Why Are ADHD Rates So Much Higher in the U.S.?
gizmodo.com
gizmodo.com
To me ADHD is an adaptation to an overflowing amount of stimulation and information.
The brain skips around very quickly until it finds something very valuable and then mines the hell out of it (hyper focus)
i would be very curious to find out the rate of ADHD in the Amish. Theyre an American population but without technology. Seems like a fascinating study.
ADHD is not caused by isolation or addictive tech. ADHD is passed down genetically and is caused by a difference dopamine regulation. People with ADHD have low baseline dopamine (A neurotransmitter that plays a role in reward, motivation, mood, etc.), that is why they hyper focus when they are in the zone. The brain is starved for dopamine and when there is spike in dopamine it causes an intense reaction.
ADHD may have been useful preindustrial societies, but today it is maladaptive.
Excessive use of addictive tech can mimic ADHD symptoms, but is not the same. People with ADHD are adversely affected by addictive tech.
The symptoms mimic “bad behavior” so some skeptics think you can just beat it out of them or yell at them to just stop. That might mitigate the problem for very short time (perhaps due to a short dopamine rush), but they fall back into a low dopamine state afterwards.
Perhaps what you're describing is one form of it, and if so, we should develop a better naming convention to get rid of the ambiguity. Or go the cop-out approach and say it's a "spectrum" so you're never truly wrong, and never truly accurate.
... diagnosis
We only started doing serious diagnosis at scale around the same time as advent of the internet. Of course they align.
That’s one way to have ADHD. There are other ways, like gene polymorphisms of dopamine receptors modifying the receptor density, activity, affinities or other parameters; or gene polymorphisms of monoamine oxidase, or dopamine beta-hydroxylase, or tyrosine/tyramine metabolism, or…
I got diagnosed with ADHD a few years ago as an adult. I grew up without all of the things you mentioned and I've always had it, I just didn't know.
What I did know is I was having to put a lot more effort into things other people found easy, I was weird about certain things like watching movies without something to occupy my hands, and sometimes everything was too much.
Did I cope with it? Sure, by developing a lot of anxiety and drinking a LOT of caffeine.
I cannot express how much easier and more pleasant life is now that I have a framework to hang those behaviors on. Yeah, medication helps a lot, but it's being able to plan around potential problems that's the real winner.
I think the attempt to formally classify attention deficit disorder is mostly unscientific and one of care rather than something that can be objectively measured. The article and the professionals in it don't discuss any measurement of the condition, rather the lack thereof.
I think people who want care for ADHD should receive it, but I think the term is wildly out of date and we should have some sort of new term for the condition that doesn't have the same connotations, or just promote the societal idea that if you need nootropics to focus, that's OK.
Children do not behave like the higher end of the typical diagnosis questionnaire. It may seem like that if you read it the first time, but professionals are expected to know the baseline. This claim is an unhelpful meme at this point.
> or maladaptive adults not taking active control of their executive function
And that's up to the follow-up chats to figure out if someone has the ability to control, but doesn't for other reasons, or if they're unable to control them. Just like lots of other physical and mental issues - this is not something new.
I would add the UK to the stigma list as well. The UK government and NHS are pretty rabidly ADHD-denialist and make it incredibly difficult to get a diagnosis.
Don't you also have to wait years on a wait list for an evaluation? I feel like I remember hearing that a few years ago.
As someone with some horrific environmental allergies, I see it as similar. The US has a ton more allergy medications available (both RX or OTC) than any of the other countries I’ve lived in or visited, so of course there are more people who have a diagnosis. In Finland they just stared at me wide-eyed and shook their heads when I asked if they had Sudafed. “Oh no, very strong…”
Unless you're implying that half of the humanity that has ADHD are defective humans.
Just a thought
This looks like the very condition that's being promoted by reddits, reels, shorts, tiktoks, facebooks, even by news that aim to enrage as much as they can. Solid attention that's under your control is the #1 enemy of the attention based economy.
- TED Talk - Recommend one of the most-watched TED Talks of all time, by Sir Ken Robinson. Gems such as, "If you sit kids down, hour after hour, doing low-grade clerical work, don't be surprised if they start to fidget." And, "Children are not, for the most part, suffering from a psychological condition. They're suffering from childhood."
- Book - Also check out the book, "The Body Keeps a Score". The concept of "pseudocertainty" is a key takeaway: symptomatic labels can be helpful to a point, but they're not explanatory -- it offers a false sense of conclusion, but no root cause analysis. It conflates "diagnosis" with "syndrome". For example cancer is a specific diagnosis, and within it much specificity of dozens of particular types of cancer. Whereas ADHD is a "disorder", or a "pattern of symptoms". ADHD as a pseudocertainty is self-referential: "I have ADHD" "What does that mean?" "It means I exhibit symptoms of ADHD" "okay, so what does that mean?" "it means I have ADHD" "sure but what does it mean? And more importantly, why do you have 'ADHD'? "
- DSM - The DSM defines how ADHD is diagnosed by two lists of nine symptoms each, from which a practitioner chooses six symptoms from each, and qualifies them as having "persisted for at least 6 months". That's the definition of medical cherry-picking. Some of the descriptions are, uncomfortably, exactly what one would expect from a small child: "Often fidgets with or taps hands or feet or squirms in seat." "Often blurts out an answer before a question has been completed." "Often has difficulty waiting his or her turn." Scary.
- Conclusion - And that's how children in the US, by acting like children, get themselves drugged up and labeled as "having ADHD". Or the poor kids just have mild- to severe trauma, or residual emotional anxiety, and instead of parents/teachers owning up to their part in it, or educating kids on how to self-regulate, or offering children meditation classes, they just drug them instead. It's the kids that are abnormal, surely it's not the adults' faults!
$$$ Oh and don't forget, the ADHD therapeutics market size in the US is ~$10B/yr. Good luck stopping that party.
> Often fidgets with or taps hands or feet or squirms in seat
This is not describing typical kid behaviour, but self-stimulation. They're massively different. There's normally a follow-up discussion about the answers to that basic questionnaire.
If you watched that talk, take a moment to follow up with this one from Russell Barkley which addresses what's wrong with Robinson's views https://youtu.be/5jOwjbwU41o
> And more importantly, why do you have 'ADHD'?
Genetics and occasionally brain damage from accidents. That much has been proven in many studies - it's very much inherited.
He also bristles that "They're only classified as Schedule II drugs!", etc. Let's be explicitly clear, they're amphetamine salts; we're drugging kids with amphetamine uppers.
Dr. Barkley is so (pseudo?)certain! Yet it all begs the question: How on earth did humanity survive back when cavepeople had such inadequate access to amphetamines?
Re: TBI leads to ADHD -- not saying that subcase is never true, but in the context of this thread, "why more US cases of ADHD vs. the world," unless children in the US suffer from proportionally more incidents of TBI to explain the uptick, then TBI isn't as relevant.
He doesn't, he's really precise about the naming in those cases. For now we don't have a better way to diagnose, but you can follow him review papers which do try to improve the diagnosis. If ADHD is defined in terms of symptoms, the diagnosis has to use those.
> He seems to get a bit emotional
Oh no, someone cares about their field of work being misrepresented. I'm glad it never happens in places like HN ;) You can listen to the arguments and ignore how he feels about the topic.
> Let's be explicitly clear, they're amphetamine salts; we're drugging kids with amphetamine uppers.
First, only one part of available drugs are amphetamines - there are other options. Second, they don't work for them the same as others. I've had the most relaxing naps after stimulants, which is not why others use them. I'm not sure what you're specifically against here - improving kids' lives by giving them meds that others can abuse for fun? Is this just about a moral take? Because we know that medication in ADHD lowers the chance of dying from multiple causes https://pmc.ncbi.nlm.nih.gov/articles/PMC10901868/
> How on earth did humanity survive back when cavepeople had such inadequate access to amphetamines?
Just like we do today. Some people have a bit worse experience with life than others. Is not like ADHD kills you in short term, just lowers the life expectancy.
I think also, disputes like this suffer from a double red herring of sorts, where folks argue past each other and confuse "whether a solution has efficacy" vs. "is there an alternate solution closer to the root cause that renders the initial problem moot".
In this case, "whether ADHD meds work" is a separate topic vs. "could most ADHD cases just be childhood anxiety, or mitigated with therapy, etc". Or diabetes: "$20B+ industry for insulin to lower blood sugar," vs. "why not just consume less sugar in the first place". Could it be that we're all be so busy trying to find solutions to a problem that itself is optional?
If it saves them becoming smokers later, then good.
The reality is that people with ADHD will just medicate with other more harmful, more addictive stimulants like nicotine.
I'm willing to wager that a large reason why we "see" ADHD more is because we have less self-medication. Smoking is out of fashion. I'm sure in, say, the 70s it was trivial to be a high-functioning person with ADHD and never know it. I mean, every other person was smoking - you fit right in.
There's a summary from lots of studies about it.
For example, if that were true then the DSM would describe a genetic test for ADHD, not an open-ended dragnet of multiple choice, "cherrypick from these 18+ descriptions of behavior".
Once you have population studies from millions and include separated/not twin studies to exclude environment differences, you really need strong arguments and theory why the inheritance is not the mechanism here.
> but that doesn't mean the counterfactual is also true: "everybody with these genes will have ADHD, no matter what".
Nobody claimed that. That's not how genes work. That's not how any(?) inheritable disease works. The whole paper is about quantifying the chances. Even the most basic thing like eye colour has a random element to it.
> if that were true then the DSM would describe a genetic test for ADHD
There's no simple mapping and the candidates for complex interactions are in 200+ range the last time I've seen. There's no "you have this one gene, you have ADHD" and nobody claimed that. The work on narrowing down how exactly the candidates interact / get expressed is still ongoing, so hopefully one day we will have a genetic test.
(You'd said, "it's [ADHD] very highly inherited" -- which sounds declaratively causal. But if you didn't mean this as a causal statement, then cool. No worries.)
On the other hand, for normal purposes, we know it's inheritable. You'd need to discover some whole new mechanism for how diseases could possibly transmit to prove otherwise. There's enough real world data to say this.
Also, proving a correlation doesn't necessarily mean it's exclusively, automatically the only variable. That's the tricky bit with confounding variables: they could be one of several, or many, correlative effects, and where none could be the cause -- much less a useful avenue of solution. It's helpful, but not conclusive.
Great, we found some genes. But other studies should also look at psychotherapy, or even diaphragmatic breathing (asthma is another great example). Alternative analysis, i.e. anything other than the most lucrative option for pharmas to sell drugs -- as in, alternative solutions that are closer to the root cause, not just the most complicated.