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Comment by cameronh90 | Hacker News Reader

An incredible number of people seem to have ADHD now, and the number of people being diagnosed lately (particularly young adults) seems to have shot up.

Is it really possible that this many people are ill, or is society expecting impossible things from people and ADHD-like symptoms are the consequence. Or is it something else?

I'm not trying to diminish the people who have been diagnosed with ADHD and I don't doubt the medication can be extremely helpful. I'm just wondering how so many people can have this disorder before we stop considering it a disorder. Certainly I don't have any ADHD diagnosis but a lot of the symptoms resonate with me.

Alternatively, are we seeing early stage transhumanism? It stands to reason we're not particularly well adapted to modern society and maybe this is the beginning of adjusting our chemistry to be better suited to it (or was that caffeine?).

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ADHD isn’t a disorder in the sense that people that have it are “ill”. It’s a personality type, and the disorder part of it comes when the characteristics of that personality conflict with then life you lead.

So of course children with ADHD do not function well in classroom settings where they’re supposed to just sit still and focus on something they’re not very interested in, all day. Most kids have some trouble with that. Kids with ADHD personalities really struggle.

The same is true of adults. Some adults with ADHD gravitate toward professions that suit their personalities and thrive. Others have a lot of trouble trying to succeed in their work. A common pattern in high-achieving ADHD people is to do really well in school up until university, and then crash and burn once things get actually challenging.

There are also a lot of interpersonal issues that people with undiagnosed ADHD may face.

I think that the medication can help people with ADHD achieve things that they would really struggle with otherwise. (Note that the effects of the drugs are different to them compared to neurotypical people - you don’t get “high”.) But I’m not sure I agree with prescribing it to children. I think instead we should make schooling suit them better (and while we are at it, let’s improve it across the board - it is truly woeful atm).

> Certainly I don't have any ADHD diagnosis but a lot of the symptoms resonate with me.

The symptoms resonate with everyone because they are common experiences. The difference is a matter of degrees. You may procrastinate for a few days, but an ADHD sufferer will procrastinate for months and months.

I am going to say you are almost right. Yes, ADHD is a personality type, or a phenotype would be a better word. But this phenotype is not expressed the same 24x7 by people with ADHD. Sometimes their symptoms are easier or more difficult to manage. Why? This is because of the environment (diet, stress, etc).

It is when the phenotype encounters and unmatched environment for the genetics that we find there is an expression of disorder.

Isn’t that what I said in my first paragraph? What am I missing?

I am saying, a child with ADHD might not have problems sitting in school if they have enough Omega 3 or B6 for example.

Yeah great point thanks.

> ADHD isn’t a disorder in the sense that people that have it are “ill”. It’s a personality type, and the disorder part of it comes when the characteristics of that personality conflict with then life you lead.

If it was a personality type, you wouldn't be able to treat it with medication. It's a difference in physical brain structure the same way schizophrenia is. There's far less side effects to Adderall than most other psychoactive drugs like SSRIs.

> You may procrastinate for a few days, but an ADHD sufferer will procrastinate for months and months.

Plenty of more physical effects than that, it's not all at the conceptual level. You also can't sleep well and your heart rate variability is different.

> There's far less side effects to Adderall than most other psychoactive drugs like SSRIs.

I would be cautious about saying that. They're very different and hard to compare directly.

Adderall can cause or worsen hypertension, which can cause cardiac issues or stroke. It can also trigger anxiety and, particularly when abused, psychosis.

If you stick to a low dose it's relatively benign, but with it being so intensely addictive, that's a significant challenge for some people.

SSRIs have worse psychological side effects, especially in the start up phase, but they're fairly safe physically provided you don't mix them with other serotonin drugs.

Personally I can't hack Adderall as it makes my anxiety reach psychotic levels while also making me quite sleepy.

Oh, I meant to say mental side effects. But don't SSRIs need a ramping-off period if you stop taking them? With Adderall you just get a bit tired for a week.

I also don't find it addictive at all, ie I often forget to stop taking it. Forgot today in fact. The non-stimulant ADHD drugs like Intuniv are actually substantially more habit-forming, in that you can't quit them cold turkey or your heart rate will be quite affected.

> If it was a personality type, you wouldn't be able to treat it with medication.

I don’t follow your logic here. Why do you say that? FWIW what I’m saying here is supported by psychiatrists who prescribe the medication.

> Plenty of more physical effects than that, it's not all at the conceptual level.

Of course, I just gave one symptom that many people find relatable when looking at the list of potential ADHD indicators. The symptoms you mention can also be indicators of ADHD but many people can’t sleep or have variable heart rates unrelated to ADHD, so thanks for these physical examples.

> I don’t follow your logic here. Why do you say that? FWIW what I’m saying here is supported by psychiatrists who prescribe the medication.

That's interesting, because I was thinking of something my psychiatrist said - he explained it as something like "your frontal lobe doesn't work properly" and compared it to a lightbulb flickering on and off. Of course, his practice targets engineers and I expect he just says things that sound good.

But they also start off by prescribing medication before anything else, and then diet and exercise. For a personality disorder or something like PTSD, wouldn't you start with therapy and then consider medication after?

Some therapists do suggest other things before medication. More often than not a combined approach of medication, therapy, and lifestyle changes is recommended.

Psychiatrists tend to reach for medication because it’s one of their most powerful and effective tools, and it tends to offer fast and immediate relief. And with the effects of medication it can be easier to then make other changes.

There’s an argument that goes as follows: in a hunter/gatherer context, ADHD is beneficial because the natural world is so rich, an attention flitting around looking out for a potential prey hiding quietly in the trees, berries nestled in leaves, a predator that might lurk behind, etc… would be a good thing.

In a world where kids are expected to sit their butt on a chair 8 hours a day listening to a burnt out adult babble incessantly, not so much.

In one article I read lately the author called the neural typical world “dopamine addicts”. As in modern societies favor humans who get dopamine from “following rituals”. At first I thought it was a bit absurd sounding, but it stuck in my brain and is a fascinating way of looking at the rise of ancient agricultural societies.

As in agricultural societies required following “rituals” of various types (when to plant, when to harvest) and therefore favored genetics that give dopamine based on following them without immediate understanding why they were. ADHD is then a set that of trait that persists in those societies to provide certain levels of novelty/progress (i.e. that stubborn ~5% ADHD across most all modern societies). My hypothesis is that it’d be near a game theory optimum. That optimum is now shifting in multiple ways, almost becoming more U shaped where extremes are more favorable.

I've often felt there's an optimal level of arousal for any given task. Pure creative tasks favour less arousal, organisational and physical tasks favour more arousal. Alcohol, caffeine (or coca leaves, khat, or similar) are tools we've used to shift our arousal needle closer towards what is useful for the task at hand. Unfortunately they do carry a number of pretty severe negative side effects - especially when you refine the coca leaves. In my past life, I would frequently myself spend the late night periods, sometimes a but drunk, coming up with new solutions to problems, then the highly caffeinated day time implementing them. It worked very well (until it didn't, but that's another story).

So, I'm all about self modification, but I think anyone playing that game would do well to bear in mind the potential negative side effects. Being able to grind out for days and weeks at a time may be extremely useful in the short term, but boredom is a powerful motivator for finding alternative solutions. Maybe not a good idea to turn that off for everyone, every day.

Also the medical industry has been proven wrong time and time again when they claim their drug has no long term side effects. People are still being told that SSRIs have no withdrawal effects.

On SSRI 100% yes. I can stop Concerta and not even notice it aside from taking an extra nap. Miss my SSRI - no way, major dizziness. But then again I don’t plan to stop taking my SSRI ever. In my mind people wearing glasses also have severe withdrawal symptoms. ;)

Unfortunately SSRIs can't be permanent for everyone. They completely fixed my anxiety, but also made me gain 50kg and completely lose my sex drive, so I had to get off them.

The withdrawals (for me there were brain zaps and confusion) didn't last forever though. However, my eyesight isn't ever going to improve ;)

> Is it really possible that this many people are ill, or is society expecting impossible things from people and ADHD-like symptoms are the consequence. Or is it something else?

I've never researched any of this but something does feel off to me.

Imagine going to a therapist and describing "I can't concentrate on anything, all I do is bounce around in 100 different directions". How long would it take for them to get diagnosed as having ADHD?

What if they don't have ADHD but are addicted to social media? If cases of ADHD have risen over the last ~15 years and ~15 years is when "popular" social media started, personally I find it hard to believe these things aren't connected in some way.

Like a lot of illnesses maybe a ton of people are susceptible to having their concentration broken by expected dopamine hits but in the past nothing engaged them in this way before so it wasn't even thought of as a problem. But now we have dozens of super optimized engagement tools and now after reading 3 paragraphs in a book you feel compelled to check XYZ site to see if someone liked or commented on something you wrote and you convince yourself you have ADHD.

I'm not downplaying ADHD or think it doesn't exist but it does make me curious how eerily inline the timing is with highly addicted tools fighting for your attention every day.

Lots of people are being diagnosed with sleep apnea now.

Does that mean something in the environment changed or are we just better at diagnosing it?

I don't mean to detract from your more general point, but given the associations that sleep apnea has with obesity (and even just non-obese elevated BMIs) I think that is very plausibly an environmental change.

> Does that mean something in the environment changed

Absolutely. Smoking and being overweight are huge risk factors for sleep apnea. It could also be something about how we're sleeping now.

Even so I think there's a difference between physical and mental disorders.

With physical disorders we mostly have pretty clear, objective and mostly society independent metrics for success, for example not dying and retaining mobility. If anything, our expectations have slightly reduced over time now that we don't need to walk for miles to fetch food and water. Yet still there are valid questions regarding over-diagnosis and over-treatment of benign conditions that we wouldn't have ever detected before PET-CT scans.

With mental health, metrics we use such as happiness and ability to do one's work and daily activities, which are themselves extremely environment-dependent. They even vary hugely within society. When asked "are you able to perform adequately at your job?", the answer might be completely different if the job is software development rather than being a journalist.

Then there's the deeper philosophical question of what are we even "supposed" to function like, and whether that's even a valid question to ask.

> Is it really possible that this many people are ill, or is society expecting impossible things from people and ADHD-like symptoms are the consequence. Or is it something else?

Civilization is humans, who are animals, pretending they are not animals. This pretending is often very hard.

What does that actually refer to—that humans pretend not to be animals?

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