Comment by CodeMage | Hacker News Reader

Comment by CodeMage | Hacker News Reader

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It's more horrifying to me that HN has turned into a kind of place where people will confidently assert their judgment something they have no knowledge about.

My son has ADHD. There are other ADHD cases in the family, so we knew that could be the case with him, but we waited until he was in middle school to even try to check, because we didn't want him to "depend on drugs", as the trope goes.

We got the diagnosis from two different doctors, to be absolutely sure.

The medication makes a stunning difference, and it has nothing to do with complacency at all. It has to do with being able to focus better and to overcome an obstacle that people like me don't have.

And the medication shouldn't be the only thing to use for ADHD. It should be used as a tool to help, but that's just the start. It's important for the parents to work with a psychologist, for two reasons: 1) to help the child develop their own tools and strategies to overcome the cons of ADHD, and 2) to help the parents understand the child better.

Like I said, I don't have ADHD. The things my son has to struggle with are often difficult for me to understand and identify with. The medication helps so he doesn't have to struggle as hard. And he's less "complacent" than ever, and that's a good thing.

What you're saying is the equivalent of "it's horrifying to me that so many children are forced to wear glasses so they become more complacent in school".

Two things can be true at the same time. Some kids truly do have a disorder that benefits from medication. Some kids are prescribed medication they don't need simply so they are able to do something that no child should reasonable be expect to do: sit in a chair and listen to people talk at them for 8+ hours a day. One truth does not preclude the other.

> One truth does not preclude the other.

Do you have any evidence to support that children are prescribed medication to sit in a chair when they don't have ADHD at a high enough clip to warrant the appearance of being concerned about it at equal weight to actually getting those with ADHD help? Comments like this only further stigmatize getting those with ADHD the help they need, so before you make them you'd better be damn sure it's worth it or else you're taking part in stigmatizing parents who get children the help they deserve.

That's true. And it's also true that ADHD is overdiagnosed and overtreated, and the rate is non-negligible.

That is a problem that both the public and the medical community are aware of. I agree with maintaining awareness of that, but I strongly disagree with going to the extremes and stigmatizing ADHD medication and everyone involved.

Look at the comment I objected to. Does it read like a rational, polite way to maintain awareness of that problem? Or does it look like a knee-jerk judgment that's parroting a popular trope?

I wrote that it is horrifying so many children are drugged to be more complacent in school. I saw you objecting to that and assumed I'd need to come back and support the idea that ADHD is over diagnosed and over medicated (e.g. the diagnoses have about doubled in the past couple decades in the US and are substantially higher than in European countries and US pharmaceuticals have a history of being over prescribed). Yet now I find that you are already aware ADHD is overdiagnosed and overtreated - so what exactly are you objecting to in my original comment? You don't think it's horrifying that parents, teachers, and doctors are basically conspiring to drug kids to keep them from acting up in schools?

School is a pretty boring and restrictive place. Children are notoriously poor at dealing with boring things and young boys in particular are particularly prone to the kind of misbehavior that will get them in trouble and drugged.

I've already expressed what I object to: that it's a pithy, kneejerk, judgmental trope-parroting that does more to stigmatize the majority who want to help their kids, than to help combat the abuse perpetrated by the minority of bad parents.

It is remarkably difficult to find any figures even estimating the overdiagnosis and overmedication rates for ADHD. Most of the talk around this issue tends to make a big deal out of the rising rate of ADHD diagnoses.

Those who talk about it responsibly and rationally recognize right away that this doesn't necessarily mean we have an overdiagnosis crisis on our hands, and seek additional information. The best study I've been able to find about this [1] does indicate that there may be some overdiagnosis and overmedication going on, but even there it's not framed as "parents, teachers, and doctors are basically conspiring to drug kids to keep them from acting up in schools", nor does it lend any credibility to that claim.

Are there bad parents who don't want to deal with their kids' behavior and try to get them "drugged into complacence"? Yes, definitely. Do we know how many and how that number compares to other kinds of parental abuse? No, we don't. Is it a problem of epidemic proportions? There's no evidence for that, and the onus is on those of you who make that claim.

More importantly, if we distance ourselves from the sensationalist tropes about "drugging kids into complacence", we can ask a better question: are there currently any perverse incentives in the medical community to overdiagnose ADHD and overprescribe medication? This might be the case, but it remains to be proven and it should be dealt with just like any similar case of perverse incentives.

So what do I object to? I object to the sensationalist "Will Nobody Think Of The Children" overstatement and hyperbole. I object to people bringing up the same trope over and over again, out of ignorance, and doing their best to stigmatize the vast majority of us who are doing our best to provide our kids with the best life we can. I object to not trying to constructively work to slowly evolve the best approach to dealing with a concrete, real and potentially debilitating problem that was discovered too recently to have a perfect solution to it, just because drumming up outrage and spreading FUD is easier and more gratifying.

And yes, school can be a pretty boring and restrictive place, but that's just the tip of the ADHD iceberg. Reducing the whole problem space to just that is not helping, either.

[1]: https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

EDIT: I realized that I forgot to provide the link for [1], so I'm adding it now. My apologies for the oversight.

To me you're coming across as defensive when you make these insults and assert that I'm ignorant and don't know what I'm talking about (when, ironically, you have no way of knowing and are therefore ignorant to my level of exposure to the topic). I understand being defensive - you've made a significant decision about your child's health and I hope for your, and his, sake that it's the correct one.

Your defensiveness aside - it's actually not a "trope" or a kneejerk reaction to notice that the rates of ADHD and ADHD medication have doubled in the past couple decades in the US and are significantly higher in the US than in Western Europe. The US has a pattern of over prescribing medications - the current opiod epidemic is an example. My understanding of this is that it's most likely there is over-diagnosing, and therefore overmedicating, of ADHD, and that's bad.

"Are there bad parents who don't want to deal with their kids' behavior" - there are, sure, but that's not what I think is most common. My intuition is that bad parents would just not care what their kids are doing and leave it to the school to handle. If I had to guess, I would guess that the modal problem parent is one who, understandably, wants what is best for their kids and is concerned about what the schools are telling them. The schools, for their part, want kids who don't overly disturb the system. The doctors hear about a problem that they have the pharmaceuticals to treat.

I don't think the people involved are evil and acting out of malice or laziness but I do think that this group works together to create a system where a fundamentally boring place (school) has a problem managing people who are fundamentally bad at being bored (boys) and they, in part, solve that problem by giving them drugs (ADHD medication). I've been thinking about my choice of the word "complacent" from earlier, and maybe it's not quite right - I originally meant it in the sense that the natural state of the boys is to think of school as a problem and rebel against it and their medicated state is to not rebel against school as much or to the same extent.

If I'm coming across as defensive, then I haven't been clear enough. I'm not defensive, I'm furious but I'm trying to channel it into rational discourse. There's nothing "defensive" about wanting to stop the propagation of this trope.

And yes, it's a trope. I said very clearly that this is not about rising rates of ADHD diagnoses and medication. The trope I'm referring to is the tendency to not only jump to a conclusion that it means we have an overdiagnosis crisis, but to present that conclusion as a fact and a significant problem.

The reason why I'm furious about it is because this narrative has been pushed for years and it has a negative impact on those of us who wish to help our children. In my personal case, it created a strong urge to avoid addressing the issue and just hope it would go away with "better parenting". If it hadn't been for the stigma of "you just want to drug your kids into submission", I would have started helping my kid earlier -- not with medication, but by finding a psychologist to help us.

Again, the focus on "school is boring and kids misbehave, so they get drugged" is too narrow and damaging to those who are affected by ADHD. Imagine being interested in many things, but not being able to advance in any of them beyond initial interest because your brain doesn't let you overcome simple obstacles that require concentration and it only lets you do so if you become somewhat obsessed by a particular random thing it settled on.

Yes, the study I (belatedly) linked in my previous post does indicate that there might be some overdiagnosis and overmedication of milder ADHD cases. And yes, that's something that we need to be aware of and work to improve.

I'm not objecting to raising that awareness. I'm objecting to the utterly irresponsible and damaging way to do so.

Do you think society is currently tilted too far in the direction of undermedicating ADHD? That though we went from 5.5% of children diagnosed with ADHD in 1997 to 9.8% in 2018 we still have more ADHD yet to find? More than a tenth of children are so psychologically flawed they need mind-altering medication to address what's wrong with them?

There is a widespread belief in ADHD and that it should be medicated. That's why millions of children are so medicated. There is institutional belief in that idea as well - that's why so many doctors prescribe these drugs to children. It's not the case that treating ADHD is some minority view that needs to be protected from criticism.

I read your comment as suggesting that I shouldn't share my opinion on the topic because my opinion stigmatizes children who need help. I hope I can highlight the problem with that sentiment by giving an example like if I said you shouldn't share your opinion because the children who are over medicated need help and you are silencing and stigmatizing ideas that would help the over medicated kids.

There is no reason to think my comments are "utterly irresponsible" or "damaging" and you are being hyperbolic by describing them so - any more than your comments are damaging because they encourage over medication. Again, I'd refer you to the "defensive" element of my prior comment. And, since you've mentioned tropes, one trope I'd like to point out is the trope of thinking that "Because I strongly hold belief X I will accuse anyone disagreeing with X of being bad or harmful." You are entitled to your opinions, but not to try and silence people who disagree with you.

There is a "widespread belief" in ADHD and that it should be medicated because there is evidence for it. The ADHD my son has and the ADHD my nephew has, among others, are not things I choose to believe in irrationally.

As for where the society is currently tilted, it's possible -- and likely -- that ADHD is being both overdiagnosed and underdiagnosed at the same time. Like I said, it was discovered recently enough that we, as a society, don't yet have a perfect solution for it and we're still learning more and more. The approach is still evolving.

And yeah, going from 5.5% in 1997 to 9.8% in 2018 is the jump everyone loves to quote and panic about, but it doesn't constitute a crisis. Especially if you frame it as "more than a tenth of children are so psychologically flawed they need mind-altering medication to address what's wrong with them". That's exactly the hyperbole I'm objecting to here.

Let's start by acknowledging that 9.8% of children diagnosed does not equate 9.8% of children medicated. Once we hopefully agree on that, I'm also hoping we can agree that ADHD is not this binary thing that manifests exactly the same and in the same degree in every patient. Just like we've discovered that autism is not a binary thing but rather a spectrum (and even more nuanced than that), ADHD can't be reduced to "either you have it and you'll forever medicate, or you don't have it".

So yes, we're still dealing with a developing situation and there's more work to be done. That's not something I dispute and I'm not trying to "silence" that opinion. As I already explained repeatedly, I am objecting to the way you presented that. Or rather, I'm objecting to the way you didn't present that at all.

You just tossed out a judgmental, dismissive comment and got upset when people pointed out that it wasn't constructive -- or even true, on its own. It didn't come across at all as what you're claiming you wanted to say, but instead of recognizing that you communicated wrongly, you're now claiming I'm trying to silence you. Given that, I'm starting to form an impression that we could go back and forth like this forever and nothing will come out of it.

who told you it's over-diagnosed?

Science generally agrees ADHD is under-diagnosed. Read the statement of consensus. There's some sort of moral panic cause the beautiful souls of a bunch of people can't fathom stimulants can be used for medical purposes cause "all drugs are bad and Concerta is essentially meth" which is absolute BS.

There's no need to spew hearsay and lies when you know next to nothing about a medical condition that affects 5% of the population.

I based what I said on the study by Kazda, Bell, Thomas, et al [1], although there's always a chance that I might have misunderstood it. From what I understood, it seems that there's a certain degree of overdiagnosis in milder cases of ADHD. Again, it's perfectly possible that I either misunderstood it or that they're wrong.

If you look at the rest of my comments in this discussion, you'll see that I'm not pushing the moral panic you mention -- on the contrary, I'm pushing against it strongly -- and that it's definitely not true that I "know next to nothing" about this condition.

It wouldn't surprise me to find that ADHD is being simultaneously over- and under-diagnosed, because it's new enough that we're still discovering more and more about it. That's why I don't dispute that there's probably some degree of overdiagnosis, but I strongly object to pushing the narrative that it's some kind of an overmedication epidemic or crisis.

[1]: https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

I sat at a desk for 8+ hours a day, then I proceeded to sit at a desk for another 2-4 hours.

I didn't have a singular issue with sitting at a desk. I could - and in fact did - sit at a desk from sun up to sun down 5 days a week without complaint.

Did I resent it? Yes. Do I think schooling should have been done differently? Yes. Could doing school differently have cured my ADHD symptoms? No. Absolutely not.

Living with undiagnosed ADHD is hell, whether you are a child or an adult.

In my opinion it's normal for some kids or people to be distracted easily or have more energy than others. They require more attention. Also a child's brain is not fully developed. Why do we expect all kids to be great at focusing? Do you think the focus is worth the reported short and long-term side effects[0]?

[0] https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=aff...

It's not simply being "more distracted", that's oversimplification to the extent of belittling people who have the disorder.

Fully developed or not, ADHD doesn't disappear. Neither does it change if someone wants fully working executive functioning or control over their "train of thought".

The "focus" is worth it, especially if you make a fair comparison with those that weren't so lucky to get help.

Errr okay...That's like your uninformed opinion, bro.

Glasses are not drugs. That's not at all equivalent.

These drugs are altering brain chemistry and one's natural state so they fit into the unnatural environment that is school. It's horrifying to me that people are doing mental gymnastics to defend drugging kids who don't want to sit at a desk for hours every day memorizing useless information. If I was a kid today I'd fit the qualifications and be drugged to better fit into that environment. It's a crime that future generations will be rightly horrified by. Not unlike how we are starting to be horrified by the treatment of animals in factory farms. We're not treating these kids much better.

Again, this is not about wanting to sit at a desk for hours every day. He's perfectly content to sit at a desk for hours every day, in front of his computer, and yet he'll have the same problems focusing on most things.

Yes, the medication alters brain chemistry and one's "natural state". Do you honestly think that we have the science to realize that it alters brain chemistry, but we don't have the science to realize that some brain chemistries are drastically different from others?

As for the whole "natural state" thing, let's not indulge in appeals to nature here. I forgot where I heard "dog poop and arsenic are both found in nature, but you wouldn't eat either", but it stuck with me. Schizophrenia is a "natural state" for some people. So is depression, or autism. Should we just leave everyone in their "natural state", because it's sacred for some reason? Hence my comment about glasses: some people are naturally short-sighted, too, but they enjoy being able to see better.

Sure, school is an unnatural environment. Civilization is mostly an unnatural environment, too.

What infuriates me, though, is that people who haven't had to walk in my son's shoes -- or mine, but his are more important -- have the audacity to judge from their position of ignorance and declare all the effort and care we went through "a crime that future generations will be rightly horrified by".

You clearly haven't so much as an inkling of how debilitating ADHD can be.

Wish I could have been a proper part of this world we live in as a kid but my diagnosis and treatment only came in adulthood.

Please read up on the diagnostic criteria for ADHD (it's not just "can't sit down"!), and understand that not everybody is born with a brain chemistry that serves them well in life. People with ADHD are affected by it even when they're not in school.

Lucky for those with ADHD, most respond to medication very effectively.

that's bs.

ADHD affects your natural ability to make decisions and control your emotions. Has all kinds of health repercussions from overeating to unnecessary risk taking to difficult relationships with others.

Please stop talking about stuff you don't know like you actually have any knowledge of it, and spend the time you save by reading some science:

https://www.sciencedirect.com/science/article/pii/S014976342...

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