He does say that there hasn’t been time for evidence of the long term dangers to become apparent.
Do we know that accidents are the causes of excess mortality for people with unmedicated ADHD, or are they deaths of despair because of a lack of accommodation?
Edit: Looks like there is evidence supporting the idea that it’s accidents.
I would still be cautious about assuming this is true given how weak almost all social science and medical research is.
> The reduced ELE linked to ADHD was found to be a function of the first order variables of less education, less annual income, greater consumption of alcohol and tobacco, diminished sleep, and poorer overall health status relative to the control group. Moreover, ELE was also shown to be a function of the second order traits of deficient behavioral inhi- bition in daily life and, much less so, of low verbal IQ, greater interpersonal hostility, and deficient nonverbal fluency.
and:
> For instance, besides ADHD-C itself, this study showed that behavioral disinhibition (as assessed by EF ratings in daily life), verbal IQ, the comorbid psychopathology of hostility, and the EF of nonverbal fluency (and its associa- tion with nonverbal working memory) all uniquely contrib- uted, in descending order, to variation in life expectancy. The largest percentage, however, by far was contributed by behavioral disinhibition.
Nigg (2013)[2] says:
> ADHD is clearly associated with worse physical health outcomes across multiple domains. These include unhealthy behaviors and outcomes like smoking, illicit substance use disorders, accidental injuries, obesity, and even suicide attempts and completed suicides.
----
Basically, having ADHD means you have less self-control, engage in riskier behaviour (including riskier eating habits, substance abuse, driving, sex. It also means you struggle in life, resulting in suicidality, aggressiveness and anti-social behaviour. You sleep worse. You're more likely to smoke because nicotine is a stimulant which has a medicating effect on ADHD symptoms.
[1]: Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors, Barkley 2018
[2]: Attention-deficit/hyperactivity disorder and adverse health outcomes, Nigg 2013 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322430/)
This is the stuff that seems like it could be dealt with by society being more accommodating rather than drugs.
How do you define “chores”? It’s seems very true that people with ADHD find it hard to get through a to-do list in a linear fashion. If that is what it means to do chores, then maybe there is a way to prevent rubbish accumulating that doesn’t require that of you.
> that doesn't change that most of my friends don't find it difficult to take out the rubbish if they want to.
Do you want to take out the rubbish? Or do you start out wanting to and then want to do something else?
Both can occur but the first one is more problematic: I want to take out the rubbish but it feels like torture to force myself to start the task. It's not something easy to explain if you haven't experienced it, but it feels something like there's an invisible wall that prevents me from starting.
On meds there is almost no wall. I simply choose to do something and start doing it. It feels miraculous to me. Society has nothing to do with it.
I have had that experience and I know others who have it too. From my point of view that wall is me not wanting to do the task. The idea that I want to is not the same as actually wanting to. If I stop thinking that I want to do the task, and just do what I actually want to, then I will do a lot of different things, one of which will be taking out the trash.
The same goes for to-do lists. If I put things on a to-do list, it is almost impossible for me to make myself do any of them, let alone in order.
If instead I write them down on the list, but then just let myself do whatever is in front of me that feels like I can easily do, then things will simply chain together and I’ll find that I’ve done the things on the to-do list along with a l bunch of other turns that turn out to have been worth doing to.
> On meds there is almost no wall. I simply choose to do something and start doing it. It feels miraculous to me. Society has nothing to do with it.
In my view society has everything to do with thinking we need to do things in a linear fashion. I don’t dispute that meds will help you do that, nor do I dispute that work may require that you do it.
I do dispute that we need to operate that way.
I'm hesitant to agree with this statement outright -- on the population level, I do think it makes sense to pursue interventions that increase life expectancy. But on the individual level we must ask, are we comparing apples-to-apples years of life? For example, I would pick 10 years of life with vitality over 12 years with mobility issues.
For ADHD medication specifically, for most people diagnosed with ADHD I would expect to see both improved life quality AND life expectancy. Of course, specific individuals may experience worsened life quality on medication, in which case they will have to weigh up whether they want potentially longer life with lower life quality.
Given the kinds of mortality causes from ADHD, I would think the calculus looks more like "ADHD meds make me feel yuck but maybe that's worth it to not get fired regularly, because my family needs me to support them financially and being fired regularly makes me depressed and suicidal".
https://doi.org/10.1176/appi.ajp.2008.07091465
https://doi.org/10.1097/chi.0b013e318157cb3b
https://doi.org/10.1097/01.chi.0000128797.91601.1a
You done much reading on the subject to the contrary you can talk about? Any books on the topic you’ve read that you can name?
Have you? Or did you just find some papers that support your view with a quick search?
Remember, most social science and medical research from this time period is now considered very weak.
A few papers don’t make a ‘well established consensus’.
I also have a pretty heavy background in stats, I’m well aware of the replication crisis, and I’m deeply skeptical by nature. My opinions are backed by an overwhelming preponderance of evidence, which you seem to feel qualified to criticize despite not having been aware of its existence until today, much less having actually read any of it.
Did you try looking for more papers to confirm if it was really just a few? If so, what did you see?
I feel qualified to question anything I like on an Internet forum, as should everyone. To defer to your opinions without you stating your qualifications would be idiotic.
Throwing up a few links and expecting people to know that you have read over 100 papers and 6 books makes no sense at all.
Nobody is going to treat you as if you are an expert on the subject unless you show them why they should. Until this point you’ve just been making claims from authority.
> The drugs have been around for decades. Using them daily with increasing numbers of children during a decade or so of brain development, has not.
is harmful medical misinformation though. I do think most people reading a confident assertion like yours on this particular forum would assume a personal/academic history or at least some solid background knowledge with the topic at hand to be backing the claim.
I would rather not flaunt my credentials. You shouldn't believe me - you should believe the sources available at your fingertips. Wikipedia's not a bad start if you don't like reading academic papers.
“The long-term effects on the developing brain and on mental health disorders in later life of chronic use of methylphenidate is unknown. “
It comes from Wikipedia, which presents nowhere near as rosy a picture as you do. In fact it supports my position that we are nowhere near as clear about the effects of these drugs as you confidently claim.
Here’s another one:
“A 2008 review found that the use of stimulants improved teachers' and parents' ratings of behavior; however, it did not improve academic achievement.[56] The same review also indicates growth retardation for children consistently medicated over three years, compared to unmedicated children in the study.[56] Intensive treatment for 14 months has no effect on long-term outcomes 8 years later.”
https://en.m.wikipedia.org/wiki/Attention_deficit_hyperactiv...
If you think this is harmful Medical misinformation, perhaps you should edit the Wikipedia page rather than asking people to read it.
The first quote is a symptom of you choosing to seek your information from the “ADHD controvieries” page in bad faith instead of reading the normal, better-edited pages on the topic (note the page is flagged and not well-maintained). It’s not bad science, but the citations are outdated - from before the era of mainstream fMRI data, which has been arguably been the biggest new source of understanding on the subject over the past twenty years. Additionally, the second source quoted, which is by far the more relevant one, focuses on preschool-age children and makes its claim in that context - context which you chose to edit out.
Your second quote is a relatively mainstream finding. There’s not a robust linkage between academic performance as determined by grades and medication-based ADHD treatment.
It’s not bad faith. There is much more than what I quoted that is reasonable to question about ADHD research and treatment.
What is bad faith is to tell people not to look at the contradictory results. If you choose not to look at results that don’t confirm your view, then of course you will think there is a consensus.
> Your second quote is a relatively mainstream finding. There’s not a robust linkage between academic performance as determined by grades and medication-based ADHD treatment.
That suggests strongly that the drugs are prescribed to benefit teachers and classmates, rather than the individual with ADHD who doesn’t gain.
What is bad faith is to tell people not to look at the contradictory results. If you choose not to look at results that don’t confirm your view, then of course you will think there is a consensus. There's plenty of evidence to suggest medications benefit individuals with ADHD, e.g. lower rates of substance abuse in adulthood, higher rates of academic achievement (as in graduation rates/highest level of degree attained), visible normalization of volume in areas of the prefrontal cortex associated with executive functioning compared to healthy controls.
My primary goal here is to demonstrate publicly that you're an uninformed crank who doesn't know the subject, so that parents don't deny potentially life-changing medication to their kids. You changing your mind would be a nice bonus, but not necessary. Thanks for talking long enough to out yourself.
The only person who has told anyone not to look at anything is you. If you can find somewhere where I am telling people not to look at things, then you might have a point.
> My primary goal here is to demonstrate publicly that you're an uninformed crank who doesn't know the subject,
Inspector Javert enters stage right!
> so that parents don't deny potentially life-changing medication to their kids.
Noble, but you haven’t demonstrated that. You’ve made some unsubstantiated claims to your own expertise on the subject but otherwise you are just another commenter on the internet, who is a strong advocate for medications.
You say, ‘potentially life changing’, and of course there are people who have that experience. But you say potentially, because it would be a lie to claim certainty.
> lower rates of substance abuse in adulthood, higher rates of academic achievement (as in graduation rates/highest level of degree attained), visible normalization of volume in areas of the prefrontal cortex associated with executive functioning compared to healthy controls.
None of which can be attributed directly to the effects of medication. Substance abuse and lower executive function are well established sequelae of adverse childhood experiences.
It’s fairly easy to see that if drugs make kids easier for schools and families to manage, then they will have fewer adverse experiences, so there is a causal pathway that supports this outcome.
And frankly if you as a family can’t handle an ADHD kid, or find suitable education for them, such that you won’t end up problematizing them, then indeed medications will be a benefit.
Nobody is questioning that.
However a singleminded focus on medication, a denial of the trade-offs, and a refusal to consider the context, means we can only look at it from this dismal perspective, and renders us incapable of recognizing that medication is not in fact positive for everyone with ADHD.
We know that there is a wide range of different relationships to medication use chosen by diagnosed adults. By no means all of them choose to use it as their only tool, or even at all.
I know you are focused on defending medication, but I think you’re doing so to the exclusion of every other consideration, and it’s not clear why.