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Comment by zepto | Hacker News Reader

> If your life expectancy due to taking ADHD meds improves by a couple years because you're less likely to crash your car or overdose on recreational drugs

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.

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There are actually a lot of causes. Barkley (2018)[1] says:

> 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/)

> It also means you struggle in life, resulting in suicidality, aggressiveness and anti-social behaviour.

This is the stuff that seems like it could be dealt with by society being more accommodating rather than drugs.

How is society being more accommodating going to help with me wanting to be able to live my life like a normal adult rather than struggling with simple things? It isn't society's expectations that make life most difficult for me, it's my own.

Where did you get your idea of how a normal adult lives their life, if not from society?

I did get it from society, of course. I wouldn't equate changing society's accommodations with changing how easy the normal adult finds life, though. Changing accommodations has no impact on how easy my non-ADHD friends find their lives compared to me. Society can accommodate my difficulty in doing chores but that doesn't change that most of my friends don't find it difficult to take out the rubbish if they want to.

> Society can accommodate my difficulty in doing chores

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?

> 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.

> 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.

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.

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