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Comment by leereeves | Hacker News Reader

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?

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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.

> 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.

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 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.

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

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