Undiagnosed adult ADHD could cost UK billions a year, report finds | Hacker News Reader

Undiagnosed adult ADHD could cost UK billions a year, report finds

theguardian.com

29 pointsDanBC42 comments

Obviously this can only be solved with more medication! Remind me to buy extra Pfizer stock.

Edit: fair enough. I do realize people who are seriously affected benefit from these medications. I did not mean to trivialize their struggle. However, i do think the sheer number of people currently receiving these relatively heavy medications is alarming. I think overdiagnosis is a serious problem with adhd.

Yes, think about the lost tax revenue because of all those undiagnosed ADHD patients who are working in the creative sector instead of in a proper office job. A decent dose of medication could have given them a so much more fulfilling life ..

It's not that people with ADHD just have different jobs, it's that any job can be difficult to keep, and even just managing your own life. ADHD is far less trivial than some people make it out to be.

Not just jobs, I can't even watch movies or play single-player videogames when I'm not on my medication (both things that I really enjoy doing and they help me unwind)

You have no idea the mental anguish from having to rewind a movie that you are watching alone (because other people won't put up with this) for the 3rd time because you still missed an important plot point a few minutes ago. It makes enjoyable things feel like work, and then you don't want to even try. The things that are supposed to help me relax just end up causing frustration. Or even the irony of not being able to fall asleep because I keep getting distracted thinking about stuff that I forgot to do today...

Medication and therapy literally saved my life.

Have you tried meditation?

I've tried a LOT of things, including meditation.

It does help when I can get it to, but the biggest helps have been from following a VERY structured consistent schedule that I follow militantly, and some other small lifestyle changes like making sure I eat right and exercise helps quite a lot.

But at the end of the day, the medication just helps so much more, and the side effects are manageable, so I'm pretty happy with it. I do take amphetamines and I do worry about possible neurotoxicity issues that it may have, but I'm planning on working with my doctor in 3-ish months to start trying out other medications again (as right now I'm moving and don't want to mess with anything).

Do you find carb intake has any effect, positive or negative?

I haven't noticed anything specific, but I haven't really ever been focused on carbs alone. Most of my dietary issues were simply eating at all (I could easily go an entire day without getting hungry, and the medication only makes this worse), and making sure I was cutting my caffeine intake out (didn't work) or at least making it very consistent (like most stimulants it has a positive effect on the ADHD, but unless it's consistent it can cause more problems than it solves).

I'm still working on this, and it's one of the major reasons why I want to talk to my doctor and try different medications again, but I have heard some say that low-carb high-fat diets are beneficial to ADHD, and I know that many agree that having "enough" fat in your diet is crucial. I also really need any extra calories I can get right now, so cutting carbs isn't the best idea until I have a handle on my weight.

I don’t have an official diagnose for ADHD. But I do feel that I have an attention problem sometimes. Low carb, high fat diet in combination with fasting I find helps a TON! I’m like another person. So focused. I don’t eat until 2pm, just coffee and theanine (to reduce the jitteriness).

> ...because you still missed an important plot point a few minutes ago.

Asking genuinely out of curiousity, what do you experience during this periods of 'blackout'? Is it the mind wandering onto other thoughts or focusing on one specific item?

It's not really a "blackout"... I guess it's actually kind of hard to describe.

Have you ever tried to read a sentence and listen to someone talk at the exact same time? You are only going to be able to "focus" on one or the other, or you'll fail and understand neither of them.

Without medication (and on bad days) my entire life is like there is a second part of my brain that is vying for my attention. Either focusing on something not important (hey i never noticed his hat, did he always have that? I think he did in the beginning... Oh shit I missed what's happening again), or in many cases focusing on the act of trying to focus that I forget what I'm actually supposed to be focusing on (and then the pity party in my head starts about how pointless it is to even try here right now, and that then is a 3rd distraction).

There's also times that I can hear and understand what is happening, but everything from about 3 seconds ago is just... gone... So I can read and fully comprehend a sentence, but I'm trying so hard to focus on that sentence that I don't commit the previous one to memory, and any references back to it get confusing because I don't remember what happened there.

Interestingly that last one happens most with the 6 digit 2-factor authentication codes. I break them up into 2 sets of 3, but when i've said the second set of 3 to myself to try and remember the whole string long enough to switch apps and enter it, I've forgotten the first 3...

Like most things, it's not as bad at some days and times, and worse on others.

This happens to me often as well. I need to copy something simple onto another page, I read it and scroll/flip to the next page and I totally forget what the word or phrase was. Even if it was something super simple.

I've had this problem for many years, although it's not perfect that problem is largely solved and being able to shift focus so quickly has become a super power.

When your focus shifts so often you can't develop basic cognitive functions(especially executive function). The part of your brain that is suppose to regulate focus is really funky. But I bet when you find something your really interested in your brain won't stop focusing and it feels like you have blacked out and are doing everything in "automatic" mode. This is called hyperfocus and it can be incredibly useful if you can "control" it.

You might cycle through various medications over the years, some might even cause you anxiety and other horrible side effects. But it won't actually fix the underlying problem which are structures in your brain that aren't developed properly.

Luckily there are solutions; treatments to improve your mind ability focus like Neurofeedback. Once you can focus you need to find a physically/mentally stimulating task that requires serious cognitive functions like memory, task execution, focus switching and the many other functions. I like to dance and play music. I've done a lot of work reverse engineering the brain and made incredible progress improving its ability to operate.

Don't ever that listen to that pity party in your brain. Once you cross a certain point(after A LOT OF WORK) your ADHD becomes a gift and you will never want to give it up not matter how much failure and loss you have experienced. ALWAYS remember you are different, everything about you is different from the normal population and trying to conform to their systems, ways to of thinking and working will rarely work for you.

EDIT: I will add I understand that medication works for some people and that's great. But it was largely a waste of time for me and seriously affected my liver.

I've talked a lot about the bad parts of ADHD here in this thread, but I'm already at the point where I wouldn't change it. It's not something that can be cured, and if given the chance, I don't think I would "cure" it entirely.

ADHD has made me much better at many things than most of my peers. Learning to deal with it has given me tools that are applicable to most parts of life, and have made me a very productive and useful person. My own personal "law" of "anything you can forget you will forget" has taught me to externalize everything. I'm a software developer, and I'm militant about testing and automation because of it, and that has benefited me greatly in my life. And hyperfocus is amazing when it happens (and it happens to the right thing! It sucks when you hyperfocus on getting your font sizes right...)

But like most things it's different for everyone, and for me the medication is a large part of my treatment of the (bad) symptoms. I'm still not convinced that neurofeedback techniques are effective, and I am quite happy with where I am right now, but that doesn't mean there isn't room for improvement. That's why I want to revisit my medication when my life calms down a bit in a few months and see how it goes. Generally things get worse before they get better, and in this case I get to choose when they get worse, so I'm going to plan that choice out well!

I'm so glad you have managed to be happy with ADHD. I didn't mean to imply anything in my post, I was talking about some hypothetical person with ADHD (whose had a similar past to mine ;) ). I just wanted to make the point to whomever is reading it that as difficult as ADHD makes life, it can make it so much more rich and meaningful. No matter where you might be stuck you can find a way to overcome the difficulties.

I have most of the symptoms described by the OP, including a severe difficulty focusing on movies/books.

For me, it's basically that my mind wonders if I'm not very interested. It's my mind's default mode of operation that I think about everything related to the thing I just thought about. Comes in very handy when programming, but is kind of annoying when trying to get through some mediocre material.

Something worth noting is that my focusability seems directly based on how interested I am, not how action-packed something is. For example I have no problems watching the 1981 German classic Das Boot, where people just sit in a submarine for 3 hours. However something that is popularly belived to be made for ADHD people like The Transformers is excruciating for me even though there's so much going on visually every second.

Stimulants like Adderall make me even more focused on things I could focus on already sober, but also make me even less focused on things I don't care about. So basically just intensifying my natural tendendices, as opposed to changing them.

I never understood comments like this. Some people, me included, benefit tremendously from medication. Unless you've been in the same situation I think you should be very careful about crass comments like this. You're talking about peoples quality of life.

The problem is that most of these medications have bad side-effects and only suppress the symptoms. It's not that these drugs are inherently evil, but that they are erroneously used way too early and often.

The biopsychosocial model [1] is ignored more and more. That is, social and psychological factors are given less and less weight. For example, someone who is working an unfulfilling job in a big city is too easily prescribed some SSRI instead of promoting a career change and heavily increased social interaction to form deeper relationships.

The trend even just among biological factors is frightening. Classic example being bad diet. Promoting improved eating habbits and exercise is increasingly looked at as body-shaming. Because this removes personal responsibility. It's easier to tell someone that they just have bad luck with their brain chemistry than to point out that their life choices suck.

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

You can't really do anything else than suppress symptoms on a chronic illness. ADHD is a chronic illness. You don't use SSRIs to treat ADHD. Full stop. I'm not sure what your point about SSRIs is, it's used to treat entirely different things. Some of your claims tells me that you're just reiterating the same nonsense that people with absolutely no experience in the field keeps saying.

Being diagnosed with ADHD takes years. During these years you are given a number of tools to suppress the symptoms, including dieting, exercise and forming strict routines to live by. The medication helps you to stick to those routines, to help you back when things in $life becomes unpredictable, for reasons outside of your own control. Either one of them alone won't be very helpful, and that is something anyone with ADHD can tell you.

Furthermore, most medication used to treat ADHD has a very short half life, and is typically out of your system anywhere between 1-2 hours to 8 hours. People are not medicated at all times, and most people prefer to be medicated as little as possible, because yes, there are side-effects. And nobody diagnosed with it takes them lightly.

You know what is easy? To sit on the Internet and make statements that have no ground in science and general practice. And some people do have bad luck with their brain chemistry. I hope you never get a chronic depression or something similar and have to meet your own arguments about life choices in the door way.

My young daughter as ADD/ADHD. It is no joke. ADD/ADHD is an executive function deficit, with tremendous negative impact on one's ability to regulate behavior, resist distractions, plan and persist through a plan. You can imagine how devastating that can be as you age and more and more is expected of you in terms of self-management. Deep shame, anxiety and depression as a result are common. Medication helps, sometimes a lot, and the objections against it, to my knowledge, are not rooted in evidence.

There are people who credit evidence, and people who believe in common sense, and while most of the the "common sense" people can eventually get enough shit kicked out of them by reality to learn to accept evidence, I'm half-convinced there's something deep going on here. Maybe it's cultural, maybe it's even deeper.

A close friend of mine has been in and out of the job market for years with various diagnosis, including stress, depression, anxiety, OCD, one doctor even suggested brain damage.

She was diagnosed with ADHD and ADD a few years ago, got medication for it which cleared up most of the above symptoms. She has now held a steady job, although at a reduced workload, for a few years.

I have seen both under and over diagnosis. There are many people in high pressure environments that fake ADD/ADHD to get access to Aderall and other stimulants. But there are also many others, some adults and some children, who could benefit from medication and go through life suffering, some times tragically so, because of un-diagnosed or willingly untreated ADD/ADHD.

I have seen also a number of mis-diagnosis, the issue is that a number of characteristics of ADHD are common with other forms of psychological or neurological disturbs, and it is easy to put the actual issue under the (IMHO largish) umbrella of ADHD.

Of course medications may work if the diagnosis is correct, but medicatons are as well broad-reaching, i.e. I believe they work nonetheless in a number of cases even if the affection is not properly ADHD.

> I think overdiagnosis is a serious problem with adhd.

Funny, I was just talking to a psychiatrist who lamented that the problem is more about under-diagnosis. In part because of people with attitudes similar to yours who refuse their children or themselves the ability to get a diagnosis which would help improve their lives.

And then there are people who pay extra money to get modafinil.

This article is about the UK, where adult ADHD is very rarely diagnosed, let alone medicated, compared with the US.

What happens when diagnosis? Seeking help (add your own scare quotes) will get you amphetamines with an expensive monthly 5 minute refill appointment.

There are options other than amphetamines, and many of them are tried first because they are cheaper and have less side effects.

Not to mention that therapy and just knowing about the problem can help too.

You mean other stimulants? LSD works quite well, but is problematic for other reasons (social stigma, prison rape, etc).

No, I mean non-stimulant options like Strattera and Clonidine, and a few others that I don't know off the top of my head. Also there has been some studies that show some antidepressants can have positive effects on people with ADHD.

And like I said, there is also therapy and lifestyle changes that can have a huge impact as well. I'd say that the benefits of my therapy and the medication are about even in terms of effectiveness of managing my ADHD.

Can you write a little about your therapy? How does it work?

It is a bit weird calling it therapy, it feels more like a "one-on-one class on how to deal with ADHD". They gave me a lot of tools to help with it, as well as provided a good base "structure" which was important when I was first starting (which was over a decade ago now!)

Tools like how I greatly benefit from a very strict schedule that needs many things packed tightly together at some points, but very big gaps in others, and I need to follow it to the t. Tools like knowing that exercise and eating right help quite a lot, tools like how to structure my days and put external reminders or blocks up that can keep me on track. Tools like being able to figure out that I work well in COMPLETE silence, or a very chaotic atmosphere, but not much in between. And information about things like "hyperfocus" which is an ironic symptom of ADHD for many people, and ways that I can kind of "trigger" it sometimes and use it to my advantage (while making sure I set alarms to make sure I don't keep working until 9PM because I forgot what time it was and the last time I looked at a clock was 3 in the afternoon...)

They are basically just people that have dealt with ADHD before, and can help me find what works best for myself. Also, just talking to someone about how something you tried (either medication or lifestyle change) worked can be really eye opening. You never really think on your own about how something you tried in your life really affected it, and just verbalizing that helped dial in medication amounts and show the effectiveness of lifestyle changes.

Thanks a lot. Any references you can share?

Not really sorry. I'd recommend if you are looking to search for a therapist in your area that has experience dealing with adults with ADHD (or children if you are looking for someone else, or I guess are a child yourself... you never know online!)

The important thing is to go to the appointments, which was tough at first, but after a bit the appointments were the "anchor" that I started learning how to schedule my life around, and then I was eventually able to schedule the appointments around my life.

This isn't a problem with diagnosis, though. It is more an issue of overworked doctors, not enough reliance on nurse practitioners for more "basic" diagnosis. Heck, even requiring a monthly 5 minute refill appointment is problematic in itself, considering this is a person with a chronic disorder wanting maintenance medications. Of course, newly diagnosed folks probably should have it the first few months to check in and talk about side effects... but there is no real reason this can't be done over the phone, through SMS, e-mail, or using something else fairly private and/or secure.

Fixing systematic problems will improve things. Besides, I don't have an issue with medical doctors prescribing such things if it is generally recognized as the commonly most effective treatment for a disorder. Give the doctors the time (through the systematic fixes), and there is time to discuss treatment options. Actually fix both physical and mental health care so folks can afford it while fixing systematic issues means folks can actually get coping mechanisms and other such training from a psycologist or psychiatrist as well, which might be especially attractive to folks that shy away from medicines or certain types of medicines.

This article is about the UK. Prescriptions are free to most peple in each of the 4 NHS systems.

Here's what people can expect from diagnosis and treatment. Whether this is what's provided is another question.

https://www.nice.org.uk/guidance/cg72

The recommendations are short and clear: https://www.nice.org.uk/guidance/cg72/chapter/Recommendation...

A bit off topic, but can someone investigate how much legalized gambling costs the UK per year? Every town has at least two or three bookmakers in it, filled with the poorest residents gambling away their already paltry wages.

And what about council tax? What kind of government charges extra taxes to the renting population?

As an American in the UK, I see regressive taxes like this, and then just shake my head when the MPs start asking why nobody is buying houses anymore.

> And what about council tax? What kind of government charges extra taxes to the renting population?

I'm not familiar with the details, isn't "council tax" just a property tax like it exists in the US and many other countries as well?

It's a tax paid by the tenant, not the landlord. The tax is based on the value of the property (separated into eight bands). That is, the tax is not tied to the income or assets of the person who actually pays it. I'm not aware of any equivalent in the US, except maybe city taxes in major metropolitan areas, but I believe those are generally based on income.

If developmental policy has a goal of increasing home ownership, it seems really strange to tax tenants for renting, when they could be saving that money for a down payment instead.

The regulator of gambling might have numbers: https://twitter.com/GamRegGB

Here's their website about statistics:

http://www.gamblingcommission.gov.uk/news-action-and-statist...

I think it's a huge problem. I'm especially worried about gambling (and alchol) adverts that are shown to children.

> And what about council tax? What kind of government charges extra taxes to the renting population?

Council tax goes to local councils and is used to fund (alongside money from central government):

https://www.lovemoney.com/news/50941/where-does-council-tax-...

    Road maintenance, repairs and street lighting
    Local transport services like buses
    Children’s social care
    Support for elderly and vulnerable
    Supporting children’s education
    Preventing homelessness through social housing
    Libraries, arts, museums, leisure and recreation services
    Maintaining parks and open spaces
    Waste collection, recycling and disposal
    Street cleaning and flood defences
    Administration of licences, permits and housing benefit
    Planning and building control
    Other services like coroners, courts, registrars, elections and tax collection
    Long term investment

Before council tax (a rate based on the value of the property) we briefly had a poll tax (a rate per person). Poll tax caused literal riots. So, while there are problems with council tax it's less hated than poll tax.

Thanks for the insightful comment. I'm little more than a tourist, you've been dealing with this far longer than me. :P

From the statistics page:

> 48% of people have gambled in the past four weeks

That is mind blowing. Yet only 0.5% of people 16+ England identify as "problem gamblers." That means that roughly 1% of all gamblers identify as "problem gamblers." Of course, it's gotta be pretty bad before you admit to yourself you have a problem.

A more telling statistic would be the amount of money lost per gambler per month as a percent of their income. But no gambler knows how much they lost this month; indeed, that's probably part of the problem. Perhaps the law should require bookies to track each person's winnings/losings and show them a big red number for how much they've lost at that bookie.

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