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Comment by hellofunk | Hacker News Reader

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/

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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.

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.

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

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

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