Evidence That ADHD Is a Genetic Disorder | Hacker News Reader

Evidence That ADHD Is a Genetic Disorder

sciencedaily.com

63 pointswmat71 comments

One thing to note about ADHD research: The bar for getting diagnosed with ADHD in a clinical trial is much higher than getting diagnosed with it by your family doctor. All of the symptoms involve a great deal of leeway and personal interpretation, and in a clinical trial, they are really, really strict about that stuff. A doctor, who has a financial incentive to prescribe ADHD medication is much more likely to bend the diagnosis towards positive.

There is no shortage of writings by smart people arguing ADHD is over diagnosed. I am also of the opinion that it is. But I also think ADHD is a real disorder. I have no doubt that the findings of this study apply to people who really have ADHD. I also have very little doubt that this study doesn't apply to the vast majority of kids who have been diagnosed with it.

As a child of 8 years old, I was given 120MG of Ritalin per day. I rarely slept the first 2 years. If I did it was around 6am for an hour or so. Then I had to take my morning dose for school. They also wanted me to take a pill to sleep, which felt so horrible I cannot even explain it. I was a zombie in the morning if I took it, then onto the morning ritalin dose. I would just do pushups in my room until 3am some nights just to get the energy out.

Yes, I did well in school while I was on it. Yes, I stayed out of trouble when I was on it. But I was not myself. I felt as if I were on drugs. I did not learn "how to learn" or "how to get things done" without being on drugs. When I finally kicked the habit in college, I was a mess. I couldn't do anything that took more than 30 seconds of concentration. I had to learn how to live life without drugs. For a condition I may or may not have had. It took me to more years to finish my last semester of college because I could not function. Years later I’ve relearned what I should have learned as a child – how to discipline myself and get things done.

The DSM IV/V has a very loose definition of this "DISORDER". The genetic basis I don't doubt, because at one time in our evolution it was a selective adaptation that made us better at hunting, preventing accidents, and trying new things. Now, because our society resides in cubicles, desks, and institutions, it's a "DISORDER" that needs to be medicated.

Just be good parents and give your child an environment where his or her differences can thrive. Find some open space and let them loose for several hours a day. Homeschool them with creative and intriguing lessons tailored just to them. Do whatever you can to allow their abilities become advantages rather than brand it a disorder and ruin their self-esteem by sending them to the nurse twice a day to be force-fed a pill they don’t need.

Don't just give them a pill. That's lazy and detrimental to them in the long run.

The over-prescription of these drugs is epidemic and I can't stand by and watch comments say :

"Each year a parent doesn't take actions is a year lost for a child" to convince people to medicate children for what used to be a genetic advantage (and still is given the right environment).

Each year a parent doesn't take actions to provide the right environment for their child's natural ability to thrive (rather than be told to have a disorder) is a year lost for that child.

What are you saying, that people should build corralled pens for children so that they can 'thrive' on their natural ability to bounce from left to right and generally moving about a lot but accomplishing nothing?

Your appeal to emotion argument is detrimental to all those who are (through prejudices like yours) denied treatment for what is an actual, physiological brain defect. 120 mg is a lot, it may have been too much for you, or you may not have ADHD, I don't know. But denying that a disorder exists because you had a bad experience is intellectually dishonest and holding back the treatment of hundreds of thousands if not millions, and social acceptance of treating it.

The science is clear on this point: ADHD exists, it is treatable, and the quality of life of people who have it is improved significantly with medication and behavioral therapy. That methylphenidate works has been widely proven scientifically, and its effects have been studied for decades. It's true that we don't know everything about it, and we will need further studies for decades, but that doesn't take away from the dramatic improvements in functioning that many people get from it.

Your 'argument' seems to be based on 'But I was not myself.'. I'm sorry that you apparently feel that there is some sort of mystical 'true self' that is somehow different when your neural functioning is chemically improved, and I hope that until you come to terms with reality you can live a productive life and be generally happy. But until then, don't be the crab at the bottom of the bucket.

How can you decouple self-image from "quality of life"? Presumably how someone subjectively feels is an important part of quality of life, not just objective things like their income levels and job security; someone who's really good at school but doesn't like themselves anymore isn't exactly having a high quality of life.

I'm not particularly up on ADHD research, but in antidepressant research this is now widely taken seriously, that the goal of antidepressants has to include improvement in subjective wellbeing, not solely reduction in suicide risk. Even if you don't care about subjective assessments (which, increasingly, psychiatrists do), there's also the practical reason that patients who don't like what a particular drug does to their personality are much less likely to continue using it as prescribed, making it important to find a match that the patient is comfortable with the effects of (unfortunately that's still mostly trial-and-error, because the effects of drugs vary a lot between individuals in thus-far poorly understood ways).

[Fwiw, I don't personally care much about a mystical "my real self", but I do think psychoactive chemicals can change one's personality---in fact that's almost definitionally what they do, to the extent that "personality" is just the aggregate of how the brain works---and that some changes can be ones I like living with, and others can be ones I don't like, so I'd prefer not to take drugs that change my personality in ways where I don't like the result.]

Is that so? I don't recall saying those things.

I did say an open space for them to get the energy out, so that when they return they are more able to focus on 'accomplishing things'. Whatever it is kids need to accomplish other growing up.

Yes, I'm biased (not prejudiced). Due my experience, which I stated clearly.

Taking a set of traits that don't work in modern society and calling it a DISORDER is the only intellectual dishonesty here. Prescribing meds for a behavioral traits that people don't approve of is selfish, controlling, and a true detriment to those kids.

That ADHD (which I did not deny exists, I stated it did, and that I believed it's genetic basis) is treatable by Ritalin/Adderall I don't deny.

I just happen to know the long-term effects are detrimental. Studies happen to back me up.

Studies also show behavioral therapy is as good as medication. It's far better for kids as they get to learn about life without being on drugs. They learn real life skills rather than brute force concentration through drugs.

"I was not myself" is true. I was drugged with something that crams neuro-chemicals into my brain making me into something other than I wanted to be.

There is no true self (especially mystical). There was a natural me and a me on Ritalin (which was very different). I would have preferred to learn the life skills I needed and haven't learned until recently. I had the experience for a reason and often I believe it is to let people know about it and possibly protect other kids from what I experienced.

Sincerely, -Crabby McGee

The human brain is arguably the most complex system on the planet. We have a very poor understanding of how it functions so we fall back to the old, "is this useful metric" and DISORDER only refers to things that are less than optimal.

There are plenty of environments where a mild level of ADHD is not an issue; unfortunately children are expected to be able to sit and concentrate for several hours a day. In that context the term DISORDER is appropriate which is not to say it can be compensated for just that there is an issue. There are plenty of ways to compensate for poor vision and people are starting to think of mental issues in those terms. Unfortunately it's harder to change the environment or give extra attention than a cheap external prosthetic. Thus, drugs are often the first choice, even if they have minimal value or just trade harming the user to help those around them.

120mg as a kid, damn thats a lot.

I took 90 mg as an adult and that was the absolute maximum allowed (in Iceland).

It did me a lot of good but thankfully I am off them now and doing pretty well, meditation is a great substitute.

1988 was the heyday. It was still a 'miracle-drug' at that point. I was the experimental group.

They dialed it down after year or so, although I didn't notice much change.

Once I heard on the NPR radio that children metabolizes stimulus based drug (for ADD) differently than adults. Adults experience euphoria feeling.

"Just be good parents and give your child an environment where his or her differences can thrive. Find some open space and let them loose for several hours a day. Homeschool them with creative and intriguing lessons tailored just to them. Do whatever you can to allow their abilities become advantages rather than brand it a disorder and ruin their self-esteem by sending them to the nurse twice a day to be force-fed a pill they don’t need."

Let me guess: you aren't a parent, are you? I grew up on Ritalin and my son is wayyyyyy more ADHD than I am. He was prescribed adult doses of ADHD meds at five. We homeschooled after he was sent to the principal's office in kindergarten something like 10 times in a three week span (and that was while he was medicated).

I know both sides of this story and, to be frank, I'll avoid taking advice on parenting from someone who has no experience in that situation. I'm not trying to be rude but it's just like a deep developer who has only worked on solo iPhone app projects giving a talk to 1000s of people on how to effectively manage a team of 100 developers on 3-year long projects.

120mg? Damn, that's incredible, I was on 40 a day ish throughout school in the form of Ritalin.

I've had the same issues in 6th form and university, failed my degree. In part due to lazyness and drinking, but also because I simply cannot "absorb" knowledge from sitting in a lecture hall watching someone speak for ages. I learn interactively - I did amazingly well at practicals and projects where I had a constant feedback loop (such as debugging a robot), but lectures and exams I feel are an exceptionally perverse way of learning things.

Talking generally, most mental disorders when not extreme are genetic advantages in the right situations. Bipolar and creativity, asperger's and certain forms of engineering, even milder forms of ADHD with right people skills can be pretty useful for the some types of entrepreneurship.

I am quite sure there are many more forms of mental illness that have not been documented. Heck, even I have had few very strange quirks since childhood, which I have never found documented anywhere.

I agree. I was a quirky, energetic, and mischievous child. I caused trouble. I was a brat (and still am sometimes).

I'm glad to have my ADD, hyper-awareness comes in handy often. Sometimes it drives me crazy too. But I'm learning to be aware of where my mind takes me.

The journey has been tough, but I've learned a lot about myself.

120MG of Ritalin? Sounds absurd.

It is absurd.

That's what came to my mind as well: We will be hearing these "X is linked to genetics" news a lot more often for everything ranging from boredom to our favorite color. Yes, almost everything is genetic to an extent, but not everything is a disorder, especially the brain-related ones (other than profound conditions like alzheimer's or parkinson). Can psychology define what is the "Ideal mental state"? I don't think so (and it's a little creepy).

This is welcome news. I recently got diagnosed and after taking the medication, I've found a great increase in the quality of life.

There are a few who are very anti-drug when it comes to this condition and their children. Let me tell you from personal experience, these people are doing more harm to their children than good. Education is important.

Depending on the severity, each year a parent doesn't take action is a year lost for their child.

"Let me tell you from personal experience, these people are doing more harm to their children than good."

The problem is that the science clearly says the opposite:

"At the end of 14 months, core ADHD symptoms were reduced more in the children treated with stimulants than with behavioral therapy. However, at the end of three years, 'medication use was a significant marker not of beneficial outcome, but of deterioration. That is, participants using medication in the 24-to-36 month period actually showed increased symptomatology during that interval relative to those not taking medication.'"

http://www.madinamerica.com/madinamerica.com/Children_files/...

"At the end of six years, medication use was 'associated with worse hyperactivity-impulsivity and oppositional defiant disorder symptoms,' and with greater 'overall functional impairment.'"

http://www.madinamerica.com/madinamerica.com/Children_files/...

"Within 21 months, 11 percent of children treated with a stimulant for ADHD developed 'psychotic symptoms.'"

http://www.madinamerica.com/madinamerica.com/Children_files/...

"Two-thirds of the adolescent patients hospitalized for mania at the University of Cincinnati Medical Center had been on stimulants 'prior to the onset of an affective episode.' Stimulants, the researchers concluded, may 'precipitate depression and/or mania in children who would not have otherwise developed bipolar disorder.'"

http://www.madinamerica.com/madinamerica.com/Children_files/...

via http://www.madinamerica.com/madinamerica.com/Children.html

I don't have time for a full rebuttal, and it may well be true that medication is a worse approach to ADHD treatment than behavioral therapy. However, I want to point out by example that science is not true that "science clearly says" this.

---

1. "At the end of 14 months, core ADHD symptoms were reduced more in the children treated with stimulants than with behavioral therapy. However, at the end of three years, 'medication use was a significant marker not of beneficial outcome, but of deterioration. That is, participants using medication in the 24-to-36 month period actually showed increased symptomatology during that interval relative to those not taking medication.'"

If you actually look at the data, it shows that all participants (behavioral, combined therapy, medication only) showed marked improvement at the end of 14 months, then deterioration from the 14 month improvement at 36 months.

In conclusion, all participants showed improvement at 36 months versus their scores at the start of the study.

Additionally, they found that a number of participants who begun in the the medication group stopped using their medication after 14 months (down from 90% at 14 months to 70% at 24-36 months). Whilst, on the converse members from even the behavioral and community care group begun to use medication through out the study (up to 40% in the behavioral group. 60% in the CC group).

Their conclusion says it best: "It would be incorrect to conclude from these results that treatment makes no difference or is not worth pursuing.... medication management-may only make a persistent long term difference if it is continued with the same intensity as during the MTA's initial 14 month period".

----

2. "At the end of six years, medication use was 'associated with worse hyperactivity-impulsivity and oppositional defiant disorder symptoms,' and with greater 'overall functional impairment.'"

As compared to whom?

--------

3. "Within 21 months, 11 percent of children treated with a stimulant for ADHD developed 'psychotic symptoms.'"

ADHD is usually treated at the same age when psychosis is first diagnosed. It could be that ADHD symptoms are positively correlated with psychosis.

A close reading of the paper might actually provide that data.

Even if the side-effect does exist to some degree that does not mean that it is "clear" that the drug isn't beneficial especially considering the 89% of children that didn't experience this side effect.

Traditionally, what is done is more work into identifying those who could suffer from damaging side effects early and shunting them out of a medication program.

----

That's about all I can do now, but essentially there is no indication that stimulant medication is wholly poor performing and that early studies indicating efficacy were flawed.

What there is is evidence that side-effects exist, and preliminary investigation into the degree and distribution of those side-effects.

Additionally there is strong evidence that medication use is variable amongst participants versus other drugs for chronic conditions where drug use is sustained.

Thanks for your response. Here are a few issues I would raise though:

"It would be incorrect to conclude from these results that treatment makes no difference or is not worth pursuing"

They are defining treatment as either medication or therapy, not just medication.

"medication management-may only make a persistent long term difference if it is continued with the same intensity as during the MTA's initial 14 month period"

OK, but this is completely speculative. The researchers don't even give any reason to believe that this would be true, let alone point to any evidence.

"It could be that ADHD symptoms are positively correlated with psychosis."

The research states that all of the kids who developed psychosis were on ADHD meds, the group that was diagnosed with ADHD but was not medicated did not develop any psychosis at all.

"there is no indication that stimulant medication is wholly poor performing and that early studies indicating efficacy were flawed."

There were no early long-term studies indicating efficacy though, these are the only studies that were ever done.

If we're getting into a debate of whether medications can have other effects than intended, I cannot argue that.

ADHD and ADD should be treated in completely different ways. People diagnosed with ADHD have a much higher chance of psychotic symptoms than those who are only of the inattentive type. Then there is the old saying, "if you've seen one child with ADHD, you've seen one child with ADHD."

In my experience, and for many others, it has provided a world untold, halted depression, increased motivation and enjoyment in life. Stimulants aren't perfect, but we're throwing the baby out with the bath water when we ignore their usefulness.

This highlights the problem in my mind. We're not dealing with very well-grounded science here, we're dealing with statistical improvements from a shotgun approach to medication for a set of somewhat subjective symptoms. Most people who take the drugs are going to get decent results for a while. Some people will get great result for a long time. Unfortunately this leaves everyone else.

I agree with the shotgun analogy, it is certainly true. Hopefully advancements in individual genome sequencing and the advancement of personalized medication seeks to improve upon this point.

What you're experiencing now is called the honeymoon period. You can go Google for what people on r/drugs have written about their experiences with this, or you can just wait to find out on your own.

edit: http://www.reddit.com/r/Drugs/comments/excne/advice_needed_h...

It may be my honeymoon period, but plenty of others who are well past their honeymoon period and still enjoying the benefits of stimulants.

Again, it's not a perfect drug, but it works if you use it as a tool and not as a silver bullet.

Your experience is yours. How long have you been on medication? What medication specifically?

I've heard that some new meds are not stimulant. They might be good. But the old Ritalin/Adderall stimulants have quite possibly caused the psychotic symptoms you are talking about. That's what they do.

Are you familiar with street meth? Ritlain/Adderall are pharma grade long duration forms of that. They have made me crazy before. And they don't "Halt Depression" they get you so busy you that you won't reflect on yourself.

Artificial increases in motivation are silly. If you aren't inspired on your own to do something, you probably should be doing something else.

Stimulants are much less than perfect and throwing out a pharma grade street drug with the bath water is fine with me. It's drugs or it's not.

There are ways to handle ADD/ADHD without drugs. Change the environment. Forcing kids to take meth is just wrong.

> How long have you been on medication? What medication specifically?

I'm on Concerta. It's effectiveness outweighs Ritalin according to most. I've never used Ritalin or RitalinXR nor would I, since much better drugs have evolved, and will continue to evolve.

> Are you familiar with street meth? Ritlain/Adderall are pharma grade long duration forms of that.

I'm not going to try and make a case against your experience, since you could have very well had a negative experience with stimulants. One thing I know for certain, is that Ritalin/Adderall/Concerta are not the same as street meth - by any stretch of the imagination. Just because they are derived from certain drugs doesn't mean their potency, effect or side effects should be the same.

> Artificial increases in motivation are silly. If you aren't inspired on your own to do something, you probably should be doing something else.

For me, I get really sparked up about what I am doing but tend to have trouble executing the details because I'm getting overwhelmed with the overall concept. Does that mean I should walk away from an industry I love? Or are you saying I secretly don't love it?

> There are ways to handle ADD/ADHD without drugs. Change the environment.

ADD/ADHD should be a multifaceted approach and shouldn't lean on any specific treatment. Some may be better suited for behavioural therapy and meditation. Others may find themselves performing fine with medication with some extra fish oil. Regardless, everyone should explore all avenues to get a good understanding of how the condition effects the patient.

> Forcing kids to take meth is just wrong.

Firstly, no one should be forcing their children to take anything. The process should be more of: "Do you feel that you can concentrate better, or have a better sense of being while on this medication?" If the answer is "No", then obviously your child stops the medication. The child actually gets a say in the matter.

Now if you want to talk about forced treatment, examine for a minute, circumcision - wrong on all fronts. There is now no plausible reason for people in the developed world to have this procedure done and yet it is being done around the clock without any permission from the human being its being done to.

If you're willing to throw out a "pharma grade street drug" then wouldn't you be willing to throw out any pharma-grade drugs that are used directly on the street such as codeine, morphine, Valium, Vicodin, and any other broad spectrum pain reliever.

Not pain meds for legit pain.

But as a ex-addict of benzos I would restrict those to epileptic patients...

The data on benzos for mania, depression, and suicide is scary. Long term use has terrible effects.

Most docs don't prescribe the heavy ones for psychiatry anymore. Seizures are a different story.

"Most docs don't prescribe the heavy ones for psychiatry anymore. Seizures are a different story."

Benzos have actually made a huge comeback recently, and are quickly catching up to their peak prescription levels in 1975. In 2009, benzos were 3 of the top 20 most-prescribed psychiatric drugs prescribed in the US:

1. Alprazolam (Xanax) 44,029,000

3. Lorazepam (Ativan) 25,868,00

10. Diazepam (Valium) 14,009,000

There were 83 million prescriptions for benzos written in 2007, as compared with 103 million at their peak in 1975. (Granted there are more people today, but still.)

source: http://www.erowid.org/general/newsletter/erowid_newsletter18...

(And also Anatomy of an Epidemic, p. 131)

That is scary.

My experience,when I was addicted, was that I couldn't find a doc to prescribe them for me. Was it the dead-faced junkie staring back that prevented it? Probably.

It's sad they are so heavily prescribed again, because I know how it feels to rely on a pill to stop the pain and get out of my own head/anxiety. I'm lucky to have found another way.

"Are you familiar with street meth? Ritlain/Adderall are pharma grade long duration forms of that."

No they're not, you apparently don't have a clue about the pharmacological aspects of Ritalin.

To all intelligent readers: please ignore the trolls in this thread, there is a small but vocal group of opponents who build careers out of applying to parents' feelings of fear of medications and the guild of having their children on it. Then when parents are confronted with ADHD they go looking for information and the first things they find on the internet are these nutcases - it's like searching for information on the objective potential issues with eating meat and ending up on a PETA site.

Dextroamphetamine is a psychostimulant drug which is known to produce increased wakefulness and focus in association with decreased fatigue and decreased appetite. Drugs with similar psychoactive properties can be referred to or described as "amphetamine analogues", "amphetamine-like", or having "amphetaminergic" effects. Enantiomerically pure dextroamphetamine is more potent than racemic amphetamine and has stimulant properties similar to racemic methamphetamine, though it is less potent and has not been shown to cause neurotoxicity, which is associated with methamphetamine use.

Wikipedia.

And I work in IT.

Right, and Wikipedia exactly proves my point! Ritalin != 'a more potent form of crystal meth'. Yes it's chemically related, and yes it has in the abstract and in people who do not have ADHD similar effects, but no it's not the same. H1N1 and seasonal flu are both influenza strains, except that one kills tens or hundreds of millions over a few years and the other one everyone gets once every few years and shrugs it off with a few days in bed. Does that mean that they're all the same?

In this case the weasel words are "has not been shown to" which of course is not the same as doesn't.

I'll address just one part of this.

It may seem a bit counter-intuitive, but stimulant therapy actually reduces problems with substance abuse for those diagnosed with ADHD. This is because people with ADHD are already at great risk for developing comorbid substance use disorder.

http://pediatrics.aappublications.org/content/111/1/179.full...;

Any time you expose a person to stimulants there is a risk that they can develop mania, addiction, etc. However people with ADHD are already doomed in this regard, and avoiding treatment for this reason is foolish.

Also, I should disclose my bias, I'm diagnosed ADHD-pi, and a stimulant non-responder.

"via http://www.madinamerica.com/madinamerica.com/Children.html

Please, a few cherry-picked quotes from the site of a journalist with no medical qualifications whatsoever who has made a career out of crusading against psychology in general. I have a couple of links to sites that will prove how smoking is in no way or form related to lung cancer, or how God will punish all us sinners who don't support executing gays, would you like to read them too?

I'm glad to hear this as well, and even more glad to hear it today. Despite being medicated, I still struggle to focus on activities which are not intrinsically interesting to me. Even though I want to focus, paying attention to work that is not intrinsically interesting to me requires extreme levels of self-control and leaves me feeling mentally and emotionally drained. And just yesterday, when I was unable to access my medication for 24 hours, I had what can really only be described as a nervous breakdown at work from trying to make myself focus. I don't want to use this as an excuse for not achieving, but having scientific evidence that this is a "real" thing--and not just a set of bad habits and lack of concer--helps reduce the stigma that only compounds my problems. I don't want to be held to a lower standard, but I do want to be afforded the grace given to people with other mental health issues.

I also have that problem, inability to concentrate on non-intrinsically-interesting mental activities combined with huge emotional/energy drain when I force myself to.

I'm curious how normal it is for humans to be able to concentrate on non-intrinsically-interesting mental work, though. I can believe that there's a range of skill in it, but can't seem to find data on the range. From what I can tell in academia, very few people actually have the level of concentration considered "normal" or "expected" without either taking some variety of medication, or mustering exceptionally draining bouts of force-yourself-to-concentrate. There are a few exceptionally-good-at-concentrating people, but I suspect they're actually the abnormal cases, representing the top 10% of some bell curve.

It'd be interesting to see data, anyway. For example, I'd be interested to know what the average +/- 1 or 2 stddevs is among the population on a test of ability to concentrate on non-intrinsically-interesting mental work (if that can somehow be measured). Similarly, for diagnosis myself, I'd be more interested in a percentile number than anything; rather than just saying that I suffer from poor concentration on non-intrinsically-interesting tasks, I'd like to know how poor my concentration is relative to the median. Does "poor" just mean that I can't match what the top 10% of the population does? Or does it mean I'm in the bottom 10%?

The standard workplace expects you to concentrate on work for 8 hours a day. Barring the occasional firedrill (which provides enough stimulation) I struggle with it too. Does nobody else surf the internet when they should be working? Do people actually work for a solid 8 hours (not just be at work, but actually working?)

I think the idea of it as a bell curve is a good one - ADHD is supposed to be the poor bottom end. But I do wonder what average really looks like.

I think more, parents don't want to admit that their child has a problem. How do you know your child has ADHD, or if he/she is just being lazy, or not concentrating hard enough?

A lot of Asian parents find the two synonymous.

I've seen the opposite more often: people who set no boundaries for their children have out-of-control kids. Instead of it being bad parenting, it must be ADHD. Quick, medicate him so I don't have to put up with him. At least in the pediatrics office my wife works in, they are trying to stop that.

Btw, I don't mean to imply ADHD doesn't exist or is only a result of bad parenting. It does and it isn't.

I'm one of those people who wishes they were diagnosed as a kid.

I've been diagnosed by two different psychiatrists with ADHD. I've been on Adderall (XR) at dosages up to 80mg, Strattera, Wellbutrin XL + 10mg Adderall (actually my favorite, but not so effective), and now I'm on Concerta (Ritalin) 27mg/54mg.

The 27mg dose of Concerta is minimally effective without affecting my sleep, so sometimes I need to boost it. I hate stimulants though, and I wish I could get along fine without them but it's just not possible. Strattera worked good but the "sexual side effects" were too weird for me to continue on. Wellbutrin + Adderall worked okay (with the benefit of me generally being a bit happier) but my psychiatrist after moving didn't want me on two medicines that can raise your blood pressure.

I ended up going to 6 different schools between 8th grade and graduating across 4 different cities. Despite that, I graduated high school with a 3.5 and started college as a Sophomore. My first semester in college I got a 1.8 and thrown in academic suspension. The next three years would be really rough. After that, I went to my family doctor and got adderall, and that helped out a lot at first, but it wasn't a miracle drug and I still had to really force myself to concentrate in weird ways to get through school, and that's really where the adderall helped. Towards the end, school got easier and I enjoyed it more, but I could also sit down and do homework.

I've gone off meds completely for a few months at a time almost once a year, and I just can't do it. I wish I would have been diagnosed with it as a kid and had the behavioral therapy along with it instead of having to wing it for the past 6 years, but that's in the past. I also wish there was a non-stimulant that worked really well without side effects too, but for now, I'm happy with the Concerta.

I'm 26, and I was diagnosed with ADD last year, at the suggestion of my dad, who was not diagnosed until his 40's. It took me almost a year to start actively researching ADD, because I grew up in an upper-middle-class community where it was primarily over-diagnosed in unmotivated kids whose parents were convinced that brain dysfunction was the only thing that could possibly keep their children from being A students. To say the very least, I was skeptical.

When I finally began learning about ADD, I was startled by how standard my story was. Reading Driven To Distraction was a watershed experience for me; at times I was convinced that they had simply copy-and-pasted my academic transcript: "Dreamer," "Has a creative mind that would produce incredible results if he applied himself once in a while," "Inconsistent. What happened to the A student sitting in my classroom last year?"

In perspective, so much suddenly made sense; not just my experiences in high school, but beyond that as well. I failed only one class in my entire academic career, a programming course in my second year of college. How ironic and confusing that my only failure would be in the subject for which I had the most passion. Now it made sense. Only two or three years ago from today, I almost lost my job because my output was so inconsistent. I barely scraped by and recovered, but the experience shook me. Now, I understood.

There are many forms of treatment, all of which I have experimented with. When it comes to medication, it took me a long time to settle on Adderall, which lets me focus like a normal person without any appreciable side-effects. The drug was a game-changer for me, like the first time I put on glasses.

I think I'm glad that I wasn't medicated as a kid, if only because of a deep uncertainty about medicating something as malleable as a child's brain. Conversely, going 25 years without diagnosis has also drastically affected every part of my life. (I have no idea how my dad dealt with it for almost 50 years.) This was also something that I grew to understand as I learned more about ADD; undiagnosed, it can lead to perennial struggles with depression, self-esteem, poor impulse control and a host of others. I think the most important thing about ADD isn't necessarily medication or even "treatment" but simply awareness.

"Laziness" is a symptom, not a root cause. If we can be mindful about the signs of ADD in childhood, we have already taken a huge step towards improving the quality of life for people with the disorder, and everyone they interact with. I'm sure there will be debates about how to treat it for many years to come, but simple awareness can only help.

I literally double-checked to see if this was copy/pasted from an old post of mine. Getting treatment for ADHD changed my life for the better immediately and dramatically, as well. And I've even used the, "It's like putting on glasses for the first time" metaphor.

Glad to know my post resonated with someone! I still struggle almost daily with ADD-related complications, but getting on the treatment bandwagon was a huge step forward.

Still struggling? That's kind of depressing. Sorry, hope it gets better.

BTW, your website (http://mattdeboard.net) appears to be down. (Just FYI)

Yeah thanks, I need to tweak apache workers

You said you got diagnosed on advice from your Dad, what exactly should somebody look for before they go to a doctor and get diagnosed? Are there any sure signs? How does somebody know that they're not just lazy or have a short-attention span.

My dad's advice was the last grain of rice. Getting diagnosed was the result of a long period of slowly accruing more information about the disorder. If you suspect you might have it, it's worth going to see a psychiatrist or psychologist; if you don't really have that kind of time or cash, then buy or borrow "Driven to Distraction", which has a section devoted to figuring out whether you have it.

Even if you don't, reading the book will probably still give you some insight into your own personal habits!

Check out the virtual doctor at totallyadd.com[1]. They have also a very informative PBS documentary.

[1] http://totallyadd.com/virtual-doctor

Same story. My greatest passions had been sore areas of chronic evasion and it frustrated me immensely. Amphetamine changed my life.

Another popular (anecdotal) explanation why this disorder is more prevalent in America is that somehow the same genetic trait that motivated inviduals to pack up and move to another continent, when amplified (after hundreds of years) is somehow responsible for hyperactivity.

Basically "the settlers were a restless folk" they all come to America and breed with each other, after hundreds of years you end up with a good number of people who are "too restless to function".

Anway that is one popular theory, not sure if I personally endorse it but it would seem to be somewhat supported by this find.

Of course the counter-point could be that doctors + parents + pharma companies are just more eager to diagnose it in America, and I can see that happening too somewhow.

Nahhh. I think it has more to do with people being dead poor in their own countries and is why they immigrated to America (Occam's Razor), better opportunities. It is still the reason why people come to America today. Also, too many people want to use disorders as an excuse for their lack of success. "See, is not me, I'm actually pretty smart, is this damn disorder that is holding me back. Not my fault."

The overwhelming majority of "dead poor" people still wouldn't leave their home country. Most people have very, very strong ties to friends, family and familiarity and have great difficulty with the concept of uprooting thier life, no matter how bad, in such a manner.

> Children with ADHD have a significantly higher rate of missing or duplicated DNA segments compared to other children

The problem with this study is they looked at kids who had been diagnosed and were on long term drug therapy. This is similar to studies that show that ADHD diagnosees on long term drug therapy have "brain damage", which matches the brain damage of long term stimulant users. The findings are not an indicator of ADHD, they are indicators of brain and genetic damage from long term drug use.

Much more effective than Ritalin, and safer, for treating ADHD is the prescription drug Desoxyn. It's not used as much because of the stigma of taking methamphetamine hydrochloride. I mention this because everyone agrees that methamphetamine is not an innocuous drug to take long term, the same goes for Ritalin, they both have very similar effects on brain chemistry.

This is not at all similar. It would be highly surprising to me to find that long-term exposure to ritalin leads to deletions and copy number variations in someone's DNA. Furthermore, it is improbable that a drug causing DNA changes would cause the same changes across a population in a statistically significant way. Can you point me to any research that shows this to be the case?

For me, ADHD isn't a disorder as much as a collection of personality traits. I have a bunch of traits I constantly have to look out for to ensure I complete work, and I've built a system so that I can cope really effectively, w/o medicine.

To argue that it's any other case is sorta weird.

I don't think "disorder" and "collection of personality traits" are mutually exclusive terms.

I guess to be more specific: I don't think this should be treated as a medical condition. I'm in the Temple Grandin camp of neurodiversity.

http://en.wikipedia.org/wiki/Neurodiversity

I agree with you. I don't think just because one's trait isn't optimal to the modern environment it should be as a mental disorder and try fixing by medication.

ADHD is a real problem, but the rate at which it's diagnosed, and the rate that kids are just thrown Ritalin and other drugs is alarming. A child's brain is a very plastic environment that is still developing. The impact it can have on the brain is not as predictable as a developed adult.

It would be foolish not to try more sensible approaches like diet/exercise/parenting FIRST, and if those have no impact, then consider alternatives. However, this is not how parents of today approach problems. They want the quick fix: give my child a pill/shot/instant gratification, so I can get back to my job.

Also, this article is from Sept 2010.. not exactly news is it?

I think this article understates one point. ADHD is already known to be highly heritable, which already tells you genes are involved.

http://i.imgur.com/G7jDX.png

Also, the first association between ADHD and polymorphisms affecting the dopamine transporter was found in 1995.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1801209/

This study is nearly a year old. Even at that, it is not an example of the first eidence that ADHD is a genetic disorder. There's at least one other study from 2009 (http://www.research.chop.edu/publications/press/?ID=475) that had similar evidence.

This is a debate about a pseudoscientific norm set by a bunch of "experts" who evidently dislike children and have convinced millions of parents their children are sick because they fidget in class.

First, I do not believe ADHD is an disorder. It's a certainly a condition, but it's not an disorder. And so I say this: ADHD is a genetic advantage and not a generic disorder.

The term ADHD is meaningless. It is simply the level of activity deemed excessive by the "expert" making the diagnosis.

Interesting. Is there any way I can volunteer my DNA for them to have a play with? I was on Ritalin all through school.

"ADHD" is not a medical condition. It is the level of activity deemed excessive by whichever "expert" is making the diagnosis. It was voted into existence by a show of hands.

Genetic? I highly doubt th... Squirrel!

Reply on news.ycombinator.com