Comment by jrapdx3 | Hacker News Reader

Comment by jrapdx3 | Hacker News Reader

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.

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.

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?

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.

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.

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.

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.

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