible for me to study for more than 40 minutes; I would fall asleep no matter where I was. It was not a matter of motivation or dedication. I was hitting a physical barrier that I could get around any other way.

I agree that there is over-diagnosis is a problem, but especially as a person who came around to medication as a last resort, it is very offensive to say that I don't need it. I avoided it for years, but within a few months I was able to use all of the strategies I had learned, coupled with the meds, to seriously turn my life around. I went from academic probation (GPA in the 2.2 range) to top of my classes with about 15 mg of adderall a day. I've tried placebos, I've tried therapy, but I would not be able to do the work I do today without drugs.

Have you ever thought about your body and mind were not designed to do things that need constant focus?

Look, I understand you may not understand what it is like having ADHD, but your post came off incredibly dismissive. Telling a person with ADHD to "just focus" can be like telling a person in a wheelchair to "go for a run": it is incredibly frustrating to hear and can be nearly impossible. This may be a hard concept for you to get your head around, but this is a real problem for some people and medication is a real(and often necessary) solution to a real problem.

I agree that there are people who will benefit from the use of prescription medications to treat different life issues. I too suffer from hours of staring at work, unable to start or finish. I don't think I have a learning disability or a disease that needs treatment. But I think there are many alternatives to help people who cannot start and finish work tasks.

I can usually find a quiet and productive work environment free from distractions. I can usually adjust my caffeine intake levels. I can usually adjust the amount of personally stress in my life. I can usually adjust the amount of sleep. I can usually break up my work into small enough chunks to get started. I can block certain computer activities which are distracting.

Yes everybody is different. No, we should not throw out the baby with the bathwater. Yes, we should be exploring alternative treatments besides powerful amphetamines which can cause addiction and health issues. I don't believe having a problem justifies all the cost that go along with treatment. Sometimes the solution is worse than the problem.

I don't want to have to do drugs at work to keep my career from those who want to take a pill and work for 12 hours a day.

"Sometimes the solution is worse than the problem."

For someone without the condition, perhaps.

My entire life I've tried to work with managing techniques, such as those you suggest, and a hundred others, none of which made a blind bit of difference. Caffiene does not seem to affect me in the same way as it does most people btw. So I've spent a good part of my career trying to find roles and bosses more suited to my scatty ways - often far from easy - once I realised I was a little unusually wired.

The biggest problem ADD has is that everyone gets distracted, struggles to focus sometimes, so the majority of people exatrapolate that out and presume there's nothing wrong. Then go on to suggest 5 things that help them with their occasional distractions. That's like telling a wheelchair user to just walk. "Well have you tried walking differently?" "Tried a stick?" I spent 50 years trying to just walk and I still can't. My first week on meds however, when I was told I'd probably wouldn't yet notice a difference, was indescribable. Truly I don't have the words. I almost dropped into depression realising I could have been like this my whole life. "Is this what other people have all the time?". I could have achieved so much!

That I achieved some measure of success with the condition, compared to how my mind could have worked surprises and disappoints in equal measure - what might I have achieved?

For many actually with the condition it's highly debilitating. They can't not be distracted. Ever. Often they're being distracted from being distracted from... IT IS NOT "oh look, shiny" on facebook. For some powerful amphetamines will be the best solution of those yet available (in very low doses compared to dietary or recreational uses). You don't get any of the same effects as you would taking amphetamines at a party. It's a neurological imbalance, so a neurological treatment will often be fitting.

Course I probably shouldn't think of it as a learning disability and just adjust the amoutn of tea I drink and look at some ideas for people who cannot start and finish work tasks.

I don't want over diagnosis, or easy diagnosis of very young children, and ideally want some more tools in the box I can choose from.

Why do you assume that I'm not already using all of the techniques you described, in conjunction with the meds? Why do you assume that you know what's going on inside my head better than I do?

I'm not being rhetorical, I honestly would like to know. It's a huge problem that so many people refuse to believe that mental illness exists, not just for me and not just for ADD. You wouldn't say to someone with chronic fatigue syndrome "Yes, nobody likes to get up for work, but you just have to suck it up and deal with it." You wouldn't tell a diabetic that they shouldn't have to take shots just to get through the day. What makes you feel qualified to do that to me?

> Yes, we should be exploring alternative treatments besides powerful amphetamines which can cause addiction and health issues.

Absolutely we should! I would love to find a non-stimulant treatment that works for me. I regularly do research and ask my doctor to see if there are any new treatments available. Until they come up with one that works, I'm going to keep doing what I need to do to get by.

Also, I'd love to see a source on "addiction and health issues," because Ritalin and the other common ADD meds are not addictive, and have no long-term side effects for the large majority of patients, at clinical doses.

> I don't want to have to do drugs at work to keep my career from those who want to take a pill and work for 12 hours a day.

This is a strawman. That has never happened to you; your career is not under threat from drug abusers. My career will absolutely crash out immediately if I stop taking my meds, I've tried it before. What you're doing is no different than medical marijuana prohibition: you'd sooner let patients suffer than run the risk that someone might get high.

Imagine this: you're an adult professional, writhing in pain and occasionally vomiting, weeping in frustration while laying in bed not able to get out.

Because you ran out of heroin.

That is what my life was like. If that doesn't sound like a medical condition to you, then I don't know what you're thinking.

This medical condition is called withdrawal.

You are right in that discontinuing ADHD medication can lead to withdrawal symptoms.

But you are dead wrong in that ADHD does not disappear after withdrawal. As it would if it were a drug addiction.

ADHD was there before taking medication, and it will persist long after stopping medication. (If we assume the diagnosis was correct.)

It can indeed cause withdrawal symptoms but not so bad since psychiatrists suggest "treatment holidays", where you are free to choose not to take them for a few weeks.

Other psychiatric medications are often withdrawn slowly. For example, a patient on weekend leave in hospital would be called straight back to the ward if they lose their prescribed benzodiazepines e.g smashing a bottle of solution, due to withdrawal. Especially the case if used during alcoholism detox, where the seizures could kill otherwise.

Many of the symptoms also do not go away with medication. It's not a magic bullet. It just raises the floor a little bit so things are easier to manage. Some days the medication doesn't help all that much if other things off set it.

I just realized that my post was extremely easy to misread :/ I hope it's fixed now.

I think mine was too since I was agreeing with you, ADHD is most definitely not a symptom of stimulant withdrawal.

Were you writhing, vomiting and weeping before you ever took a hit of heroin? Did you continue writhing, vomiting, and weeping for months after quitting with no reduction?

No?

Sounds more like detox.

I'm regular drug addict and know the feeling.

In this case its called rebound effects.

When you have a medical condition that you treat with medication, a shocking consequence of discontinuing treatment is a return of that medical conditions symptoms.

On the bright side, people don't call you a slacker anymore. Now your just a drug addict.

You're correct.

I have had experienced something similar with Xanax. The symptoms returned but worse than ever and I was certain that taking loads of it is absolutely necessary. Once you are able to go off, the symptoms go back to normal. Anxiety doesn't appear, but Xanax only makes it worse. It is same story with stimulants.

"Detox" doesn't start before you ever take the drug, and continue long after you stop. Might as well say that diabetes is just insulin detox.

16 million Americans seems to correlate fairly well with the medical consensus that around 5% of adults have some degree of ADHD. Perhaps it's not as widely over-diagnosed as sometimes claimed?

" But to suggest there's some biochemical reason for this that's cured by amphetamines seems like pseudoscience to me."

A pseudo science that very strongly runs in families.

A pseudo science that's strongly linked with dopamine transmission.

A pseudo science that has some medical evidence pointing to it being an under development of the frontal lobes.

I suggest you google the field a little.

okay well lets delve into the science here:

http://www.ncbi.nlm.nih.gov/pubmed/27489770 "Quantifying patterns of brain activity: Distinguishing unaffected siblings from participants with ADHD and healthy individuals."

http://www.ncbi.nlm.nih.gov/pubmed/27471442 "Neural Biomarkers for Dyslexia, ADHD, and ADD in the Auditory Cortex of Children."

http://www.ncbi.nlm.nih.gov/pubmed/27422412 "Network Structure among Brain Systems in Adult ADHD is Uniquely Modified by Stimulant Administration."

as you can see there is no ambiguity that ADHD is a biochemical and neural network-grounded disorder backed by a galaxy of studies. the sad fact is that stimulants don't work for up to 20% of people with ADHD, dooming them to dysfunction.

and yes, the pharmas are greedy, and promote overdiagnosis. and yes, modern life promotes ADHD-like symptoms-- but the whole point of ADHD is that it's a priori relative to life experience.

I think you are being a bit dismissive of what is a widely accepted mental disability[1][2][3][4][5]. If you want to spout some nonsense about how you feel about the field, that's fine, but note that you are falling into the same category of people that don't believe in climate change because winter was "pretty cold". It just so turns out that the world is not all about you, and while it may be difficult to understand that this may be a real issue for some people, you shouldn't say that this is a substance abuse problem. To say that is at the very least ignorant.

[1]: http://psycnet.apa.org/journals/bul/121/1/65/ [2]: http://www.sciencedirect.com/science/article/pii/S0890856709... [3]: http://www.mednet.org.uy/~spu/wp/WPA_2_2003.pdf#page=42 [4]: http://psycnet.apa.org/psycinfo/2000-00431-006 [5]: http://www.sciencedirect.com/science/article/pii/S0387760406...

This is FUD.

ADHD is well researched, and well understood by those who study it. The problem is that people think ADHD is just an issue of self discipline or attentiveness. It is not. It is a serious disorder with serious effects that are unambiguous. No doubt there are stimulant seeking people who claim to have ADHD to get stimulants, and people without ADHD representing that they have ADHD may lead to the impression that the disorder is ambiguous when it isn't. Also if someone has ADHD for long periods of time they may have co-mobidity with other disorders such as depression, etc. and this also may muddy perceptions.

ADHD is not strictly an attention issue. It's named for attention because that is an early and obvious symptom but it is much worse then that. Calling the disorder an attention deficit disorder has turned out to be very bad as it leads people to the wrong mental model of the disorder. Thinking that it's just laziness on the part of the patent or the patents parents, in the case of children. This is a tragically misguided perception, based in ignorance and the poor choice of names.

In actuality ADHD is a developmental disorder that is a more general impairment of executive function that includes regulation of emotion, working memory and the internal perception of time and other effects in addition to inattentiveness. This impairment is due to abnormal dopamine transport that can be clearly observed in MRI studies.

These studies have been repeated many times in many contexts, with various controls, and been thoroughly confirmed.

Also, you are wrong about Adderall. There is a significant difference between meth and Adderall. Stimulants are by for the best understood, most tested, longest used, and lowest risk medications in psychotherapy. Only a few stimulants show clinical improvement in the function of people with ADHD, and the improvement can be profound. Caffeine for example does not show these clinical improvements.

So basically you know jack shit about this topic, and therefore should keep quite, just like any other medical condition you know nothing about. It actually causes harm by interfering with the dissemination of reliable information in the study and treatment of a very serious disorder.

For better (read: actual) information start here:

Here: https://youtu.be/GR1IZJXc6d8

Or for a more complete talk:

Here: https://youtu.be/SCAGc-rkIfo

I am curious, are there activities that you're capable in without the need for medication?

It may or may not be work-related, like snowboarding or board games etc.

Since I've had the responsibility of managing the treatment of at least a thousand adults and adolescents with ADHD, it's a subject I've studied quite a bit. And as the medical literature attests ADHD is probably among the most researched of all medical conditions and its reality is unquestioned based on the scientific literature.

When people say "I don't believe in ADHD" I point out it's not like believing in Santa Claus, the reality isn't changed by our "belief". Might as well say "I don't believe in cancer", it's not going to make it disappear.

The fact is that ADHD has been shown to affect 4 to 5% of American adults and 5 to 8% of children. When the same diagnostic criteria are used, populations of other countries show comparable prevalence. This means it is a much more common disorder than usually considered.

The key issue in my estimation is the level of disability ADHD can produce in adults. Studies show devastating adverse outcomes in virtually all domains of functioning. People with ADHD fall far behind peers in educational achievement and employment, and far exceed peers in rate of divorce, motor vehicle accidents and injuries, greater rates of general health conditions and larger health care costs.

Furthermore, despite the availability and relatively low cost of effective treatments, among adults with ADHD only about 1/5 receive treatment. The total costs to the economy of untreated ADHD very likely is on the order of $100 billion annually in the US alone.

Bottom line is ADHD is a very common and disabling condition with a high cost burden to the individual, family and nation as a whole. We underestimate the impact of ADHD in all these domains at our peril.

If I could ask a question that may sound like a challenge but it is not meant as one:

How does ADHD lead to divorce, motor vehicle accidents and injuries, and greater rates of general health conditions?

Is this correlation still present after controlling for confounders like education and economic status?

The two biggest factors that I can come up with would be the lack of ability to control attention, and the inability to consider the long term repercussions of actions.

If you can't force yourself to keep attention on the road, you're going to crash. If you can't think about how that daily pint of ice cream will affect you beyond "it tastes good now", you're going to gain weight.

And when your eyes continuously glaze over when your wife is talking to you, it can lead to marriage difficulties.

Sorry, sweetie, what were you saying?

Heh, yeah. I've said that a few too many times. I'm just glad she understands.

Have you ever gotten distracted and started thinking about some random bullshit during sex, after only a few minites, despite being very attracted to and in love with your sexual partner? Imagine if that happened every time and how it would affect your relationship. What would your partner say? Now imagine it happened again while you and your partner were discussing the issue.

The marital issues most frequently revolve around the affected partner (if there is only one) acting in disorganized, ineffective, irresponsible ways in the view of the unaffected spouse or partner.

A frequent pattern is that the "normal" individual becomes demanding that the affected partner performs better, which arouses the affected person's opposition and irritation.

Ultimately they become constantly angry at one another. Episodic or constant "warfare" is corrosive to the relationship which ultimately can't sustain the stress, resulting in failure of the relationship.

This whole subject is challenging, believe I know! :)

The correlation is between diagnosis of ADHD and outcome parameter. IOW among adults with ADHD divorce rate is much higher, IIRC around 2 times the non-affected population rate.

The "causal" pathway is obviously complex, but bear in mind ADHD has a broad impact on functional domains, so an individual afflicted with ADHD will fail relationally, in education, employment, health and so on, one adversity compounding others.

For example, a married man loses his job because he can't get paperwork done, or keep schedules organized, which puts a strain on marriage due to financial stresses, eventually producing enough discord that the wife bails on the marriage.

The research on functional deficits has been going on a long time, and is well-vetted in peer reviewed journals. The confounds have been accounted for.

Part of the issue with adults getting treatment could be down to a combination of a belief that folks grow out of it and insurance - unless that has changed. My brother was diagnosed with ADHD as a child. The medication that worked for him wouldn't have been covered by insurance after he was 18, from what I understood. I don't know exactly why this was (I'm 11 years older, so missed some of the discussion), but if similar things are true there might be folks that simply cannot get their meds, if they know about them.

In general longitudinal studies demonstrate that hyperactive symptoms typically attenuate by early adulthood, but inattention is much more likely to persist. Reports vary somewhat, but around 1/2 of childhood cases remain diagnosable as adults, and a greater proportion, ~2/3 have persistent characteristic manifestations that adversely affect functioning.

Getting treatment as an adult has become much easier in the last 10 to 20 years. Those of us in the "front lines" have pushed the cause and now it's seldom a problem, except to the extent health care coverage is a problem in general, but that's another issue.

As a generic guess, if your brother still needed treatment when he was 18 or 19 years old, there's a chance he would have persistent functional difficulties, and if so, treatment could be useful. As always adequate assessment is necessary to know what's needed.

When people say "I don't believe in ADHD", they're not saying that the symptoms don't exist, they're just rejecting the premise that a large percentage of the population is disabled by it.

As someone diagnosed with ADHD and who occasionally takes Adderall for it, I certainly empathize with this viewpoint. I love the way my brain works both on and off medication. I feel like my ADHD gives me a creative swiftness that evades most people. However, there are indeed times when I need to buckle down and focus one aspect of something for an extended amount of time and that's where the Adderall comes in.

Like introversion or any other number of tendencies, I think of ADHD as a dimension of personality rather than a disability. Do I consider myself disabled by it? No. But I can certainly appreciate that our academic system disadvantages those with the condition to the point that it appears to be a disability.

And yes, I am aware that some people have ADHD to such an extent that they are functionally disabled by it. I just don't think it's everyone that is diagnosed.

It's funny that you compare ADHD to cancer. You can see a cancerous growth. You can feel it. There are tests for it.

Criteria for ADHD are completely symptom-based. There is no infecting agent, no parasite, no detectable chemical poisoning or imbalance, no irregular growth, nothing! There is no standardized physiological test. You just observe how a person behaves and then say they have ADHD - a disease whose criteria humans defined completely arbitrarily. What qualifies as a mental health disorder says a lot about a society. Call me an ADHD-denier but I remain skeptical. I think ADHD is mostly an issue of searching the problem within the brain when it's everywhere in our society except the brain.

Is not the problem misdiagnoses? There are a lot of conditions that mimic ADHD, I think the problem is that a lot of diagnosis are not thorough enough.

I went to a top tier school. Lot's of people would pop ADHD medication, received from friends, to cram before exams.

I've heard from doctors that it's not supposed to work like that, but here we are, friends are still taking it to get an edge.

Also it seems kind of prevalent in Wall Street. It does seem like a lot of people benefit from it, but I think a lot of people think: would I be working in Wall Street if I where doping? I think that's the crux, we are all competing for the highest salary/status in either small or big ways. I'm not saying it's wrong. Might be good for humanity that everyone that shows any effect starts to take it. It's the insecurity of not knowing if we should take it that makes people become frustrated at the doctors and patients. I don't think anything can really be done about it as long as we are competing. The next question would be: If this doesn't work, what medication will work to make me better than the best? Almost everyone says than we shouldn't care about that, but their actions speaks louder than their words, how many do you know that moves away from big cities for example? No one. Have a nice watch? Brags about working a lot?

I'm generally not fond of this sort of article and this one is no exception. They present a case that drug companies like selling drugs but we knew that. What they don't do is present a good case that ADHD is actually overdiagnosed. The world in general is not very good at accepting psychological conditions. ADHD is commonly regarded as "youth", "laziness", or "lacking discipline". Watching a loved one fight to focus continually is just heartbreaking. We still have quite a number of cases where people are stuck fumbling without help.

This is a book review, not an article per se. I'd assume the book goes into much more detail.

Also, from the review:

> Schwarz has no doubt that A.D.H.D. is a valid clinical entity that causes real suffering and deserves real treatment, as he makes clear in the first two sentences of the book: “Attention deficit hyperactivity is real. Don’t let anyone tell you otherwise.” But he believes that those who are disabled by the condition deserve a wider range of treatment options than an endless litany of stimulants with chirpy names like Vyvanse and Concerta.

But what does "real" mean, exactly? That it's a recognizable pattern of behavior? That doesn't necessarily mean it should be treated as a disease.

Why not? People are suffering and we have safe medications which improve their lives.

Not treating ADHD is far more dangerous. People with unmedicated ADHD are more likely to do poorly in school, abuse drugs/alcohol, suffer from depression etc.

I'm sure some people's school grades benefit from taking amphetamine-like drugs, but that still doesn't imply they are suffering from a disease in the first place.

It's far from clear why having the symptoms of ADHD should be considered a disease, in any objective sense. If kids are suffering because school is boring or society is restrictive, that doesn't mean there's something wrong with them.

>It's far from clear why having the symptoms of ADHD should be considered a disease, in any objective sense.

We have children facing social rejection, failing/dropping out of school, becoming dependent on drugs, suffering from depression/anxiety and other mental illnesses, committing suicide, etc.

In a perfect world we don't have to change our lives to fit into society at all! Unfortunately, the world isn't perfect. We have an obesity epidemic because people sit in an office working all day. One treatment I'm sure you'll approve of is going to the gym. Unfortunately gyms are pretty unnatural.

Why should obesity be considered a disease in any objective sense? People are suffering because modern life is sedentary. It doesn't mean there's something wrong with them.

—We change our behaviors to make up for the personal problems that come with society. We do unnatural things like go to gyms and take medication to help our bodies (which were made for a world where we live in caves and hunt wild animals) function properly in this society, because we agree its advantages vastly outweigh its disadvantages.

This analogy doesn't really work, because obesity is caused by living a modern sedentary lifestyle, whereas I'm suggesting ADHD is what we're labeling kids with for not living, or rebelling against, that sedentary lifestyle.

Obesity is a disease in an objective sense because it directly causes ill health. There's lots of studies to show that. The symptoms of what we call ADHD seem to simply be caused by unhappiness and boredom with the way we live today. We're demanding kids do something that makes them unhappy, and any reaction to it, is labeled a disease.

> take medication to help our bodies [...] function properly in this society, because we agree its advantages vastly outweigh its disadvantages.

This seems like a problematic kind of statement, because the implication is that people who don't fit into society should somehow be coercively medicated. What about their rights and bodily autonomy?

It's a perfectly fine analogy. They're both problems which are problems because of our society.

You're suggesting physical illness is more "real" than mental illness.

>We're demanding kids do something that makes them unhappy, and any reaction to it, is labeled a disease.

It's far more than kids not being able to pay attention in class. ADHD affects many aspects of a person's life—and adults too. Living independently with unmedicated ADHD can be incredibly difficult. Everything from social life, working, to driving, is harder/riskier.

The argument against treating ADHD is based on unfounded fears of psychiatry and medication. "What if this, what if that". Well this and that isn't happening, peoples lives are being improved, and people are suffering because of dangerous FUD like this.

> It's a perfectly fine analogy. They're both problems which are problems because of our society.

One is a disease caused by conforming with our sedentary society. The other is what we label those who refuse to go along with our expectations for school, work and conformity. Really, they are more like opposites of one another.

> You're suggesting physical illness is more "real" than mental illness.

That's right. It's pretty hard to rigorously define a mental illness outside of the context of a given society. Mental illnesses are not real in the same sense that, say, a broken leg is real. They are socially determined. Other societies outside the West don't have the same kind of mental illnesses we do.

> ADHD affects many aspects of a person's life—and adults too. Living independently with unmedicated ADHD can be incredibly difficult. Everything from social life, working, to driving, is harder/riskier.

Being ugly makes life hard, too. Does that mean being ugly is a disease? Should all of us ugly people get plastic surgery to treat our disease, as a matter of course?

Ultimately, none of this shows ADHD is an objective disease. In the anthropological view of mental illness, it is a disease - because our society claims that it is, and for no other reason. Psychiatrists are not that much different from witch doctors. (https://news.google.com/newspapers?nid=1755&dat=19710325&id=...)

I seem to find myself recommending Gatto's The Underground History of American Education on a reasonably regular basis, and indeed here I am doing it again. The Internet Archive has it in various formats at https://archive.org/details/TheUndergroundHistoryOfAmericanE.... While its conclusions are far from incontrovertible, the author does a good job of sourcing and supporting his argument, and I think you might find it worth your while.

I have no diagnosis of ADD/ADHD. I have recently, however, started to wonder. I'm an adult (39), and recently things that have just always been true for me are getting more rigid and interfering with my life. Things like: I need an exact amount of input: too little and I get bored/distracted, too much and I can't focus and get irritable. This has a huge impact on my ability to do work, to socialize with friends, or even have a serious conversation.

If someone could give me a pill to "fix" this, that sounds awesome. Now, real medication means balancing the side-effects, etc, so even if I were to get a diagnosis I'd have to do a lot of research and consideration. But I think outright saying "No, people should suffer without consideration" is not an full answer.

(And I'm allowing that I may be having completely different issues - getting a proper diagnosis/understanding is an important things that's not part of the above debate)

Shorn of all pretense you're essentially wondering if you'd benefit from or enjoy taking drugs. This is quite possible. People take drugs for all kinds of reasons. What I object to is calling this a disease.

Let's take that back a step.

If we're talking about "disease" in the sense of "a condition that interferes too much with normal life absent some intervention" and not "caused by bacteria or viruses", then we already have a bunch of subjective terms in there. And I don't think you can get a reasonable definition that DOESN'T have some subjective terms.

Given that we're talking subjective terms, you're stating something like "If you have a condition that makes you suffer more than most others in certain circumstances, and this condition can be treated with pharmaceuticals, I'm fine with that, but I don't want to call that condition a 'disease'." Others might say "drugs can make your life easier, but I don't believe that you actually suffer more than others in those circumstances, you just don't handle that suffering as well". With current technology we have no means to distinguish the two.

And I almost certainly agree with your statement regarding certain circumstances. There are people that have medical conditions that make them overweight - likely including some conditions we've not identified yet. There are also people (such as myself) that just value eating over losing weight. I know of no way to know which is which for most cases, but for situations such as mine I'd not call it a condition or a disease, I'd call it overeating. All of which is to say I think I know where you are coming from.

But I lack the basis to say when other people are suffering more than I do under the same stimuli. I have no way to know if something is a disease/condition unless I've experienced it. Any more than I know if Bill Cosby raped anyone, or if the convicted murderers sentenced this year actually killed anyone.

So I extend some trust in the collective people (while at the same time thinking some large collections of people are idiots, say, politically).

Honest, non-trolling question: On what basis do you have your confidence that this is not a disease/condition?

Whats a "disease" and whats not is not easy to define. If we could look at the living brain at a microscopic level, comparing individual dopamine receptors and the connectome of individual brains, it would be quite easy to give objective evidence for most mental diseases. But we can't. But we can see viruses and tumors and that leads to your idea that those are more "real" because it's more easy to see them. But is "visibility" really a valid criteria here?

For example look at a disease like fibromyalgia: For a very long time there was no objective evidence that this disease really existed, so people suffering from it where often seen as hypochondriacs. Today we know it's really a disease because modern medicine found ways to make it "visible" so it's accepted as a real disease now. But with your way of thinking you would've denied those people analgesics because a few years ago there was no objective way to tell if they really suffered the pain they reported.

OTOH depression is still an "invisible" disease: You can only look at the symptoms to diagnose it, there is no "objective" evidence for it. But still there are lots of people suffering and dying from it. And we know from lots of studies that it's possible to cure or at least manage this disease for a certain percentage of sufferers. So I would consider it unethical to let people suffer or even kill them self only because we can't see objective biological evidence that they have depression.

Now with ADHD it's not as clear as with depression because the symptoms aren't that severe. So you argue that it's just the society which wants "conforming" individuals and declares non-conforming ones as "ill". But if people are really disabled by something which prevents them doing certain things they want to do which the majority (> 90%) of people can do, while medication exists which let them do it, is it really ethical to not give them the medication? Those people are objectively suffering and there exists lots of evidence that their suffering can be reduced be giving them a certain medication. So it's unethically to let them suffer even if there exits a way to stop their suffering.

And yes, if there would be a medication which could lift the IQ of person with low IQ into the average range, I would also consider it unethically to not give this medication to people with low IQ. But such a medication don't exists today.

We simply don't know what the impact is of administering powerful amphetamines to children upon their development. Is there a population of children that would "age out" of the ADHD spectrum and develop coping mechanisms, if they were not given pills that prevent that? In such a case, the medication is actually hampering their development.

We have 80 years of data from giving children low doses of stimulants.

>In such a case, the medication is actually hampering their development.

Again, the actual data say otherwise. Medication tends to help children develop proper coping mechanisms. Not medicating is more likely to result in social rejection, drug abuse, depression, dropping out of school, and so on.

Most of this anti-medication sentiment is unscientific unfounded FUD.

You're conflating "not medicating" with "not treating", which is exactly the sort of thing that feeds the criticism that U.S. overdiagnosis rates are being driven by the pharmaceutical industry. Behavioral therapy is also effective, and avoids some of the negative impacts of medication. There are studies that compare medicated ADHD patients to untreated ADHD patients over the course of adolescence; but people who are skeptical over the over-prescription of ADHD drugs aren't actually advocating for non-treatment and non-intervention. Almost no one doubts that ADHD is a real problem for some children that requires medication. The question really is about the extent of overdiagnosis in the US, and the long-term use of medication for children, especially very young children. Stimulant drugs are not recommended for children under 6, and yet still something like 1% of US children under 6 are taking them. Both ADHD diagnoses and pharmaceutical treatment is far, far more prevalent in the US than other developed countries, and it is certainly a good question as to why. Parents naturally have a lot of anxiety about their children's schooling, and the marketing of ADHD plays upon and exacerbates that anxiety (to the extent that if you mention any hiccups in your child's adjustment to school, people immediately begin talking about ADHD). It is also true that kindergarten is the new first grade in terms of literacy expectations, which means more long, boring desk work for young children who are frequently seeing their exercise time reduced or eliminated. Those are problems also.

To which I'd add, the fact 'ADHD' symptoms are stereotypically behaviors of male children. I don't think it might be a total coincidence that we have a trend of drugged-up little boys for behavior deemed unacceptable, at the same time childrens' education is dominated by women.

Children's education has always been dominated by women. I think the problem is more that young children are suddenly being held to a standardized curriculum in which they are expected to learn to read in kindergarten (instead of 1st grade) while their recess time is curtailed or cut entirely. Then when the boys or the youngest quartile of 5-year-olds have trouble sitting still or focusing on desk work, it becomes pathologized.

Boys are more often diagnosed with ADHD (by a factor of 2 to 3) but that probably because boys simply have a higher base aggression level which is "added" to the ADHD symptoms which makes ADHD in boys easier noticeable than in girls. So girls are probably underdiagnosed because nobody notices their attention deficit symptoms and their hyperactivity is still not annoying enough to send them to a counselor.

Ugh. I hate this. My son has ADHD, and the public school just couldn't cope with him. He was bored so often, and had no release for his energy because they rarely gave them recess (it got taken away if the class was too noisy, because teachers are idiots). When he was diagnosed, we made the difficult decision to give him medication. It made a big difference to his behaviour in school, to the extent that if he ever forgot to take it, the teacher would call me and have me take it in for him.

Now we're coming to the end of the summer, more than two months where he hasn't taken his medication, and he's been completely within the limits of what we can cope with. But I guess we're not trying to control 30 of them. He's starting at a private (Waldorf) school in a couple of weeks.

Ironically, we can now barely afford it after I just got fired from my job as a software engineer, because my own problems with ADHD were hindering my ability to work quickly.

Now I have to decide whether to start him at his new school with or without his medication. I mean, did it really help him, or was it just helping his teacher? Should I let him be himself, or am I doing him a disservice by not giving it to him? He needs to do well in this school, and students there start with a month-long probationary period.

It's a really tough call.

You can make that argument for most if not all mental disorders (cf. Erving Goffman). The fact is that persons with ADHD face significant difficulties functioning in modern society and suffer as a result, which is our best criteria for treating a mental issue as a disease.

Like I said elsewhere - does that mean that being ugly/unattractive is a disease? Or having an awkward personality, or having a low IQ? Or for that matter, being a member of any discriminated-against minority?

It seems unjust and coercive to tell people they have a disease and should be medicated simply because society demands it.

Those certainly could result in some mental disorder. An awkward personality and to some degree low IQ could be symptomatic of a mental disorder as well. It's definatly possible to make a convincing case that all mental illness is a manufactured construct [1]. But I don't think you can reasonably say ADHD is not a disease and still believe, say, depression or anxiety disorders are diseases.

[1]https://en.wikipedia.org/wiki/The_Myth_of_Mental_Illness

Interesting link, thank you.

Before we talk about forcing people to go on drugs they don't want, let's get to a place where society lets everyone who could benefit from treatment at least have the option of receiving it.

The problem with this is that offering people the treatment can create the disease, in some sense.

So don't call it a disease. Call it a Snuffleupagus. Just don't stop treating patients affected by this particular Snuffleupagus because it doesn't meet your definition of a "disease".

We aren't morally obliged to treat people for things that aren't diseases.

You aren't morally obligated to do anything, you can go live in a hut in the plains of Montana if you want. But people with ADHD who seek treatment appreciate the efforts of the medical professionals who help them.

The fact it's about a book rather than a scientific article makes me suspicious. Finding people who are untreated and struggling is common. So what's the point of it being a book? Other than cashing in on the "it's all in your head" sentiment? Claiming it's real in a small aside just seems like ass covering.

Yep. Dealt with this my entire life. Teachers, doctors, and counselors suggested I see someone regarding a possible ADD diagnosis all through school as my supposed "brilliance" (their words, not mine) came along with a seemingly unbeatable tendency to zone out in class, constantly talk to other kids when I knew I was supposed to be listening, and flat out forget to do major assignments while I just sort of daydreamed or got sidetracked the moment something else came along.

But my father didn't believe in ADD or at least thought it was overdiagnosed. By god, when he was a kid, there was a name for my behavior and it was lazy, careless, or just plain selfish. So all of those recommendations were ignored.

It took me dropping out of college, going off to work in dead-end, unrewarding and un-challenging jobs while avoiding contact with my folks out of a mixture of shame, resentment, and anger to finally motivate me to see a counselor who eventually referred me to a psychiatrist.

Got put on a mild dosage of stimulant medications, got myself about $15k in loans to enroll at another state university, finished my degree with no lower than a B in any class, and finally got myself into something of a career path. It's been weird because I always felt like I'm 10-15 years behind where I should be but then I remind myself that there is no "should" and I'm thankful that I've improved my quality of life.

Medication (and stimulant medication) isn't a panacea and there are obviously tradeoffs but I think that for a very real subset of people, the avoidance of it out of some misplaced ideas of pill-pushers or lack of "grit" is a real shame that causes some very real problems.

Thanks for sharing your experience.

I'm curious (after reading the book review): when you saw the psychiatrist, was the medication the only treatment? Or was it combined with other (non-medicinal) treatments as well?

And these kinds of experiences are why ADD deniers fill a lot of us with rage. Their willful ignorance is hugely destructive and damaging to the people they're able to influence.

The point about changing the kid instead of the environment is an important one. If attention deficit is defined as a kid having trouble coping with the standard 7-hour school day (more like 9-10 including homework) where he is expected to sit still and work on boring and non-essential worksheets, then the condition isn't over diagnosed at all.

And if we're not willing to change that environment--and I don't think we are--then we should medicate the kids so at least the experience is tolerable and they can have some success with it. Given that artificial stimulation to cope with the modern workforce is universal (espresso shots, liters of coffee, energy drinks), they might as well start getting used to it.

> And if we're not willing to change that environment--and I don't think we are--then we should medicate the kids so at least the experience is tolerable and they can have some success with it

And as a result traditional response has been amphetamine-salts for children as you say. But I completely disagree that this is something we should do.

For one I think we don't have good enough science to know how potentially dangerous or helpful ADHD drugs really are. Is it going to help them adjust later, or will it be harder? Are they going to be dependent on amphetamines their whole life? Evaluation of drugs which are primarily targeted at emotional and behavioral problems is difficult enough in neutral conditions, since it is hard to control/evaluate/quantify results. Yet the conditions we are dealing with are totally not-neutral.

Basically big pharmaceutical companies fund lots of research - if the research doesn't support their product they can shelve it and fund some other studies until they have research which does. It's an awful field with too much money and lots of dishonest science.

Secondly, using medications to treat ADHD (because that makes money for their producers) is as you pointed out making us avoid the cultural / environmental problems which cause this issue. But I disagree that this is inherently from the 7-hour school day as you point out. Kids went to school for 7-hours 50 years ago as well, but ADHD diagnosis and medication use has been constantly increasing. [0]

A large factor to this is the increasing amount of stimulation that kids today are actively exposed to that they weren't in the past (I can't remember references of the top of my head, I'll try and find one though). Basically if you grow-up with 4-6 hours of TV or video games per day, yeah it's hard to sit down and read a book. Obvious right? And your recommendation is really to give amphetamines to 7-year olds? Rather than limit consumption of mediums that are inappropriately over-stimulating for large durations?

[0] http://images.slideplayer.com/18/5690061/slides/slide_2.jpg

> traditional response has been amphetamine-salts

Not exclusively. Methylphenidate (Ritalin and friends) is generally the first-line drug in the US at least, due to milder side effects and a lower potential for abuse.

Always found this odd because at least for me, methylphenidate (and its surprise result of mixing with alcohol, ethylphenidate) made me feel more of a "buzz" or desire to take more compared to the typical amp-salts.

I actually had my doc switch me over because I don't like the idea of any more side effects or anything that might lead me to abuse than absolutely necessary.

I guess a lot is down to individual neurochemistry but I felt that mpd was almost like cocaine whereas the generic Adderall I'm on now just makes me able to focus.

> Kids went to school for 7-hours 50 years ago as well, but ADHD diagnosis have been constantly increasing.

There was much less emphasis on doing well in school back then. Most people didn't go to college and didn't need to get the grades necessary to do so. They could have a solid middle class life without even a high school diploma. Not being "cut out for college" wasn't the end of the world.

>we don't have good enough science to know how potentially dangerous or helpful ADHD drugs really are.

We have nearly a century of usage which suggests these drugs are incredibly safe.

We medicate a lot of problems which are caused/worsened by society. We need a solution: Either we fundamentally restructure society, or we medicate.

Since we're not fundamentally restructuring society any time soon, medication is our best option and we have a lot of data suggesting stimulant medications in these doses are pretty damn safe—and certainly outweigh the negatives of not medicating (failing school, abusing drugs, other mental illness).

The real epidemic here is the pejorative use of the word "medication". The distrust of treatment is always based on ignorance and appeals to nature, tradition, etc.

> We have nearly a century of usage which suggests these drugs are incredibly safe.

Non-industry funded long term study (30+ years) citation needed.

> We medicate a lot of problems which are caused/worsened by society. We need a solution: Either we fundamentally restructure society, or we medicate.

I think this is a false dichotomy, not backed by any credible research and is a clever way for the pharmacy industry to sell drugs instead of society expending effort on alternative solutions.

edit (To clarify): Specifically you are jumping from "lot of problems which are caused/worsened by society" to a polarized choice of "medicate" or "fundamentally restructure society". But it should be clear that there is a whole field of available approaches which aren't "fundamental restructuring" which can attempt to alleviate such problems and unless research has enumerated and depleted all other available gradual options, this again, is a bogus dichotomy.

We have real data which heavily backs the case for medicating.

You have emotion and conjecture.

>Non-industry funded long term study (30+ years) citation needed.

What do you want? You're suggesting all these studies are funded by pharma cos and the scientists are falsifying data?

If you're not going to believe any of the data and stick to your own emotions on the subject there's no point discussing this.

Until you have anything besides personal feelings and unfounded beliefs we should obviously stick to what we're doing. Anything else is dangerous and unscientific.

> We have real data which heavily backs the case for medicating.

> You have emotion and conjecture.

No, I asked for you to provide a reference to a credible study, you have failed to do so. There is no need or place for ad-hominem attacks here. Who is 'we' btw?

> You're suggesting all these studies are funded by pharma cos and the scientists are falsifying data?

What I wrote explicitly was:

>>> if the research doesn't support their product they can shelve it and fund some other studies until they have research which does.

Are you claiming this is not true? Or that this does not happen?

On a side-note: standards in psychology research are much lower than in hard sciences, so the conflict of interest is exacerbated.

> Until you have anything besides personal feelings and unfounded beliefs we should obviously stick to what we're doing. Anything else is dangerous and unscientific.

Per chance, despite the immature nature of your tone - you are actually a researcher who has worked on many studies supporting what you claimed above and your research has been funded by pharmaceutical companies.

Has really not a single study with a source of funding which is not pharmaceutical company been able to replicate your results? I would consider that deeply suspicious in any field; and on the contrary to argue that it's not, is dangerous and unscientific.

Of course it has.

http://www.europeanneuropsychopharmacology.com/article/S0924...

One thing that has definitely changed is the level of academic expectations for young kids. Working with educators, it's apparent how much expectations have changed even in the last 10-15 years.

Things that children were once expected to know in 1st grade are now expectations of children in kindergarten or even pre-kindergarten. Kindergarten is the new 1st grade, in terms of reading, and that means children have to spend more time sitting and copying letters and words.

In kindergarten, some children will be a year older than other children, and a year is a massive amount of time, developmentally speaking, when you're talking about 5-year-olds.

The biggest risk factors for an ADHD diagnosis are being in the youngest quartile of your grade and being male. Neither of those are actual medical problems.

> One thing that has definitely changed is the level of academic expectations for young kids. Working with educators, it's apparent how much expectations have changed even in the last 10-15 years.

Really, I think this needs a reference/citation?

We didn't read a classic English book until 7th or 8th grade when I was in school. In contrast to say my parents education in Russia where they read Pushkin in ~2nd grade. Math education was several years behind what they were taught as well.

Pushkin wrote quite a lot of child books, easily accessible for 2nd grade. It's not like Tolstoi or Dostoyevsky (those had to wait until grade 10).

There are also great children's authors in English - A.A. Milne, Oscar Wilde's stories, Mark Twain, Kipling, Baum (Wizard of Oz). All of these could be accessible at various stages within grades 2-5.

Yes, of course. I just wanted to explain that reading Pushkin at 2nd grade is not as impressive as it might sound in English. :)

Yes, the effect is very dramatic over the last 10-20 years, but I suspect it's been hard to document. It's clear in terms of some expectations: a generation ago, it was expected that children would learn the alphabet in kindergarten, but today children are expected to enter kindergarten knowing the alphabet. So many kindergarten classes spend a few weeks reviewing the alphabet before rushing into words, leaving behind some children that didn't get pre-school before the age of 5.

http://www.npr.org/sections/ed/2016/01/08/462279629/why-kind... "In 2010, prekindergarten prep was expected. One-third more teachers believed that students should know the alphabet and how to hold a pencil before beginning kindergarten. Everyone should read. In 1998, 31 percent of teachers believed their students should learn to read during the kindergarten year. That figure jumped to 80 percent by 2010."

http://blogs.edweek.org/edweek/inside-school-research/2014/0... ".The percentage of teachers who reported their students never received physical education more than tripled, from 14 percent to 45 percent"

https://www.bostonglobe.com/ideas/2015/06/13/common-core-kil... '“When we require specific skills to be learned by every child at the same time, that misses a basic idea in early childhood education,” she says, “which is that there’s a wide range to learning everything in the early years.”'

Meanwhile in Scandinavia children don't even begin formal education until they're 7.

Some children don't just have trouble with sitting at a desk at a 7-hour school day. When your imagine children with ADD/ADHD that's probably what you think because it makes sense that inattention or hyperactivity is most correlated with the times where that would be most detrimental. But most of these children have just as much trouble with a whole day of regular indoor/outdoor play too.

Edit: As a parent of special needs child who recently started non-stimulant ADD medication to great success -- I really wish my reply wasn't downvoted. The amount of misinformation in this topic is staggering and frankly a little depressing. I think I'd go crazy arguing against every post talking about boring school work so I'm not going to do that. Many problems are far deeper than this straw man.

From my sample size of one, myself, I was diagnosed with ADHD quite young, as well as tourettes and OCD to add into the mix. I had no problem focusing on school work when it was interesting.

Then again, when is school work ever interesting? I suffered from chronic boredom. It didn't end well for me though. I was rebellious and refused to listen. I'd like to think my obedience issues were worse than my hyperactivity issues.

This comment made me think of Aaron Schwartz's article on schools just being instruments of corporations preparing us to be drones in eight hour jobs. [1]

I don't know where I stand on it, but I found myself realizing I believe it a little more when I read your article of preparing kids to work for 9-10 hours and keep focused.

[1] https://newrepublic.com/article/127317/school

This book also deals with similar themes.

https://en.m.wikipedia.org/wiki/Lies_My_Teacher_Told_Me

It's no coincidence that young males are more likely to exhibit ADHD symptoms. My school attempted to convince my parents several times that I needed medication because I disrupted the class.

While I am not proud of my prior misbehavior, I'm thankful that my parents had enough medical knowledge to refuse to put me on pills.

There are many who genuinely suffer from ADHD and their parents did not allow them medication due to ignorance. And they have the exact opposite story to tell.

It's a tale of ignorance all around. Overzealous diagnosis leads to problems which leads to mistrust. People who get misdiagnosed suffer, and those who are properly diagnosed, but assumed to be misdiagnosed also suffer.

Exactly. My parents shied away from looking into ADD/ADHD treatment for me because of the blowback about overdiagnosing, instead ascribing to the more regressive and I daresay petulant "kids will be kids" outlook of my behavior and educational issues growing up. I didn't last one semester at college, and my life was a mess for close to my first ten years of adulthood, at which point I finally overcame the "this is just the way you are" mindset and sought treatment. Started on medication and my life turned around overnight.

So while it's certainly important to keep an eye on pharma, it's also wildly irresponsible, unfair, and unscientific to claim "it's mostly made-up because I don't like the implication that a lot of people have a mental problem". Particularly disgusting is including the anecdote about the person who faked ADHD symptoms to get stimulants, then killed himself when his supply was cut off: prescription drug abuse/addiction is a serious issue, but one that is completely separate from the proper diagnosis of a medical condition.

There's rightfully been a backlash against the "better living through chemistry" postwar mindset that every problem should be medicated. But I think in this case it's ultimately less about medicating and more about fear of and unwillingness to address mental issues.

I am kind of disappointed with the people reporting that they have been "suffering" with adhd or add. I was prescribed add/adhd medication from 5th grade until 12th. It wasnt until I started practicing yoga was I able to make myself focus.

I had always, my entire life, HATED taking "my medicine". It changed me, it made me just like everyone else. Now that I am in my later 20's I take pride in the fact that I am "ADD". It is disappointing that people with this gift listen to society and somehow think they are not normal. Take some time and read about benefits of having add/adhd, it will surely put you in a better state of mind.

I will say there are edgecases of people that truly have issues, but I beleive your average add/adhd patient could do without it.

Another thought. We are bashing these kids that have problems conforming to or being a part of our schooling standards. Why do they have to conform, why are more schools not conforming to the add/adhd children? Why must we have to change our natural state of mind? It doesn't make sense to me that we have to take drugs and alter the natural way we were made because we are outspoken in class, or dont want to listen to a teacher lecture.

Rant is over.

I've always been skeptical of ADHD diagnoses, thinking that it was widely over-diagnosed and a problem in American culture more than anything, and not as commonplace in reality. My googling took me to this article which suggests I am wrong:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525089/

One thing that has troubled me as a self-taught "dietician" (re: for fitness, using PEDs effectively, etc) is wondering how much the pronouncement of ADHD might correlate with dietary and lifestyle habit changes over the past couple generations. Basically, I have a hunch regarding general population and dietary overlap.

I was a "hyper" kid for a lot of my formative years, and didn't undergo medication for it, but wonder if it'd been even more pronounced with not quite as strict of a household regimen (I was fortunate in this regard - pretty routine home-cooking, balanced diet, occasional sugar treats but not a staple). A 2012 article I just quickly dredged up seems to note there's interest and some control studies possible for recommendations that don't deny the utility of medication, but seem to look for dietary conditions worth evaluation[1].

[1] http://www.oregonholisticcounseling.com/uploads/Kids_Nutriti...

When I was a kid (6-12~) I had to take Ritalin everyday—sometimes during school the teacher had to give it to me (this was in South America were casually asking a teacher to give me meds was ok). When we suddenly moved to the US and I started middle school here I stopped taking it.

I've always suspected I was and am still "hyper", because I have trouble focusing and always have to fidget or walk around the office. I just don't get up and run around like I did when I was 7. Even then, without meds, I managed to do pretty great in school and college, as well as my programming career. I've always wondered how much different I would've been had I taken ADHD/"focus" meds.

Same, I had lots and lots of outdoor activities (unstructured) mostly revolving around riding my bicycle. I'm sure I got lots of energy out that way. I rode to and from elementary school, and would ride after school, then also was an active swimmer. Not sure some of those are everyday options for young people (generally speaking in urban/sprawl suburban/helicopter parenting places). Mostly I think my home discipline helped me 'focus' on doing school and those things, to allow things to get channeled...like picking up guitar seriously at 14.

Not going to get good at guitar without focusing and practicing, if I'm honest. So, in a time when I would've been out riding my bike, I was concentrating on the instrument and tiring out my brain daily I think. Well, and the whole "don't do well in school don't get to play guitar" thing hanging over my head (for the best).

I kind of think I'd be, well, maybe a less creative person today because I like to let my mind wander. A person recently asked "How do you remember so much erratic & tangential information so fast?" and my only reply was thinking my brain is like a giant orb-spider-web-thingy that can fire stuff all around really fast and bring it back. I like to think my wandering mind made the most of spending time in the local library as a kid too - pick up book, read for a while, get another one, etc.

I had a similar experience where my 3rd grade teacher was pretty much solely responsible for getting me medicated. I took Adderall every day from 3rd grade to about Sophomore year of high school, when I convinced my parents that I was capable of managing myself without it. At the time, I detested it because it subdued my extroverted nature, for instance, I would read books at recess instead of playing kickball or talking with friends. After graduating undergrad just fine and landing a software engineering gig, I looked the medication again, and it's a lot more helpful than I remember giving it credit for. My personal hypothesis is that the dose I had as a kid was a bit too strong, but the one insight I gained from taking it after being off of it for so long is that I don't absolutely need it to function, but it sure makes things a hell of a lot easier for me.

Obviously, this is just anecdotal, but my experience seemed similar enough to yours that I thought I might share a hypothetical answer to your question.

The issue is how much regular behaviour is being targeted as something that requires medication

I'm far from an expert on this, but I've always thought that the symptoms (inattention and/or impulsivity and hyperactivity) are only maladaptive in modern culture, where young people are expected to spend long hours sitting quietly at attention in school.

Is that a disease, or a flaw in modern culture?

The article addresses this issues: One clinician quoted in the book more or less admits defeat: “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

The article briefly mentions the issue then moves on.

But is it true that "it’s too expensive to modify the kid’s environment" or simply that established powers make more money by "modifying the kid"?

In a way, those can both be true simultaneously. Just from the assumptions that the "established powers" make more money by modifying the kid implies that even if modifying the kid's environment cost $0, it would "cost" them lost profits of modifying the kid.

Costs are relative, and I think the point remains that the kid's parents are relatively powerless to alter the kid's environment significantly enough to solve the adhd problem. Thus, the decision of the cost/benefit analysis of modifying the environment vs modifying the kid falls to the "established powers", also known as, collective society.

By "established powers" I meant the people with enough political power to influence educational and medical policy.

As long as everyone with significant influence is comfortable with the status quo, there's little pressure to search for other options, even if many parents might prefer another option.

It would be interesting to know if length of school day correlates with diagnosis rate (controlling for confounding covariates), or if, e.g., Montessori schools have fewer diagnoses than public schools (again controlling for confounding covariates like family income, etc.).

Controlling for confounding factors in a study like this would be very close to impossible. Income is one factor, but parental involvement, household stability, discipline methods (I don't have data to support this, but I have a feeling that the average discipline methods differ greatly between Montessori kids and public school kids), and many others come into play. It'd be interesting if someone could pull it off, but this would be an unbelievably difficult study.

Another way to approach that might be to see (for example) if students from public school diagnosed with ADHD do better in a Montessori school.

> I've always thought that the symptoms (inattention and/or impulsivity and hyperactivity) are only maladaptive in modern culture

If you read through any edition of the DSM, you'll find that most disorders in it are defined by symptoms being maladaptive in the subject's current actual environment, not by objective, context-independent criteria.

From the point of view of someone with those behaviour/mental patterns, is it easier to treat them as a disease, or restructure society?

I've got moderate-severe ADHD and I can tell you no amount of societal re-structuring could help me nearly as much as medication. You got the base symptoms down (though I don't have the hyperactive component) but you're missing the nature of the inattention. If something interests me, I can dive into it really deep because my attention is focused like a laser beam. But having that happen is rare and fickle, most of the time (off medication) I can't focus on anything, even things I like. It's a horrible experience, wanting to read a book about science but you can't so you just watch some TV and feel bad about yourself.

These are very old studies. It is now known that ADHD is a genetic disorder. In fact it has unusually high correlation. It is absolutely not caused by environmental factors. Though there is one virus (that I'm aware of) that may cause it.

It is not only an issue of attentiveness, but ranter all executive functions. The poor naming of the disorder, and the observability of a persons focus, causes people to over emphasize the inattentiveness symptom.

If you are interested in understanding the reality of ADHD I'd suggest watching some of the talks by Dr. Russel Barkely.

Here: https://youtu.be/GR1IZJXc6d8

For a more complete talk:

Here: https://youtu.be/SCAGc-rkIfo

Why single out ADHD? What about over-diagnosis of depression and other mental illness? This kind of nonsense is fodder for those who believe ADHD and other disorders aren't a serious problem. What's the solution to overprescription which doesn't deny safe, life-changing drugs to those who need it?

"People deserve a wide range of treatment options"? Insightful. There is a wide range of options, but stimulant medications are significantly more effective than anything else.

If faking symptoms for drugs is the concern here... why? How much effort should we really put into weeding out fakers at the expense of those in need? Stimulant medications used properly are incredibly safe and improve attention/focus in healthy people. Maybe it's time certain people stop forcing their outdated moral ideals on the rest of us.

While I do think that ADHD is a real condition, I don't think that the solution is to medicate children with a very serious life changing drug that alters the core aspects of a child's personality and behavior.

The true solution is to revamp our country's education system and provide a framework that can accommodate the wide variety of personalities that come into the classroom. Instead of forcing children to think one way, we should let them think the way they NATURALLY think, and flourish with their native mindset.

I strongly recommend this eye-opening video for those of you who haven't already seen it: https://www.youtube.com/watch?v=zDZFcDGpL4U

"I don't think that the solution is to medicate children with a very serious life changing drug that alters the core aspects of a child's personality and behavior. ... Instead of forcing children to think one way, we should let them think the way they NATURALLY think, and flourish with their native mindset."

This is wildly inaccurate and ignorant, and basically perfectly sums up why the problem isn't being treated effectively.

1) The drugs aren't serious and life changing and they don't alter core aspects of your personality. People seem to confuse the effects of mild stimulants like ritalin and adderall with the effects of powerful antidepressants like prozac (I blame South Park, et al). Stimulants can have negative side effects, but they're more along the lines of what you'd expect from too much coffee: loss of appetite, hyperalertness and sleep problems, in extreme cases twitchiness and cardiovascular problems. These are well-understood, and any doctor would adjust/halt the drug if they got worrying. In terms of personality, the person is just getting a boost to their deficient executive function. The net result could be that they're less likely to do things impulsively, but not that they're less likely to do things, period.

2) I'm all for letting children think how they're going to think, and agree that our education system is far too constraining and cookie-cutter. But there's a huge and meaningful difference between "let kids think how they want" and "don't treat problems that are preventing kids from thinking lucidly". Some excellent research has shown that even if parents and teachers bend over backwards to facilitate kids with ADHD, unless they get some kind of treatment (and medication is both much more effective and far less expensive than behavioral therapy) they're still going to struggle.

So what people who advocate "let (kids) think the way they NATURALLY think" are effectively saying is "let some non-negligible fraction of kids have a dramatically lower chance of success and happiness in life rather than acknowledge that they have a disorder and treat it".

To your first point, I would strongly disagree, and actually argue that you are the one being wildly inaccurate and ignorant. I know many people first-hand who were affected negatively from the drugs. As an example, I once had a very charismatic friend who was extremely bright, happy, and just fun to be around. In middle school, he started taking medication. He became detached, depressed, quiet, and generally dull. He would at times be himself, but overall, other friends and I noticed a drastic [negative] change in his behavior. To me, that is extremely serious, especially as a child where you are forming your character and social abilities and exploring your imagination. Another example, I have a cousin who takes the medication. Throughout her childhood, she experienced unusual and unpleasant side effects like headaches, stomach pain, anxiety, sleep issues, etc. Her doctors have rotated her through different medications, but it seems there was never a golden ticket with 0 side effects. You argue that these are negligible side effects, like coffee. I would say that these are much worse than coffee, at least in the extent of how they effect people, and at the same time would argue that it doesn't even matter if the effects WERE the same as coffee. Do you want your child to be on coffee and redbull? Not me. I know plenty of other people who experienced the same symptoms and personality changes I described here, and although that is not conclusive evidence, there seems to be a large consensus on this issue (as far as the side-effects and changes in personality). And if you think there is no chance of any long-term health consequences derived from prolonged use of these "mild stimulants" like ritalin and adderall, then I am going to reluctantly step back and say we should just agree to disagree.

To the second point, you seem to be confusing my observation as a call to blindly end the use of medication. My argument isn't that we must end the use of medication and ignore the issue, it was that we need an overhaul of the education system so that we can get rid of the pills and preserve the well-being of the children. Not a practical or easy solution, I agree, but it is an important one at the least. And of course there will be children who fall at the far end of the spectrum, where no matter how accommodating the system is, they will still need the assistance of medication to truly thrive. But at least we can safely say we tried at that point, instead of assuming that these children are all "troubled" and need big pharmamama to feed them the milk of corporate greed.

In the U.S. we force children to sit still through hours of classes, wonder why they get distracted, and then medicate them. In other countries kids get more breaks to expend energy and are then more attentive - e.g., http://www.theatlantic.com/education/archive/2014/06/how-fin... "In every one of the experiments, students were more attentive after a break than before a break. They also found that the children were less attentive when the timing of the break was delayed—or in other words, when the lesson dragged on."

I agree. How do you expect children to sit in a class room for 7 hours a day?

I got my diagnosis for ADD (and a few other stuff) a little more than a year ago when I was 19. For me, it's always been really "weird". I suppose I could share this personal anecdote here, in a hope that people stop seeing everything as binary. Sure, there is "big pharma" problem. I buy 150 USD worth meds on my own to know that (insurance does not cover it). But that doesn't/shouldn't hinder those who genuinely are in need of help, be it in form of medication, therapy, or just plain ol' family support.

Without and before the stimulants, absolutely nothing was urgent to me. Not showering, eating, getting work done, studying. Nope. It always came as a surprise when I used to see other folks deciding to do something, and then _actually_ getting it done! How is that even normal! Now, though, I realise that that's what "normal" is.

But that's just probably what others see as laziness? I don't know. Perhaps it is Executive dysfunction? But I am glad that I managed to get help, and ever since that, actually able to get myself together.

Having lived in India, mental illness is still taken as a taboo, at large. Nobody at my family, myself included, knew about even the existence of ADHD, let alone see a psych!

I remember my parents always being told: "Your kid can do better, but he doesn't study! If only." And this went on all the way till my second year at University, when the night before my end-term exam, I ended up with a breakdown because I __just could not__ manage to focus and study the material. I ended up barely passing the paper.

Not everything has been bad, though. There's always this phase of "super focus" for me -- I find something interesting, and then obsess over it until it isn't interesting anymore. Channelled in right direction, I managed to learn a lot in math, computer science and of course programming.

I do think that a lot of mass-education is needed with this regards.

“We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

Unfortunately, we can't modify much of the environment without giving up a lot of what we have. And, that's the trade-off of rapid progress - evolution is no where near as fast. We probably should change the schools for many reasons. But, changing them so that they're somehow more natural is probably an impossible goal, at least until we invent more technology.

Humans have had to deal environmental diseases at every major milestone: choosing residential over nomadic; domesticating livestock; using grain as a primary food source; choosing urban over rural; inventing industry, the corporation, and desk jobs; inventing dangerous chemicals for products and fuel; inventing processed foods; inventing weapons of mass destruction. The diseases that have come with these have been trade-offs that we have accepted.

As a sufferer of several psychological diseases, I suspect that mine are all environmental in some way - stress, close-quarters living, giant social hierarchies, living by the calendar and clock, being exposed to all sorts of toxins, etc. My nature tells me that I should be out running through the forest and chasing game - not sitting at a desk and typing on a keyboard. But, am I going to live alone in the forest? Hell no; I enjoy what I have.

I take several psychological drugs, and they have awful side-effects. And, I self-medicate in other ways. But, those are the trade-offs that I've chosen to be able to do all the things that my mind conjures.

I was diagnosed ADHD when I was 7 and the doctors put me on Ritalin.

This was the early 1970s when very little was known about how to prescribe the drug to children. The doctors put me on a dose of 20mg 3X per day. It almost killed me. I remember having an overdose in 2nd grade (at least now I know that it was a Ritalin overdose). 60mgs of Ritalin is high even for an adult much less a 7yo.

The teacher was required to distribute the pill to me mid-day. She would stop class, and say, "Rip, come up front and take your 'hyper pills.'" Thusly singled out, I would sheepishly trudge up to the front of the classroom and get my medication to the snickers off all my classmates. It was scarring.

Also my nighttime dose was usually enough to keep me awake all night. At that age I had night terrors which were exacerbated by the drug and lack of sleep. I'd return to school wiped out like a zombie.

I'm sure I did present with all the classic symptoms of ADHD: inattentiveness, restlessness, talkativeness, inability to complete tasks, constant need for interaction, etc.. I am still this way to a degree.

I'm pretty sure that nobody really bothered to try to understand what my home life was like. I was the only child of two raging alcoholics. They would get drunk and fight for hours 3-5X per week until all hours of the night. I was a terribly depressed, anxious child. And since the underlying cause of the anxiety (my horrible home) was never addressed, I've no doubt that to this day I carry around a form of PTSD from my childhood.

I'm sure there are many people from great homes with no external factors driving their ADHD. However, I know in my case, I suffered greatly from an untreated trauma, and was simply medicated so that I wouldn't disrupt my peers at school. It also didn't help that I have ~140IQ and found school absolutely tortuously boring until I finally got into an honors program in my high school. My peers were still struggling to read books aloud while I was knee-deep in LoTR.

How can we blame young children because they can't sit still and quiet day in and day out while absolutely nothing interesting ever happens? How is it that after years of being unable to complete homework assignments, nobody ever really started questioning what was happening at home?

Looking back, it is absolutely shameful how this was handled.

Treating behavioral problems in small children must begin with understanding and treating the possible behavioral problems of the adults first, otherwise it's just compounding the damage.

Interestingly when I got old enough to start using marijuana I quit the Ritalin. I found myself quite able to study on weed and my grades in college positively reflected my increasing marijuana consumption. My first year in college I used none, thinking that this would be best for my schooling, and I performed poorly. Thus discouraged, I figured that if school was going to go badly I might as well get high. My grades went from Cs and Bs to Bs and As and onto the Deans Honor Roll. I took my senior final in probabilistic modelling thoroughly blazed and broke the curve for the whole class.

Also interestingly, I cannot take other typical anti-anxiety meds. Anything in the benzo class, for example, causes terrifying complete amnesia even at low doses.

All anecdotal, I know, but I also know a lot of other people with more or less my same story.

I was diagnosed in grade school, took Ritalin through high school. Maybe it helped, but I'm sure a lot of folks here had similar experiences to me in school. School just sucked in general: I was always bored, and when I wasn't bored I was being tormented by classmates, mercilessly.

Ritalin might have helped my grades. I dunno, though, as I graduated second to last in my class at a super posh boarding school. Ritalin made it VERY hard to sleep, that's for sure. That wasn't helped by typical boarding school hazing bullshit.

All I know is that when I flunked out of college and got really, really depressed, I stopped taking Ritalin and moved to the Bay Area. I've never felt ADD or ADHD here simply because people understood what I was talking about. Computers weren't really a thing where I'd come from, beyond being tools for work.

I'm not convinced I don't have ADHD or what not, but I do know that I had a massive existential crisis when I first got here trying to figure out what aspects of my personality were really me, and which aspects were just me tweaking on Ritalin... Like, did I really enjoy doing X, Y, Z? Or was I just all Ritalin'd up and doing it because of the drugs? Who was I, really?

If I could do it all again, I feel like me being held back 1 year in school would have accomplished the same thing as Ritalin, but I'll never know. Socially, I was just not up to my grade level, even though I was easily grasping and becoming bored by class work. I definitely move and talk fast, but I am able to do long stretches of work when I have to, and when I care. That's the key, here I think.

Maybe that's the whole problem: kids like me just don't have the patience for stupid busy work, like homework, penmanship exercises, or date memorization. When I actually was interested in something, like Philosophy, I geeked way out over it and could concentrate for hours...

But I ramble (imagine that!). Long story short, today, I don't medicate my ADHD with Ritalin. I've just arranged my life so that my job and world are filled with stuff I care about, and not stuff I don't. Compared to some of the other ADHD adults I've met, I think I'm completely calm, frankly.

From the outside, it's probably way fucked up I was put on Ritalin. Inside, meh... it built character I guess.

Overall, I am wary of the overconfidence with which mental problems are handled. I don't know if heavy medication for psychological issues is worth it when we know so little of the long term effects. And looking at the history of these medications, I find it difficult to believe that everything is fine at the present moment. Maybe the future will tell how many of the present prescriptions are dangerous.

This echoes the point made in the article:

> One clinician quoted in the book more or less admits defeat: “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

I know exactly how you felt.

I was diagnosed with ADHD, OCD, and tourettes quite young, my mother and father separated when I was very young, and my mother had the habit of moving to a new town every 2 years. All of this lead to a less-than-stellar experience in school. I eventually made it onto the short-bus. As you were ridiculed as an individual in class, I was ridiculed by group association.

I don't know if my "IQ" was up there , but I was the kid making web-pages while my class-mates were doing the word-processing class. Obviously this meant I'd get terrible marks in class as I'd never get around to doing the work but that's the over-reaching theme of my experience in high-school.

So. Bored. Every. Day.

Except I didn't listen. Nope. When I was interested in something you could bet I'd be in the top-of-the class. If I wasn't, I'd probably not even finish it. Unlike you, who got though it, between my home life and everything else I didn't even finish. I dropped out in grade 10.

However I never really did have trouble focusing. I focused on what was important to me and now I'm in a place in my life where I'm happy and working in a skilled, knowledge-based career making great money for my age and I'm doing the things I've always wanted to.

Its important to note that in addition to supply-side forces increasing diagnoses, there are demand-side incentives as well.

I don't know how many parents are eager to put their kids on speed, but there are also accommodations provided by schools that they might very much want their kids to have. Like having the option to turn homework in late, or getting extra time on tests. Its worth noting that the option to turn homework in late is probably useless or worse for actual cases of ADHD, since it just moves the consequences of actions even further into the future, for people who have a deficiency in the ability to handle loose feedback systems (as opposed to tight feedback systems where consequences are immediate).

Wish this article was not paywalled.

I believe I am "ADD" (not hyperactive) myself, and so is my 8 year old daughter, at least so far.

But I do not want her to get that label, and for the school system to label her that way, because the last thing I want is for them to demand that we medicate her.

When we are talking 5% or 10% of the population, from my perspective "disorder" starts being the wrong word to use. That is a significant enough of a percentage of the population that the classroom/workplace should adjust to _them_ not the other way around.

Somehow I've made that happen for my own life, with a lot of frustration. I just need to figure out how to make it work for my daughter.

We don't have to give up modern education to meet the basic biological needs of children any more than we need to give up our jobs to be healthy adults. Initiatives like http://standupkids.org/ demonstrate pretty clearly that there are plenty of obvious, easy ways that we can address these needs. The obvious answer as to why we haven't tried them yet is money. But that seems like a lazy explanation, because American schools are some of the best-funded in the world. I think it's really a reflection on how we in the West view child-rearing in general. I read a really interesting interview a few months back discussing Freud, where the psychologist being interviewed was basically saying that Freud's model was implicitly based on the shame he felt about his childhood self, how the relationship between therapist and subject is derived from the relationship between parent and child, and that every time Freud was speaking to a subject sitting in a chair in front of him, he was talking to his 8-year-old self. Ironically we tend to see the natural reaction of a child as somehow wrong. If a child can't sit in a chair for 3 hours, the child is wrong, rather than the idea of sitting in a chair for 3 hours. So as the article points out, the conversation begins as "How can we modify the children to fit the environments we've built for them" rather than "How can we modify the environments we've built for children to fit their needs?"

I started taking these stimulants like vyvanse in college about five years ago. Although I can exhibit symptoms from time to time, I do not think at all that it is medically necessary for me. After trying them once, it made things a lot easier, and besides a few episodes, the good effects have been able to balance out the bad. I do get very worried occasionally though that I will have to suffer long term consequences. I am very much dependent though now this fear has not yet been strong enough to get me to stop.

The article briefly mentions "hyperkinetic infants" and doesn't address the well known effects on neonates by the consumption of caffeine by pregnant women (http://www.ncbi.nlm.nih.gov/pubmed/3420441?dopt=abstractplus) and the way advertisers market sugar and caffeine to children.

Note that the author directly acknowledges the existence of ADHD in the book. His concerns are directed toward the pharmaceutical industry's push to increase sales of stimulant medications. From the article:

  Schwarz has no doubt that A.D.H.D. is a valid clinical entity that causes real
  suffering and deserves real treatment, as he makes clear in the first two 
  sentences of the book: “Attention deficit hyperactivity is real. Don’t let 
  anyone tell you otherwise.” But he believes that those who are disabled by the 
  condition deserve a wider range of treatment options than an endless litany of 
  stimulants with chirpy names like Vyvanse and Concerta.

In my experience, I think most patients, parents, and clinicians would readily agree that ADHD is over-diagnosed and over-medicated. It's surprisingly common on internet forums and threads like these to find people insisting that ADHD is over-diagnosed in others, but that their own case of ADHD is genuine. Or parents who believe that stimulants are over-prescribed in general, but that their own child's case is an exception.

Clinicians feel this pain perhaps most directly. Few patients or parents arrive at the clinician's office seeking a diagnosis for their attentional symptoms without already having self-diagnosed themselves or their children as having ADHD using online tests, often from the pharmaceutical companies. Even fewer patients are open to alternative suggestions for addressing their problems, having already decided that they want a prescription for stimulants, and they want the exact stimulant formulation they saw online or heard about from their friend. It's an uphill battle for the clinician to argue against this, as denying patients the medication they've decided they need for themselves is a recipe for angry complaints that increasingly-busy clinicians don't really have time for.

The pharmaceutical industry knows full well that their target market tends to self-diagnose and decide what they want before ever stepping foot in to the doctor's office, and their marketing material is geared to maximize that effect. The ADHD information on the Vyvanse website, for example, reads more like a horoscope than a list of symptoms. From the Vyvanse website:

  Kids may make careless mistakes in schoolwork, have difficulty remaining focused in class, and seem not to listen when spoken to directly.

  Teens may avoid homework and may be easily distracted by many things, including unrelated thoughts.

  Adults may forget to keep appointments, pay bills, or return calls and avoid completing forms or reviewing paperwork.

Unfortunately I don't know what the solution might look like, as the blame is shared by patients, parents, clinicians, insurers, and pharmaceutical companies alike. The fact that we allow companies to market diagnoses and medication directly to people represents a massive conflict of interest, as this incentivizes them to appeal to the widest audience as possible.

Better education of patients and parents would go a long way toward dispelling some of the myths around ADHD. It's entirely normal and expected for teens and children to not want to do their homework and to be distracted at times, just as it's unrealistic to expect adults to never miss an appointment, bill, or phone call. Kids naturally want to play video games or browse YouTube instead of doing their homework. At some point these issues reach the level of ADHD, but that level is much higher than most of the population would like to believe when it comes to themselves or their children.

I don't want to add anything further beside asking people who are about to comment how it's not a real disease to read the comments here, written by people who have ADHD or which friends and relatives struggle. Listening to them and whether it helps is much more relevant than any opinion or vision of a world without need for Ritalin.

I've observed this whole drama unfold first hand. Having been born in the early 80's, I grew up on Ritalin and most of my classmates did too.

I actually do have ADHD, but I'm unmedicated for well over 15 years now. This is completely by choice; every time a new doctor sees my medical history they basically ask in a rather pushy manner, "Ya want some pills for this?"

I didn't grow out of ADHD, but I have had to learn a lot of coping mechanisms. I can't work with silence, I always have to have music on. If I don't, I start wandering around the internet and getting nothing done.

Pair programming is basically God's Gift to ADHD. All of my team knows that they are encouraged, and appreciated if I'm driving and they're like, "Whoa you are WAAAAAY off on some tangent here. Our card says to do X, let's do X."

To-Do lists and journaling are a way of life. Note taking during meetings is simply a must. If I don't, my short term memory gets really slippery and I start interrupting people with questions and thoughts lest I forget them in the next 20 seconds.

But the point is, while I have all sorts of weird hoops to jump through, they really aren't things that normal, non-ADHD people don't do. I just rely on and need them far more than non-ADHD people. Yet every doctor wants to give me a prescription for my ADHD. This is extremely ironic give a later point in this comment.

Meanwhile, while medication isn't an answer all the time, sometimes it is really the only option. Taking the medication is hell.

I know a group of people I grew up with who can't get through a workday without prescription stimulants. Then, they have to try to handle kids sporting events, social events, etc. on the weekends without it to try to keep their tolerances down. Still, those tolerances don't quite reset fully. Almost everyone in that group has to take regular PTO every 6 months and go off them for two weeks. They can't work. They can't clean the house. They can't care for their kids. It's pure misery. Sure, they may run off to a resort, but they're mostly just doing that so they can drink and sleep their way through withdrawals while their other half handles the kids.

In same group, there are a few that actively struggle to take their medication as prescribed as opposed to eating a 30 day supply in 10 days. We're talking getting the day's doses each morning from a significant other with the rest kept in a lock box that only said SO has the key.

Also, it's insanely embarrassing and stigmatized to get your medication filled when you're an adult. Pharmacies will be out of Ritalin when you show up to fill your prescription in the morning. "I don't know when we'll have more in, sorry." Then, a few days later you'll hear that same pharmacy filled your friend's daughter's prescription in 20 minutes a few hours after you left.

So on one hand, you have Big Pharma pushing the diagnosis and medication on children who are still neurologically developing. On the other hand, you have an informal cadre of pharmacists that think it's okay for kids to take this, but if an adult is taking it they're some meth'ed up tweaker. So kids who don't and probably shouldn't take these drugs are flooded with them. The adults that need it just to hold down a job and make rent can't get it.

The entire ADHD situation is just one massive, never ending mess. I'm so glad I'm on the lighter end of it and can side step the medication entirely.

As another who probably sits right on the border of "could use medication, but isn't interested in it after self-management for 20+ years" I really like how you mentioned practical habits that can alleviate the downsides to the symptoms. To-do lists. Taking notes. These can be learned and if they work, to make life more constructive while not really getting into the physiological side.

Honestly I enjoyed having the mind-set to be rough & tumble in the Proposal Coordinator (or Manager/Writer/etc) type role with 2-6 overlapping projects. It is/was almost a natural fit for being kind of hyper & then shutting down at the end of the day (go home to cook, beer, pets). Having multiple projects was plenty of stimulation, and breaking them each into smaller, prioritized To-Do lists with lots of human contact meshed nicely. Stressful at times, sure, Murphy's Laws are like that, but being the relentless, focused type to put all the pieces together for the whole is quite important when the scale increases (e.g. billion dollar construction projects).

> I can't work with silence, I always have to have music on. If I don't, I start wandering around the internet and getting nothing done.

> Pair programming is basically God's Gift to ADHD.

Just keep in mind that there is a huge variation, not every AD(H)D-er is the same.

> Taking the medication is hell.

Then you should possibly contact your doctor, it shouldn't be that way as long as you follow the recommandations, but sometimes even minor changes can make major differences, even changes in dosage or even type based on the same active ingredient.

> Then, they have to try to handle kids sporting events, social events, etc. on the weekends without it to try to keep their tolerances down.

This isn't R, is it?

> Just keep in mind that there is a huge variation, not every AD(H)D-er is the same.

I covered this later on. The whole "sometimes medication is necessary" bit.

> Then you should possibly contact your doctor, it shouldn't be that way as long as you follow the recommandations, but sometimes even minor changes can make major differences, even changes in dosage or even type based on the same active ingredient.

It's less the effects of the medication and more the way that medication impacts your life as an adult. You're often accused of not actually having ADHD and faking it for "legal meth". Some people actually struggle with the temptation to use recreationally.

> This isn't R, is it?

Relevant? Yes. It is. If you can't make it through a workday without your medication, you can barely handle your social life. ADHD trying to be social is always late, always harried, always forgets to bring the thing it promised to bring, and much more. Trust me, I can't tell you what my plans are for this weekend without checking my calendar and every appointment on that calendar has a checklist of things to bring if any.

The problem is, when you go off meds, it's ten times worse than if you never took medication. Alongside that, there are the usual stimulant withdrawal symptoms, though to a lesser degree if you're not taking above as prescribed.

The reason people do this is because if you find something that works for you and you take it daily, you'll be well past the maximum dosage in a few years. Then you'll have to change medications and that medication may not work as well or the same way. You also may end up with withdrawals.

Furthermore, you really do need a reserve of pills. The only way to get that is to skip doses. The legal structure around Schedule II drugs is fuzzy. Most pharmacists will only allow you to refill your medication 30 days from the fill date of a 30 day prescription to avoid liability. If you try to fill it and something goes wrong, you could be up the creek on a Sunday with a week of work ahead of you. Insurance, pharmacists refusing to fill a prescription because they suspect you're abusing (which is literally as little as, "I thought they looked strung out"), family emergencies, and everything else under the sun can cause this.

Also see the bit about pharmacists refusing to fill prescriptions. This does actually happen, a lot.

Being prescribed a Schedule II substance is bad enough, but pharmacists and pharmacies tend to take adults and ADHD medications to the furthest limits legally possible to make your life a living hell. Imagine if schizophrenia medication was that difficult and strict to keep a steady supply of. They have trouble getting a refill and it's completely within the realm of possibility they could lose their job (or worse).

Same thing with people with serious, debilitating ADHD.

>> Just keep in mind that there is a huge variation, not every AD(H)D-er is the same.

> I covered this later on. The whole "sometimes medication is necessary" bit.

I was just thinking about the ways to cope, music/sound, pair programming. I know not every ADHD-er prefer pair programming.

>> Then you should possibly contact your doctor, it shouldn't be that way as long as you follow the recommandations, but sometimes even minor changes can make major differences, even changes in dosage or even type based on the same active ingredient.

> It's less the effects of the medication and more the way that medication impacts your life as an adult. You're often accused of not actually having ADHD and faking it for "legal meth". Some people actually struggle with the temptation to use recreationally.

That's a shame if you ask me and you have my sympathy here.

>> This isn't R, is it?

> Relevant? Yes. It is. If you can't make it through a workday without your medication, you can barely handle your social life. ADHD trying to be social is always late, always harried, always forgets to bring the thing it promised to bring, and much more. Trust me, I can't tell you what my plans are for this weekend without checking my calendar and every appointment on that calendar has a checklist of things to bring if any.

I know what you mean.

> The problem is, when you go off meds, it's ten times worse than if you never took medication.

This is where our experiences differ

There are books like "The Shallows" which make a case that the internet is shortening our attention spans. Could this lead to someone developing ADHD?

No. Modern understanding is that it is hereditary and only can be amplified by environment, but it is either you have it, or you don't.

What are the ADHD rates of children in countries with better school systems like South Korea or Sweden?

Are other countries even diagnosing these symptoms as much as the USA?

I challenge someone to provide evidence enough to scare me into stopping. Go ahead, save my life

Please don't. Your other comment was fine, and can and should speak for itself.

We detached this one from https://news.ycombinator.com/item?id=12345023 and marked it off-topic.

Sorry, mean't to be a joke. Way past the point of being saved anyway

Meh. So long as you don't graduate to a full blown cocaine or meth addiction, you should be fine for a long while. You'll have cardiovascular issues further down the line if you don't work out and/or smoke.

I mean, all stimulants to some degree or another are bad for your heart and blood pressure.

Perhaps look into that other brain pill all the kids are taking now, Modafinil. I've been meaning to try some at some point. Apparently it gives you all the bonuses of Normal Person on Ritalin but none of the jitters.

This is the opposite of what I needed to hear, but exactly what I wanted

>> I challenge someone to provide evidence enough to scare me into stopping. Go ahead, save my life

From TFA: Schwarz traces the Icarus-like trajectory of Richard Fee, an aspiring medical student who fakes the symptoms of A.D.H.D. to get access to drugs that will help him cope with academic pressure. When he eventually descends into amphetamine psychosis, his father tells his doctor that if he doesn’t stop furnishing his son with Adderall, he’ll die. Two weeks after burning through his supply, Fee hanged himself in a closet.

Are you sure your supply will never be disrupted?

What's the problem here? Someone fakes symptoms to get medication, abuses it, goes crazy, kills self.

If you read the article about this guy you'll see he was incredibly manipulative and lied to multiple doctors to get prescriptions.

The problem here is Richard Fee, no one else.

To be honest that's stereotypical of someone who was taking far, far more of their pills than prescribed. Most people, while they're prescribed a 30 day supply, skip pills on the weekends and vacations to maintain lower tolerances. They typically "save" those pills for one of three reasons:

1) The pharmacist at your pharmacy randomly decides you're a tweaker and you have to spend 2 weeks finding a new pharmacy.

2) PARTY TIME!!!

3) Pulling an all nighter and surviving the next day.

Without the book handy and the whole medical school bit, I'd say it was 3, except it was more like a couple-dayer without sleep.

I've been taking ADD meds my whole life and I've never had anything like withdrawal symptoms. If I don't take the pills, I don't get the effect of the pills: that's all that happens. In fact I regularly skip them on weekends/vacations/etc. to help keep my tolerance low; I've never had any problem doing that.

Someone who's getting amphetamine psychosis off of ADD meds is seriously abusing them. That absolutely does not happen with proper clinical doses.

>Psychiatrists are not that much different from witch doctors

I wish you had said this several comments ago.

We have nothing to discuss here.

I agree that that was an inflammatory statement that went over the top, but please keep internet tropes of rudeness off HN. They send bad signals into the community.

We detached this comment from https://news.ycombinator.com/item?id=12345614 and marked it off-topic.

I get really skeptical whenever someone uses the term "Big Pharma". 99% of the time the person using it is selling something (hey, look, a $28 book).

How dare a pharmaceutical company sell a product? How dare doctors decide to prescribe medicine? While that was slightly melodramatic, here is a quote from the article:

Schwarz has no doubt that A.D.H.D. is a valid clinical entity that causes real suffering and deserves real treatment, as he makes clear in the first two sentences of the book: “Attention deficit hyperactivity is real. Don’t let anyone tell you otherwise.” But he believes that those who are disabled by the condition deserve a wider range of treatment options than an endless litany of stimulants with chirpy names like Vyvanse and Concerta.

... Great, so it all boils down to the pharma companies not creating enough drugs for ADHD? But it's their fault that there are too many drugs? I am not particularly impressed, and to me it feels like the author is just manufacturing conflict for the sake of selling a book.

> Great, so it all boils down to the pharma companies not creating enough drugs for ADHD?

No, some people will benefit from parenting classes or therapy as well as meds.

The author is saying that meds alone are not enough for some people.

>> "...But he believes that those who are disabled by the condition deserve a wider range of treatment options"

> so it all boils down to the pharma companies not creating enough drugs for ADHD?

Conflating "treatment options" with "drugs" is kind of the central thesis of Schwarz's critique...

> to me it feels like the author is just manufacturing conflict for the sake of selling a book.

If you've ever worked in or around a private practice doctor's office, you're aware of the pressure to proscribe.

Many, many doctors are high-quality professionals who make decisions solely in the best interest of the patient. Many other doctors are only interested in pushing as many people through the office as possible, spending less than a minute per customer and quickly writing a script for whatever the pharma rep is selling. A little bit for the perks, but mostly because it's a way to push as many people through the office as possible. The pharma rep provides fantastic marketing and "educational" material that does the doctor's job for him, allowing him to push more people through than if he had to sit down and discuss an array of treatment options with the patient.

Regardless of the author's motivations, his critique isn't without merit (and certainly isn't specific to ADHD).

> Great, so it all boils down to the pharma companies not creating enough drugs for ADHD?

By "wider range of treatment options" he doesn't mean more drugs, he means nonpharmaceutical methods as well.

> But he believes that those who are disabled by the condition deserve a wider range of treatment options than an endless litany of stimulants with chirpy names like Vyvanse and Concerta.

> ... Great, so it all boils down to the pharma companies not creating enough drugs for ADHD?

"a wider range of treatment options than an endless litany of stimulants" is not the same as "more drugs". Now, that could include non-stimulant drugs if those would be effective treatments for the condition, but the obvious meaning seems to be that the excessive pushing of stimulant drugs as a treatment has swamped non-pharmacological treatment options for ADHD.

I 100% agree. We use the drugs we do because they're effective, they're cheap, and they're relatively safe. If he thinks that we should be using non-stimulant drugs, then what classes of drugs should we be looking into? Is there (at least preliminary) research to show that another class of drugs is effective for treating ADHD?

This sounds like "I don't like the way things are, so buy my book and you can read all about how I don't propose a solution!"

It upsets at how anti-science and anti-technology some of my friends have become. Some of them believe that vaccines shouldn't be used. Some of them reject medicine and medications. Some of them avoid GMO foods. They use essential oils and 'natural' products that may potentially cause more harm than good.

But, it makes sense. I guess they fear what they don't understand, and others take advantage of that fear.

That isn't to say that we shouldn't be extremely careful with new technology and inventions. But, we also shouldn't be scared.

The quote says:

> a wider range of treatment options than an endless litany of stimulants

Notice the "than an endless litany of stimulants" part. Saying something like:

> so it all boils down to the pharma companies not creating enough drugs for ADHD?

afterwards almost seems like you are intentionally misconstruing this.

Is it not possible that the author wants "Big Pharma" to spend time researching alternative treatments rather than just cranking out "yet another stimulant?" Is it not possible that the author wants more non-medicinal treatments to be explored?

---

That said, I think that "Big Pharma" has earned its negative moniker. Just look at the front-page story from yesterday about EpiPen prices being jacked up to the point where people may not be able to afford them. I don't think that being against price gouging a "captive audience" in a way that possibly threatens their health is the same thing as being against "a pharmaceutical company selling a product."

> Is it not possible that the author wants "Big Pharma" to spend time researching alternative treatments

Or society to do that; relying on Big Pharma to spend money directly contrary to Big Pharma's interests doesn't seem like it makes a lot of sense.

Whether you consider the opinion right or wrong is beside the point that I was making (that the parent to my post seemed to be "tilting at windmills"). Saying that the author has an inconsistent position of "there are too many drugs" and "there need to be more drugs" seems like a poor reading of that sentence.

I understand the point you are making, but in reality drugs will get developed based on their likely risk/reward ratio only.

If you want more diversity, unless there is a non-market force (which honestly shouldn't be needed here, there is high demand), pharma companies will just keep picking at the lowest hanging fruit.

Eventually, they'll get up to the non-stimulant variety, but developing an entirely new class of drugs is a Herculean effort with very low likelihood of payoff. To make it work, you need more data on the disease (e.g. more time), and some luck out of academia (which is where 99% of drugs come from anyway). They will also need a lot of money to do it, so anything they can produce in the meantime is essentially on that track. Thus, the wording "even more drugs".

A couple of points:

Referring to an industry as "them" is not constructive. Comcast has a horrible reputation for internet service, does that mean we are all a part of "big tech" out to screw the little guy?

Pharma companies will develop drugs that they think they can sell. If it were possible to create a stimulant variant profitably, companies would do so like any other rational actor.

The epipen story is sad, I agree, and it would be nice if it were easier to get a generic onto the market. The money for more drug research has to come from somewhere, though, so more profitability for the industry will have a positive long term affect even if the short term is highly unfortunate for the patients.

> The money for more drug research has to come from somewhere, though

The EpiPen has been on the market for awhile. Why the sudden price hike? Were they operating at a loss before?

This does not seem like a case of "we have to recover our costs" and comes across more of a case of "we are a monopoly so fuck you, give us your money."

Yes, but that is capitalism.

These companies primarily get created because investors want to see a return, the side effect is that they produce novel drugs.

So, no, they probably don't need to raise prices. Because they now have a temporary monopoly they are finding the monopoly price point as you say.

Having said that, try coming up with a better system to produce drugs.

That is not capitalism. The existence of the FDA ensures that it is not a free market. Trying to label it as such is disingenuous.

The EpiPen product is basically a plastic housing around a syringe to make it easily injectable. There is no high sky-high R&D cost here.

Well that was impassioned :).

An unregulated free market is not the same thing as capitalism.

There is nothing preventing you or anyone from developing a generic epipen, especially since it is just a plastic housing around a syringe. It just takes time and money.

Also, R&D costs are already paid for. If they are using money for R& D it will be for something else. Profitability in the pharma industry is generally low, there are lots of failed drugs that have to be paid for by something. Arguing that companies have a moral responsibility to price products low is unfortunately not true.

No, the problem is that 'wide range of treatment options' != 'wide range of drugs'. Without reading the book, I'm certain that it has to do with the pharmaceutical industry's interest in having doctors prescribe medicine more frequently than might be in their patient's best interest, instead of adequately considering non-pharmacological treatment.

I tried to read the whole article but couldn't sit long enough. Perhaps I need a drug.

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