Why so many children in America have ADHD
economist.com
economist.com
> A typical ADHD diagnosis in America is done by a paediatrician or a family doctor in an office visit as brief as 15 minutes. The norm in Europe is an hours-long assessment by a psychiatrist.
Anecdotal evidence, but our experience is — and most people/teachers/doctors we talk to say — that most diagnosis are done via similar long tests.
I’ve not heard of doctors/teachers trying to address ADHD without a formal test being done.
Are others able to confirm that they know of diagnosis from a “15 minute doctor visit”?
EDIT: In fact, our insurance won’t even cover medication for our son without a formal checkup — every 3 months.
Sure, some may “unofficially” think or claim to have ADHD from talking to their doctor that may say something like “it’s possible you/your child has ADHD”, but I find it hard to believe that actual treatment/IEP (individual education plan) happens without a formal diagnosis.
Yes, I got mine this way. Telehealth during Covid was notorious for this, but lot of NP/PA offices now do the same thing, just with a single in person visit.
It may be personal, and you don’t have to answer, but this is the general question I have to these 15-minute diagnosis.
Conspiracy theorist anti-vax types exhibit "Big Pharma" skepticism, so media and pundits take great care to remind people of this. They want them to believe that they're picking a side in tribal politics.
edit: Another way it becomes left-coded is exhibited in this thread: victimization and grievance politics.
We just started the evaluation with our second child and it's the exact same process. Not that I doubt some doctors cut corners, but I haven't personally seen it.
The formal test was a short survey about our childs behavior in various situations. It was highly subjective with questions similar to "My child has difficulty sitting still" (Never, Sometimes, Often).
There was not example of what is considered sometimes or often and what is age appropriate for a 6 year old.
The survey was required to be answered by the parents and kindergarten teacher. That was all that was necessary to have the option of medication.
Even more surprising is that with only slight more effort we now have the option to put our child on an IEP (indivdualized education plan) where there will now be a full additional teacher in the classroom assisting her.
Overall it has been an eye opening experience. Compared to our first child, our 6 year old is more spirited, but is not violent or defiant. She is mostly concerned with her own interests and will admittedly have difficulty focusing for long periods of time. I would be very curious if her behavior is above the threshold for ADHD in other countries.
This was just our experience and it is very possible that our child was an obvious case so further analysis was not necessary. For now we have opted not to use medication. Interestingly our diagnosing pediatrician has two children with ADHD and said that they put both children on medication at 6 years old.
This is like every 6 year old lol. I bet you I would have been diagnosed with ADHD if I was tested, but in truth I was just an active kid who didn’t like sitting in a classroom chair all day.
My kid was continuously falling off his chair because he was creating a tension bridge between his chest on the edge of the table and his feet on the seat of his chair.
It was driving his kindergarten teacher crazy lol.
Related: it was a 15 minute doctor visit for us, but both me and my wife have ADHD so the doctor looked at the survey and said "boy howdy, I think you guys know what you are talking about"
I got a short quiz to see what symptoms I was complaining about and then I got asked about my drug usage and why I was seeing them.
I told them that I tried a friend's adderall once and I felt so much better immediately.
They told me drinking 2 pots of coffee a day, doing tasks out of order, "just in time laundry", and being "excitable" is actually ADHD and that I'd be better off if I took these pills every day and cut way back on the caffeine.
It took about 15 minutes.
What other questions would you have? Do you think you'd need to give me the long-form test? Lol.
I followed the advice btw. It's going well many years later and I hope RFK doesn't take the stimulants away.
Adult diagnosis is weird. I’m assuming you were not a child drinking that much coffee. Adults have decades of coping mechanisms obscuring the signal, and yet just talking to an adult with ADHD for an hour will tell you whether the person has ADHD instead of being a stimulant junkie that read the DSM to present manufactured symptoms. It’s exhausting to talk to someone with ADHD for hours if you don’t have exactly the right disposition (like being a polymath or having it too).
They will still often want you to do a sleep study, because chronic lack of quality sleep or chronic stress looks a hell of a lot like ADHD. It’s also why you want the person with ADHD to write or at least copy edit your emergency procedures because they haven’t just adopted chaos, they were born in it, molded by it. They were adults before they ever saw order and to them it was just blinding. They will absolutely write a procedure that won’t skip steps or overly rely on the actors to be calm and present of mind to pull it off.
Feels kind of reductive.
If I played too many video games so now I don't get to have my meds, I'm going to be pretty sad.
No idea what all it entailed other than the fact that they're unable to screen people out when I assume there are probably quite a lot of people doing or trying to do what he did.
So the process can't be especially rigorous.
Even today, I wonder if I should go through the trouble of being diagnosed and getting on medication. The last three days I wasted my time instead of doing the work my company pays me to do and got exactly nothing done. The entire time I kept thinking, "I really should do that work so I can keep my job and provide for me family" but I couldn't concentrate and procrastinated day after day.
Most of my children have ADHD. Before they could be diagnosed, they did have to go through extensive testing by a psychiatrist and there were interviews conducted with us as their parents and with their teachers. The 15 minute diagnosis mentioned in the article has not been my experience. We have regular meetings (every 6-8 weeks) with the psychiatrist to evaluate their dosage and how things are going.
Please make sure to take care of yourself and try going through with the diagnosis. What you described is very similar to what I was going through - severe procrastination which resulted in worse and worse performance at work, eventually I had to quit my job because of it. Later I’ve learned procrastination of this magnitude is basically your subconscious screaming at you that something is not right and you should be taking care of yourself instead of forcing yourself to work.
On a side note - ADHD is hereditary so if your children have it there’s a good chance you and/or your SO have it too.
Maybe talk to people diagnosed with ADHD as adults? Of my acquaintances like that, they mention an immediate improvement. The benefits were very obvious to them.
It is almost as if we should test for ADHD by just testing amphetamines in questionable situations and just seeing if people respond well?
Likely very questionable advice, but if you are a risk-taking type then maybe score something and just test it on yourself? Try to be scientific of course. And try to understand the risks (which you need to understand even if you were diagnosed by the medical system).
I'm in my 30s, and in the process of receiving a diagnosis after it had been suggested to me my entire life by teachers, colleagues, and friends. I avoided diagnosis and medication mainly because I was skeptical of the safety record of medications -- probably because that's why my parents never sought a diagnosis for me when I was younger.
After doing more research the past few years, I learned that ADHD medications are the success story of medical management of psychiatric illness, and they have a strong safety record
In any case, for me so far it has involved four (4) 2-hour appointments with a clinician, having trusted colleagues and close friends fill out detailed "external rater" forms in which they rated my executive dysfunction, and (yesterday) a marathon 4-hour long testing session in which I took a sequence of standardized tests under the supervision of a clinician.
I know that diagnosis of ADHD in children is a different animal, and even for adults there are clinics that provide a diagnosis and prescription in a half hour or so -- but not everyone with ADHD is diagnosed after a single 30 minute session with a provider. And contrary to another sibling comment, there are fairly robust objective metrics for identifying the hallmark features of ADHD and executive dysfunction.
What are they?
But you will find that ADHD is one of the most widely studied psychiatric illnesses with strong neurobiological basis and well known measurable correlates, and as I mentioned, has the highest response rates to medication for a psychiatric condition. So you should have no trouble finding out more!
When searching specifically for metrics used in diagnosis, some choice words come up from med central:
"A challenge with diagnosing ADHD is that the characteristics associated with the disorder – such as difficulties with focusing, shifting/dividing attention, managing frustration, organization/poor time-management, working memory, and staying engaged – are common symptoms that could have a breadth of etiologies.
As noted, *more often than not*, ADHD coincides with another disorder. "
Then for narrow-band symptoms will list examples of neuropsychological measures like D-KEFS, and finding details for each of these is again like pulling teeth. But looking at the description, all of what is tested could be impacted by other issues, including instability in home life, lifestyle factors, anxiety and depression, insomnia, etc
I'm sorry, let me stop you there. What in the world are you talking about? The government's main guy looking after America's health is obsessed with ADHD diagnosis rates -- for good reason? That is absolute madness. Got nothing better to do, I guess. No infinitely long tail of the global pandemic that was ravaging the population a couple of years ago? The threat of bird flu? Dare I mention health insurance?
Remember doctors are there to advise not to command, know the hazards and be willing to say no or consider the data from your own perspective.
Amphetamine salts (generic for Adderall) cost less than $20 a month. Generic atomoxetine is $15.
The medication for ADHD is _cheap_. A pharmacy will likely get more profit from a bottle of ibuprofen.
The gross margin on amphetamine salts even at $20 must be insanely high. We're talking about what, a couple grams of active amphetamines in a month?
It's literally a 5-minute call: "Do you have any unusual side effects? How would you rate your depression/anxiety? OK, the prescription was sent to your pharmacy".
> The gross margin on amphetamine salts even at $20 must be insanely high. We're talking about what, a couple grams of active amphetamines in a month?
This is about as low as drug prices go in the US. And for amphetamines there's an additional overhead of having a pharmacist checking your ID, storing the drug in a safe overnight, filling out the DEA forms (for every link in the supply chain), etc.
Good Rx shows the price for amphetamine salts at $15 now (in Walgreens in my area).
I can definitely tell that the profit basis for ADHD diagnoses is just not there. There isn't much money in it for doctors or pharmacies.
The trick is to know who to go to get what you want. In the USA with PPO there is generally zero friction to just making yourself an appointment with a speciality doctor and that specialty doctor will use his "toolbox" to create the outcome that you came to him and paid for. If you go to a psychiatrist, well their tool is prescription medicine, so that is what they'll use.
This sounds like common sense, but i think the population at large places too much trust in the doctor. In the US you have to be your own advocate.
I suppose in the past that would just be your family doctor, wasn’t it.
And it is no coincidence or surprise that brain stimulants like amphetamines dominated the first wave of treatment. People 'perform' better on amphetamines, always have. They work so long as you concentrate on the short term and ignore long term issues like increasing tolerance, increasing demand and ultimately schizophrenia from chronic deep sleep deprivation.
This may be the ethos in elite circles but I don’t think it’s the case in general.
The downsides are just not very downsidey, but the upsides are quite real for many people.
If you don't believe you have it, was this why you didn't previously consider taking performance-enhancing drugs?
Over time, I adapted on my own. E.g. by buying several sets of things like scissors and screwdrivers so that I don't end up misplacing _all_ of them. Or by structuring the work so that I can switch attention between high-priority tasks.
> If you don't believe you have it, was this why you didn't previously consider taking performance-enhancing drugs?
I was really apprehensive about using mind-altering drugs, and amphetamines always sounded pretty scary.
On a more philosophical basis, should performance-enhancing drugs be available more widely anyway, with appropriate safeguards against abuse?
I recently came across this article discussing a study which found that stimulants lower productivity in people without ADHD.
> “Our results suggest that these drugs don’t actually make you ‘smarter’,” said Bossaerts. “Because of the dopamine the drugs induce, we expected to see increased motivation, and they do motivate one to try harder. However, we discovered that this exertion caused more erratic thinking — in ways that we could make precise because the knapsack task had been widely studied in computer science.
> “Our research shows drugs that are expected to improve cognitive performance in patients may actually be leading to healthy users working harder while producing a lower quality of work in a longer amount of time,” said Bowman.
https://www.cam.ac.uk/research/news/smart-drugs-can-decrease...
But I agree, that's a good argument against drugs.
You can't see why an ADHD diagnosis (which isn't hard to get) no longer being a quick ticket to getting amphetamines--one of the most commonly sought-after and regularly abused class drugs since the 1930s--would be a desirable state of affairs? Are you not aware of the adverse health affects they have (cardiovascular, neurological, e.g., Parkinson's, dental, bone density)?
> it seems like 50% don't respond to Strattera
It's seems more like people take longer to respond to Strattera and either don't want to wait, or just want the amphetamines.
> It's seems more like people take longer to respond to Strattera and either don't want to wait, or just want the amphetamines.
No. Not all drugs are effective for everyone, this includes different stimulants.
But more than that what is the condition, if the only means we have of defining it is a subjective biased interpretation by an individual?
I am sure there are differences in brain chemistry that make one more stimulated, more long term goal oriented, and etc, but given the complexity of the human brain, and our lack of understanding/tools to measure, its not clear to me we should be so sure given any patients failure can be directly attributed to a singular condition.
Testing someone in a completely artificial environment (sitting in an office during a diagnosis playing some tasks clicking on a computer screen) is hard for me to believe is exactly an accurate metric for revealing any of these things. Most especially, when a lot of people are actively seeking this diagnosis, and are motivated to alter their behavior to get the result they are looking for.
Im really curious how this company decided these tests are accurate at all. I assume they did some studies to find some variability in the test results and those who were already diagnosed and then determined those variability were indicative of ADHD. So what test is really doing IMO is just reinforcing the standard diagnostic criteria.
You are right that attention is a complex phenomenon, but keep in mind that people who evaluate ADHD are aware of the limitations -- that is why TOVA isn't typically the only mechanism used for diagnosis. ADHD evaluation often involves multiple sessions in which other possible explanations are ruled out or explored, along with questionnaires from friends and family who know the person -- incidentally some of the questions on the ones I collected from my friends/family were about my driving!
Even with this, there are still limitations, but there's no need to throw the baby out with the bathwater -- the goal is to produce an actionable explanation that we can use to reduce suffering, and for many people this explanation does exactly that.
Does this mean that you identified a definite cause, or does this mean as part of an ADHD diagnosis, you managed to capture a group of individuals with specific traits like being more impulsive, taking higher risks, etc?
I can for example, make up 9 seemingly related symptoms, and given a large enough population millions of people will fit it. Then I assure you I can do a wide range of studies that will find that my group of people will deviate from the norm in X,Y,Z.
Also weirdly enough, I noticed I make a lot more mistakes while driving while on adderall.
I bought into the whole "I have Adhd thing thats why Im failing at school" thing 13 years ago and have since then spent countless hours thinking and talking about it.
Im glad it helps people, but unless someone can prove definitive facts about my brain, I have all the answers I need as to why I am who I am or why I do what I do. And yes stimulants help sometimes when Im forced to do shit I have zero interest in for prolonged periods of time, simple as that
So did shamens, tarot readers, and psychics. The "actionable" part of all this is prescribing stimulants. Why can't we just focus on prescribing stimulants to those who would benefit from stimulants? Is the "ADHD" part of it really necessary?
I don't understand your question about whether or not the "ADHD" part is necessary. Yes, we should have words for complex ideas.
The comparison to shamans and tarot readers comes off as dismissive and uninformed, and generally in poor taste. Ultimately you are questioning a diagnostic framework that you don't understand very well given your other comments. There are critiques to be made and even aspects of your position that I agree with but you really need to understand the framework you intend to tear down before tearing it down
Anyway youre being really dismissive too instead of just responding to my points. If you think Im being dumb fine Im just not interested in an emotionally heated argument.
I apologize if I seem dismissive of people's mental health - not my intention Ive been dealing with them my whole life. Take care.
In any case, I still think of ADHD and a lot of psychiatric diagnoses as models. We try to make these models useful to relieve suffering. They are far from perfect, but it doesn't make sense to throw the baby out with the bathwater and discount the many people who have been helped
What am I missing?
>In any case, I still think of ADHD and a lot of psychiatric diagnoses as models. We try to make these models useful to relieve suffering. They are far from perfect, but it doesn't make sense to throw the baby out with the bathwater and discount the many people who have been helped
This is what it keeps getting down to every time I have this discussion. But I really feel like the discourse is hindering having an deeper understanding of the topic. The mental model and the resulting language, like people saying "I HAVE X,Y,Z" seems to be somewhat philosophically askew. Everything I read seems to point more to "X is a real objective thing, and were trying to find better ways of diagnosing it", rather than "X is what we call these assortment of symptoms alot of patients seem to exhibit which is helped by Y"
From a patient standpoint I think its a monumental difference with people saying things like "I am like Y because I HAVE X", as if X, what was the observed collection of (possibly unrelated) symptoms, now being a cause in itself.
There has been lots and lots of writing on the phenomenology of mental illness and modern mental health culture. There is lots to not like: for instance it tends to encourage excessive rumination and negative feedback loops and over-identification with these designations, as you say. This is why I prefer to think of my diagnoses as models -- they are approximate descriptions of my behavior, and the treatments prescribed are also approximations, and it's up to me to use these as tools to improve my life. But you might enjoy reading some prior art on the topic
But in any case, if the tools aren't useful, then discard them -- I was diagnosed with PTSD in my early 20s, and at the time it was a tremendously helpful and eye-opening -- it hadn't occurred to me that the violence I experienced was impacting me so many years later, but when someone pointed it out to me, I was able to adjust the ways I related to myself and other people, and for the most part, my symptoms are in remission today. I no longer think of myself as "someone with PTSD" -- it's no longer a helpful lens through which I can understand myself
This isn't to say that those conditions aren't precisely defined or that they aren't real, but they might be at least partially a product of our society.
Your skepticism about whether an issue "can be directly attributed to a singular condition" is just good medicine. As conditions are studied more, often it's discovered that it's actually a few different conditions that share some symptoms. Maybe all of these sometimes wishy-washy "we didn't have this when I was a kid" conditions are just medicine learning more about the mind.
Much of disorder is likely just maladaptive for, as uncle Ted put it, the post industrial revolution.
I think it's likely that as well as a healthy dose of "the world was way different when I was a kid, and didn't have as much of X, Y, Z, which contribute to the formation of maladaptive neurological patterns"
[1]: https://neurodivergentinsights.com/misdiagnosis-monday/adhd-...
This is something you only understand if you dealt with neurodivergent people. Suddenly it all makes sense, once you learn that their brains filter and process information in a somewhat different way, resulting in all kinds of different observable symptoms.
You might ask how I know I don't have it. No one really cared about other symptoms I exhibited: chronic insomnia foremost, and some anxiety. Once I got a handle on that with non-pharmaceutical interventions, my focus was fine.
And to the extent that insomnia was given any credence, it's to push pills. Generously you could say practitioners default to that because it's so often demanded by clientele, they want to just press a button to make problems go away. But they just don't bother giving you an alternative.
edit: would also mention, the first time I was diagnosed as a young child was because I was a bored daydreamer who didn't always pay attention to the teacher. This is what we're treating as a weakness to be rooted out.