ADHD Drugs Don't Boost Kids' Grades, Studies Find | Hacker News Reader

ADHD Drugs Don't Boost Kids' Grades, Studies Find

wsj.com

81 pointsgruseom109 comments

Each time a study comes out and people will link it to me (I've already had this linked to me three times) claiming that my ADHD medicine doesn't do anything and that it is worthless ... for me it isn't. Without my meds I wouldn't be able to concentrate, I wouldn't be able to get work done. At one point it got so bad at work that I was afraid I was going to get fired since I couldn't focus on any single task at hand at all.

Starting on Aderall has changed my life. I am able to concentrate on work, I get more done, I feel calmer, it is almost as if a fog has been lifted and I can clearly see what I am working on. It has been a complete shift, like the difference between day and night.

When I don't take my meds (doctor recommended breaks) I go back to being the old me, I become disorganised, I am constantly distracted and thinking about other things. I lose focus and space out. I don't like that person, because I feel like I don't accomplish anything :-(.

What many people don't understand is the stress people with ADD are exposed to. Especially when they're smart.

Imagine having a porsche in your driveway, but for reasons you can only use the first gear. No matter how hard you push the pedal to the metal, you won't be as fast as you want the car to go. Plus if you keep going full throttle in the first gear eventually you'll break something.

Sounds depressing, doesn't it? And that's exactly what happens. People eventually get depressed. It won't go away by itself. When they go to the doctor, it's basically a game of chance. If the doctor is competent, he'll do the proper tests. Unfortunately most aren't. There are a lot of syndromes, illnesses, conditions that match the symptoms.

If the ADD patient is lucky, the correct diagnosis is made. If unlucky, he may be treated for borderline, depressions, etc. Antidepressants may worsen the condition, because they may increase motivation without increasing ability.

A well diagnosed and medicated ADD patient however will lose depression in almost no time.

This is one of the most succinct explanations of what my life was like before medication and after.

Thank you!

Wow, this sounds exactly like what I've been experiencing for the last four to five years. Even the misdiagnosis, which have mostly turned me off from seeking any kind of mental health treatment. Can you recommend how to screen for a competent psychiatrist specializing in adult ADD?

I live in Vancouver and have had the best success working directly through the local hospital's mental health group. The key is to do a lot of testing. I've also found pink noise to help quite a bit in those times where I need an extra bit of focus.

A misdiagnosis and even the wrong medication is the worst to experience. Finally in my 33rd year of life (18 years since finding out about ADHD) I found a medication that helps my anxiety and depression which allows me to focus on the downsides of the ADHD.

This isn't an ad for mirtazipine. :)

> This isn't an ad for mirtazipine. :)

Genuinely curious - do you in fact take mirtazipine to manage AD(H)D? I've never had it recommended as a treatment option.

It's mainly for the depression - - but I've found since starting the medication that I've been able to focus far better than before. There are some studies around where they tested this drug for ADHD with kids.

I've tried a few other drugs for both ADHD and depression / anxiety over the years, but this one seems to be the sweet spot between helping with everything. Hardly scientific, but it's my experience.

I should note that at lower doses mirtazapine (remeron) helps with insomnia. For me, I'm on a higher dose (45mg) where this isn't the case.

To add to this; If any of you with ADHD have found that you're miraculously killing at Scrabble or Boggle after a few drinks, being on this medication is a similar feeling. It's as if the anxiety or whatever is the noise and the medication filters that out.

Unfortunately, I can't. In my opionion, ADD diagnosis must be test driven. There are some very good tests which indicate what your problems are. If someone suffers from borderline or bipolar disorder, ADD treatment may be bad as well. In the german speaking world, a test like this would be ADHS-LE. Also a test for concentration over time should be done. Here's one in german. http://www.psychomeda.de/online-tests/konzentrationstest.htm...

Start with a neurologist, and not a psychiatrist.

While a psychiatrist can make the diagnosis, IME they're more likely to go after the secondary long-term effects as described above.

Wow, that porsche analogy is so apt. That's exactly how I feel most of the time.

I felt the same way, and in the last few years growing up has done much to shift my brain to the next gear. Once I knew what concentration felt like I was able to recreate that feeling and focus. No medication involved.

Same! I'll take adderall regularly for some time. Then I'll get a decent feel for what it's like to concentrate and am able to do it without it. I don't know what's the scientific justification for what you and I are able to do but I'm glad I'm not the only one :D

I doubt I have/had ADHD, but Modafinil did the same for me.

>Imagine having a porsche in your driveway, but for reasons you can only use the first gear.

That is a good description of how I feel. When I was younger I could spend hours learning things, programming, reading, and playing video games. Eventually, around when I was 16 I would guess, I lost my ability to concentrate, and now I can't sit through a 30 minute TV show without losing focus. It was really bad for me in university, and continues to harm my career.

However, I was actually diagnosed with ADD and tried many different medications. Unfortunately all of the medications I was prescribed were either ineffective or had terrible side effects, so I ended up not taking anything beyond a trial period. Despite this, I used Adderrall two times to prepare for important tests in university. Side effects aside, it is amazing.

>If the ADD patient is lucky, the correct diagnosis is made. If unlucky, he may be treated for borderline, depressions, etc. Antidepressants may worsen the condition, because they may increase motivation without increasing ability.

Not ADD here, but starting around age 12, my body started freaking out every 4-8 months or so and suddenly my heart-rate would shoot up uncontrollably and my blood pressure would drop out. They told me to lay down and try breathing slowly, and eventually it went away (I was lucky). I was diagnosed with GAD/Panic Disorder with depression. Several years later I ended up actually developing a sever case of panic disorder and agoraphobia, mostly because I was told I had it for so many years.

Turns out I actually had Wolff–Parkinson–White syndrome - A heart condition where you have an extra electrical pathway in your heart. Had surgery for that last year and haven't had an episode since. Still struggling with the agoraphobia though. I can only imagine how my life would be different right now had I gotten the correct diagnosis.

I welcome people constructively criticizing the study, but this kind of anecdotal response is really not useful.

I had some trepidation over this when deciding whether or not to post my own anecdotes. In the end I decided that while it's not useful as a criticism of the study it's absolutely useful to curb the conclusion, that ADHD drugs are broadly ineffective, which this presentation of the study might suggest.

Edit: As an example the caption of Dr. Farah's photo reads "Dr. Martha Farah and colleagues found no cognitive benefit from Adderall taken by students." Finding no correlation to grade improvement is very, very far from finding "no cognitive benefit."

Okay, pick some other metric – the lack of grade improvement starts to cut away at the possible claims for cognitive improvement, on the whole, assuming the science is good.

On the other hand, if they were sloppy, it could potentially argue for a multimodal distribution that when forced into being viewed as an average (or with other tools that assume a unimodal distribution) then the effect gets washed out. One possible case for this is the idea that ADD/ADHD is wildly over diagnosed and, thus the incorrectly diagnosed children might show no improvement while masking the improvement of those who actually have it.

Another anecdote but a very applicable one: a fellow nerd in high school had terrible grades, before and after starting Vyvanse (re-patented version of Adderall) around the end of sophomore year. However, he was able to focus in the biochemistry class and despite the fact that he still received bad grades for lack of caring, his medication helped him discover that he loved chemistry. A year later he was accepted to an Ivy League on a 3.0 unweighted GPA because he was able to throw a never before possessed focus at an internship at Caltech where he became a published scientist within a year.

Grade improvements (along with the possibility that over prescribing is skewing the data) are a terrible metric, and a better one would be interpersonal relationships and how they behave in the classroom, which is much harder to measure. If a child is diagnosed pretty late (late elementary or middle school) they might also have a LOT to really catch up on. Just because they can focus doesn't mean they are prepared to deal with the material given to them.

If so, I would suggest saying "In assessing this study, it's important to keep in mind the huge difference between grade improvement and general cognitive effects." Then, maybe you could quote a different study that found cognitive effects (which undoubtedly exist). And then, if you really thought it useful, you could say "my anecdotal experience conflicts with this" and leave it at that. But the problem with these human-interest stories is they grab people's hearts and keeping them from thinking clearly about this stuff.

Here's an exercise: try translating your anecdotal experience into boring clinical language, e.g. "one 27 year-old male subject had a small statistically insignificant increase in grades, and self-reported feeling more focused."

The parent seems more like a comment on the reaction to the study rather than on the validity of the study.

Sure, but the problem is that it's upvoted on HN. Maybe if it had some sort of other key insight, but it doesn't. It only says "here is my anecdotal experience which contradicts the data, I feel really strongly about it." I have no problem with X-Istence or his comment per se, I just wish this thread wasn't filled with these stories.

Anecdotes are real information. I have enough anecdata and knowledge of neuroscience to believe speed/adderall/caffeine/nicotine are really effective in increasing focus and other dimensions of work quality for some. This study suggests teachers and parents want kids on adderall because it makes them more compliant, easier to deal with. This is not really surprising if you ever went to normal schools.

It's not even clear what the actual study says, since it doesn't link to it, and characterizes it in very different ways. Typical science press.

When I go and get my ADHD prescription filled, I always get a look of judgement from pharmacy workers. I've struggled with a lot of shit throughout my life that has caused a lot persistent anxiousness that has always made it difficult to focus. I don't know what the exact issue is, but I was physically/sexually abused as a child, had overbearing parents, and so on, so it's hard to correlate just exactly what's behind it. Anxiety went hand and hand with all of this, and coping became harder and harder (I didn't have a girlfriend/sex until much later in life, failing college, etc). Things got real bad in my early twenties, and meds saved my life. I could do my job, and people could see I was good at it. It helped me calm down. It worked for me, and it may not work for everyone, but please leave that option open to the individual and his/her doctor. I was unmedicated most of my life, and still keep it a secret from every single person I know. There's my anecdote.

Addict.

  > Each time a study comes out and people will link it 
  > to me (I've already had this linked to me three times)
  > claiming that my ADHD medicine doesn't do anything and 
  > that it is worthless...

Unless any of those people is a licensed psychiatrist you should ignore them and move on.

Indeed because no one who isn't a licensed psychiatrist knows anything about neuroscience, drug mechanisms or interactions, coping strategies, physiology or mechanism. Neuroscientists, pharmacists, biochemists, none of these people could possibly have any relevant expertise. Only licensed psychiatrists are worth listening to.

As far as telling someone to stop their prescribed medication, then yes, the prescribing physician is the only one to listen to.

But perhaps you are expert enough and have enough knowledge about his medical history that he should listen to you instead?

I have 0.01 as much of a problem with this proposition as with your previous one. That is an excellent heuristic for most people to use.

You created a "previous proposition" where there wasn't one, by not reading my words in context as a reply the parent post (that described a specific scenario wherein the writer's friends were telling him to stop taking the Adderall that was successfully treating his ADHD symptoms) and instead inventing a completely different context for my words.

In the U.S. at least, Adderall is best prescribed by a psychiatrist, and while there are many general practitioners who will write you a script for Adderall without referring you to a psychiatrist, they're not following what's considered to be best practice. The same doctor would be considered remiss if they didn't refer their patient with heart disease symptoms to a cardiologist. Adderall is a stimulant that can be addictive if used incorrectly, and ADHD is not understood well enough to know that it is best treated by Adderall alone.

While neuroscientists, pharmacists, etc. may be able to tell you details about ADHD or Adderall, they aren't generally licensed to write prescriptions for Adderall in the U.S., and shouldn't be telling you start, stop, or change your Adderall dosage without consulting with your prescribing doctor first.

Laypersons can and should read peer-reviewed medical journals and learn how to make their own, personal interpretations, within reason.

Does this imply that one should read/use code only of licensed/certified programmers?))

If it was code that significantly impacted your ability ti live your life, absolutely.

The point is that lots of people buying their licences/certificates because they have severe difficulties in proving abilities they claim to have.

Lots of "certified professional" Java/SAP/etc programmers cannot write any code outside an IDE or without context help, leave alone implement simple algorithms like quicksort or basic functions for binary search trees.

Very true, and also any psychiatrist who makes such statements without knowing specifics should be chastised for violating the standards of their profession.

How do you know that sugar pill wouldn't bring you same benefits? Were you taking some other smart sounding similarly administered drugs before and you began taking current ones and you observed improvement on switching meds?

Perhaps you actually have ADD/ADHD but most of the kids in the study were misdiagnosed?

During your "doctor recommended breaks" - try doing diet cleanses, elimination diet. Many foods, very common ones - wheat, dairy, eggs, soy, potatoes, almonds, etc - can cause ADD-like thinking through irritation (that you may notice or not) in your intestinal tract, etc.. Then there is also childhood emotion repression that could be a cause to ADD / scattered thinking. Food and past trauma are two things to always look into if someone's having difficulty. I always suggest a good dose of yoga with a regular yoga practice to help with the calming / releasing endorphines, serotonin, etc. - reducing baseline stress levels.

Edit: Oh, and also, if you ever had painful ear infections as a child then look into http://www.aitinstitute.org (sound / auditory re-training), or if you've never had your vision properly checked out -- you should be able to see clearly / things in focus with your eyes relaxed, if you're straining them then it means your brain/mind is actively concentrating to focus, which then will take your ability away to focus on other things fully (leading to ADD symptoms).

is there any scientific evidence for "cleanses" at all? Because the word "cleanse" sets off my BS detector like crazy.

It just means reviewing and cleaning up your diet and/or giving your digestive system a break - either with a full fast (water only), or limiting what you eat. There are gimmicky cleanses, just like there are gimmicky fitness products, etc..

So we're going to look at grades as an indicator of success here? Grades, which have been shown time and time again to have very weak, if any correlation with success?

I've dealt with ADHD my entire life. As a kid people could see I was smart, but "if only he could apply himself!" One of the most pivotal decisions I ever made was to seek counseling, and ultimately medication, when I was flunking out of college. My grades improved enough to get me through undergrad. However they were never stellar because I was finally able to focus on all of the various ideas I had kicking around in my head that I was far, far more passionate about.

I could rattle off a list of crazy successes that I would have never been able to achieve had I never sought medication, but honestly it boils down to one thing. When I want to do something that requires mental focus, said mental focus is no longer a barrier. I can actually do it. Because of that, I'm happy.

So instead of grades, what about quality of life?

Honest question: could your success be at all attributed to placebo? IOW, is there any question at all as to whether or not you could have made a conscious decision to "buckle down" and have met the same result?

I fear for myself that when facing similar hardship that acquiescing to meds could just be "dealing with the situation" and not properly processing what the actual hardship is, why it exists, and how else it could be dealt with.

I suppose that in the end, solutions mean progress. And I'm all for working smarter, not harder. Perhaps it's stigma. At any rate, I'd appreciate your perspective. Also, awkward high-five for doing what you're doing.

> Honest question: could your success be at all attributed to placebo? IOW, is there any question at all as to whether or not you could have made a conscious decision to "buckle down" and have met the same result?

I'm 27 now. I began taking ADHD medication when I was 21. With the exception of methamphetamine (yes, it's actually an old, crude ADHD treatment) I believe I've taken every FDA-approved ADHD drug there is - both stimulant and non-stimulant. Even the patch. It was a hard road to figure out what is effective for me with minimal side effects, but there's absolutely no doubt in my mind that medication contributes heavily to my success.

The sensation is difficult to describe, but when I'm not medicated I'm often completely unaware that my focus has shifted. No amount of mental exertion (aka "buckling down") changes that for me.

I'm a very passionate software engineer. I wake up in the morning and before I've put clothes on I'm reading about something to do with software. Chances are the last thing I look at before I fall asleep also has something to do with software. This has been constant since I was 12 years old -- long before I was medicated. In college, before I was medicated, there was absolutely no way I'd be able to make it through a lecture and retain all of the information -- even while taking notes. I'd pause to think about something the professor said, and a few tangents later I'd be drawing unicorn fish or something in the margins. I still have the notebooks. I've gone back and looked -- the difference between before and after I was medicated was stark [1].

Whether or not medication is the right choice is a very individual decision. Hell, even your doctor doesn't really know. If you have the ability to "buckle down" when needed and you don't feel like your life is ready to crumble because you're just barely getting by - you're probably fine. There's a ton these drugs can do to mess up your life [2] and the narcotic effects can be plenty distracting on their own if your doctor is too liberal with your dosage.

1: Something worth noting is that an outside observer might view this as having my creativity squelched. "Oh look at all the drawings, and now just boring mechanical notes? This person's soul has been snuffed out by the evil chemicals!" The truth is just the opposite - I was finally able to direct my creative energy where I wanted, and the feeling was utterly profound.

2: Appetite suppression, insomnia, depression, addiction, heart palpitations, aggressiveness, diminished sexual desire, and horrible irritability are all common side effects. They might not all meet the FDA definition of "common," but they're plenty common enough.

I'd love to know what you found has worked the best for you, if you feel comfortable sharing.

This makes me wonder if software could help. Clippy says "You seem distracted, shouldn't you get back on point?"

(I recognize this comment is unlikely to be helpful, but I'm curious about the state of the art.)

I'm pretty much the same as you, only that during lectures I don't draw anything, I just space out after a while and it's hard for me to sustain focus for long periods of time. Lectures are largely a waste of time for me.

I ended up going to a special ADHD clinic and I got diagnosed. Unfortunately, a week and a half after beginning the titration process of Concerta I started getting side-effects (palpitations). Apparently, I also have anxiety, so the doc told me that I could either start again with a slower titration process, or take antidepressants along with the ADHD meds. I decided to drop it and not take any of the meds because the side effects of the antidepressants scared me (not to mention the negative vibe you get from people when they hear that you're on psychiatric meds).

College is really hard for me. I do very well in some classes (mostly in the applied CS courses), and just average to poor in others. The reason is mainly because even though I love programming, many of the Computer Science courses are theoretical and boring to me, so after about a month into the semester I start spiraling down and barely doing the homework assignments, or seriously going over lecture notes to try to gain a deeper understanding of the material.

During the finals, I end up wasting days on doing nothing productive (like right now -- I have a final next week and I'm sitting here doing nothing) until I conjure up enough willpower to actually open the books and start studying (usually the fear of failure takes over and then I force myself to study... with lots of anxiety). And even then, I still find it hard to fully concentrate on the material. I find myself trying to read a textbook, and I feel like my mind and body are pulling me away, so I end up just getting up from the chair, and walking back and forth around the house while my mind just entertains some random thoughts.

I realize that I've been like this my whole life (my High School years are very similar). When I find something that really interests me, I will do it from the moment I wake up, to the moment I go to sleep. For example, I've done programming projects that forced me to learn new technologies where I had to read over 1,200 pages of documentation, and I would just do it obsessively until I'm done with the project. After the project is done though, and it's time to just maintain it (fix bugs, for example), I usually get very bored with it and dump it.

I guess because College assignments aren't interesting to me (for some reason, the grade on the final exam isn't enough of a motivator for me to study) I have a hard time applying myself to them the way I apply myself to things I'm really passionate about.

I wonder if ADHD clinics are a bit like a hammer in search of a nail. Unsolicited suggestion: go to a neurologist. Failing that, go to a psychiatrist.

When I took Concerta I had similar problems. The irritability was awful. My nerves just felt raw. Methylphenidate (aka Ritalin) anecdotally amongst the people I know who've taken it seems to be the most likely to cause heart problems - with one friend having been hospitalized.

If you feel like you aren't making it, there are other options.

Many neurologists don't have a deep understanding of ADHD, so if I were to go to one, I'd need to find one that specializes in this field. My ADHD doctor was a psychiatrist, by the way.

I agree with you about the Concerta. I have a short fuse, but Concerta made it much worse. Unfortunately, I don't live in the US, and the only gov't subsidized ADHD medication is 'Ritalin'. That's right 'Ritalin'. Not even the active ingredient 'methylphenidate' (which is why Concerta is much more expensive than Ritalin around here).

I know some people report that methylphenidate based drugs doesn't work for them, and yet the amphetamine-based do (Adderall, Vyvanse, etc...), but if I get a prescription for either, they're going to be very expensive, and the import process for these kind of drugs is a bureaucratic nightmare.

I guess I'll just have to suck it up. Next year is my senior year, so the end is very near!

This is a total tangent, but some of us in the USA look to countries with socialized/subsidized medicine programs as ideal. What country are you from?

I'm from Israel.

Amphetamine isn't exactly a placebo and its effects aren't exactly unknown or disputed.

Asserting the possibility of placebo is like wondering if coffee is really just dark inert water but we're all just idiots with no self-awareness that buy into the oral tradition of what coffee is supposed to be.

    > I fear for myself that when facing similar hardship 
    > that acquiescing to meds could just be "dealing with 
    > the situation" and not properly processing what the 
    > actual hardship is, why it exists, and how else it 
    > could be dealt with.

But the hardship is simple. It's the forlorn inability to focus and do.

At the end of the day, we have finite lifespans and we have needs, desires, and ambitions right now. We know that flooding the brain with the amphetamine train works right now.

By the time I was in my 20s, I was pretty tired of listening to people suggest that I was lazy or that I just didn't want it enough. Then I started taking 50mg of Vyvanse and it makes me want it all.

I'll come brainstorm different coping strategies when I find out I'm immortal.

Drinking coffee doesn't make you more alert, caffeine study reveals

http://www.guardian.co.uk/science/2010/jun/02/drinking-coffe...

  > So we're going to look at grades as an indicator of 
  > success here?

Yes, because children who suffer from poor grades are now frequently tested for ADHD, and since we can't very accurately diagnose ADHD, some children who don't need the medication will get it. It's called a "false positive." Those children's grades won't improve. The studies are really telling us that we're not very good at diagnosing this.

That's a very valid statement, and I greatly appreciate/respect that truth. If that were the tack this article were taking, I'd have no qualms. This is the perfect kind of study to combat overprescription based on poor academic performance.

However there's an unwritten assumption in this article that grades are synonymous with success. See the caption to Dr. Farah's photo. That's a very poor inference. That's what I'm taking offense to.

I read it as "success in treatment", not "success in life."

Me too.

That's exactly what I'm hearing in my head as I read this article; "But did they control for ADHD over-diagnosis?"

So we're going to look at grades as an indicator of success here? Grades, which have been shown time and time again to have very weak, if any correlation with success?

[Citation needed]

IIRC conditional upon acceptance to a job at Google grades don't predict performance at all well for anyone except fresh grads. That is the closest thing to grades having only a weak correlation with success I can remember. And that conditional upon is doing a lot of work.

Given that an IQ test is the best way of predicting work performance apart from a work sample test in hiring and IQ correlates around 0.7 with grades I find your claim implausible.

The ADHD craze is rampant on the USA, but fortunately not in Europe, where I'm from. I'm so glad of that, even if I'm more or less on the opposite side of ADHD when it comes to focus and behaviour.

Don't get me wrong, I'm not denying that ADHD is a thing. However, it seems that in the USA it's heavily overdiagnosed, and even worse, the educational system seems to be especially harmful to people with actual ADHD (some people argue that it's because of that system being focused on certain skills, but I honestly don't think it's so different here). It seems like some kind of ADHD-phobia that pushes schools to find a huge problem whenever any faint symptom is found, immediately resorting to medication and severely punishing those who don't comply.

Well great. But being in France I would have loved to have a chance to even know ADD existed before I found it myself online at the age of 29.

And I think there is maybe only 3 doctors in Paris that diagnose it. And the only medication available is Ritaline / Concerta.

As a european with ADHD i'm not glad of that at all. It's a major PITA to find competent therapists for ADHD and our beautiful universal healthcare won't pay for half the treatment.

Yes it won't boost their grades, but it will actually make them be able to be "normal" people.

People haven't lived with someone with actual/bad ADHD if they think drugs don't work.

As somebody who grew up with "actual/bad ADHD," I find this statement, frankly, insulting. As a result of being drugged with Ritalin/Adderall throughout my childhood, I've had this notion of being somehow "wrong" or "broken" ingrained in my psyche, an effect with which I still struggle to this day. There are plenty of schools in which to enroll children with ADHD, and there are a ton of career paths - generally related to creative thinking - in which we can express ourselves freely without the stigma of being somehow "abnormal."

Have you ever actually taken an adderall? It has an intense narcotic effect, which is why people abuse it. I can't believe we give it to our children.

Adderral does not have an intense narcotic effect for me.

You can also nowadays take straterra, which is a non-stimulant.

Honestly, if your ADHD is so low level that you can function well without drugs, more power to you. There are plenty of ADHD people who literally cannot, and to imply they could just take career paths involving "creative thinking" is, IMHO, somewhat wishful thinking.

While I'm happy to hear that some have found a way to control their "affliction," I've never tried Straterra and have no plans to start. As I alluded to in my original post, my ideological objections to drugging our "broken" children are more than simply pragmatic. And, even though I'm a mid-twenties male in college, I hardly ever go to class as I still can't manage to sit still long enough to listen to a 50 minute lecture. I read the textbooks instead and ace the tests.

Anecdotally (I use that word conservatively as I've read studies to this effect but don't care to look them up), I've found that those with ADHD, including myself, are more creative than "normal" people. Something about the non sequitur way in which our minds work. So it's a difference in strengths, not a difference in mental quality.

I also noticed I'm using a lot of quotes in my reply. I guess my cynicism is expressing itself through my sarcastic tone.

"As I alluded to in my original post, my ideological objections to drugging our "broken" children are more than simply pragmatic. "

Do you have similar objections to drugging alzheimers patients?

I'm trying to understand where you draw the line.

Given that actually diagnosed ADHD people have brain chemistry differences that various drugs are meant to control, i have trouble seeing a difference between the two cases.

If you want to pretend you aren't neurologically different than others, great. Maybe you aren't! Plenty are.

If you believe ADHD is a biological advantage that shouldn't be chemistry'd out, again great. Convince enough people, and eventually evolution will win.

I don't remember ever being afflicted with Alzheimer's, so I can't speak to that case.

But what is evident is that ADHD affliction is a broad, very continuous spectrum and not a black/white "disease" in the traditional sense. It's largely based on subjective factors. The hypochondriac parent will very easily convince a doctor to prescribe ADHD medication for his/her child. This reality, in addition to my own personal experience, leads me to believe that "ADHD" is less a disorder and more just a feature, like having brown eyes or fair skin.

I guess I strongly disagree.

Just because diagnostic conditions are not always clear, or overdiagnose, does not make it any less of a disease.

A lot of things mental disorders are based on subjective factors.

Would you disagree that schizophrenia is a disease?

At least 3 of the factors (and you only need two) are highly subjective.

If you wanted to argue that DSM-IV/DSM-V criteria for a lot of things have a tendency to overdiagnose or not be objective enough, I would heartily agree.

That does not make something any less of a disease, it only means our diagnostic criteria suck.

Alzheimers had very broad, subjective, diagnostic criteria once as well, right up until they made various breakthroughs in neuropathology.

Yet you seem willing to class that as a disease?

Here is the way I've come to think about neurotransmitter-affecting medications: they're like glasses. Which is to say, ADHD, depression, and other "diseases" are like near/farsightedness.

A lot of people need glasses, and a lot of people always have, because for at least the last few thousand years (since the advent of agriculture), distance-vision hasn't had any particular selective pressure on it one way or another--it didn't increase your chance of successfully reproducing to be able to see farther into your own farmland. We don't really think of near/farsightedness as a "disease", per se; parents don't worry about passing bad vision onto their kids, they just assume they'll get glasses too.

But it is useful to be able to see things that are very close up and very far away--and we structure our society assuming that people can do these things. We print relatively small text in books, and expect kids to be able to read a blackboard from the back of a classroom. We have a system of transportation that expects drivers to be able to see, interpret, and react to road signs from a distance. And so forth.

In the same way, it is useful to be able to summon focus and motivation and single-mindedness to a possibly-boring task, and we structure our society assuming people can do this, as well.

You likely could find a place--a French vinyard, perhaps--where nearsightedness was irrelevant. And you likely could create a little pocket of our own society that permits you to live productively without glasses (live in a city, work as a jazz musician, and take cabs everywhere, for example.) But this is extremely limiting, when the other alternative--just wearing glasses--is freeing. The choice is between letting a quirk of your genetics dictate your path in life, and taking control of your own body and thus taking any path you please.

---

Postscript: all this relatively ignores the question of whether a parent should seek treatment their child, who is not yet formed in their own will enough to say what they would like out of life.

I think the answer to that is simple: if and when we have the medical equivalent to glasses, something that can be put on and taken off, and doesn't affect the wearer except to allow them to experience what is "standard" (i.e. doesn't give them any extra boost above that "standard", doesn't give them a "rush", etc.) then there is no reason to not supply that item to the child, and allow them to decide for themselves the advantages and disadvantages of it.

I, for one, was found to be nearsighted in grade four--and, after getting glasses, never had to be prompted by my parents to put them on. I preferred having them on, for what they allowed me to do.

If we do not yet have a drug that works like that, then, to the degree that the child will be "changed" by the drug, that same degree of consideration will have to be given as to any potentially-harmful course of action parents decide for their child (such as, say, sending them to a boarding school.)

The "intense narcotic effect" of Adderall is due, by the way, to the immediate, large amount of it made available in the bloodstream. The whole point of newer-generation drugs like Vyvanse and Concerta is to change the bioavailablity of the drug to a small, steady stream, by effectively having the liver process and "activate" it at whatever speed the body prompts it to.

I'm sorry for what you went through, but it's not the same thing kids today go through.

(I say this as someone who was diagnosed with ADD after 23 years being unaware of it, doing very badly in school, letting relationships fall apart, losing jobs, etc. In retrospect, given the drug technology at the time, I think my parents made the right choice--when a teacher suggested they look into my neurological condition--that the treatments available at the time were worse than the disease. However, this is no longer the case.)

Re-reading that does sound a bit insulting, I'm sorry that it came out that way, I don't mean any disrespect.

I grew up with a brother who had to take dexamphetamine or he wouldn't be able to do anything, he was a totally different person under it.

Totally understand, thanks for the clarification. Obviously this is something I'm passionate about ;)

"People haven't lived with someone with actual/bad ADHD if they think drugs don't work."

Or they actually read books. All of the research shows that ADD drugs actually make ability to concentrate worse in the long term, and in the short term they increase the ability to concentrate but not the actual rate of learning. This study has zero new information, this is all stuff we've known for decades.

if you have a few good links i'd be interested in reading about the long term affects of Ritalin/Adderall/Concerta/etc. It's frankly hard to trust raw search engine results on such a biased topic.

Thank you. Without exaggeration, I would be homeless without my medication. When people argue against ADHD medication, I take it personally.

Focus and memory isn't enough, is the takeaway from this article.

You have to teach people good study habits, habits they won't necessarily have if they have ADHD/ADD. That focus is great, but only if properly targeted towards the tasks that need to be accomplished and the material that needs to be learned.

Not to mention that all the drugs in the world can't make a kid care about completing the scutwork some schools dish out.

Sitting still at least some of the time and not attacking fellow students and teachers more than they deserve is certainly a good start...

So, like everything else in the world, success at this task is a balance of many things and not just one single thing?

Tell me more...

As someone who grew up with ADHD managed by stimulant drug therapy since age 7, I can earnestly say that my experience was that ADHD drugs did boost my grades and were a crucial factor in my career success, to date (and still are).

I completely agree. I was diagnosed and have been treated since around age 7. This was before ADHD was 'popular', and at a point in time when they thought it just went away when you got older.

At least, as written, the article talks about something different from the study. The article says "However, a growing body of research finds that in the long run, achievement scores, grade-point averages or the likelihood of repeating a grade generally aren't any different in kids with ADHD who take medication compared with those who don't. "

It then says "A June study looked at medication usage and educational outcomes of nearly 4,000 students in Quebec over an average of 11 years and found that boys who took ADHD drugs actually performed worse in school than those with a similar number of symptoms who didn't. Girls taking the medicine reported more emotional problems, according to a working paper published on the website of the National Bureau of Economic Research, a nonprofit economics research firm."

Nowhere, does it say they study studied kids with ADHD, only kids taking ADHD drugs.

I could entirely believe it does not improve grades or cognition in students who are not actually ADHD, but believe it "helps them focus" or whatever.

THe article seems to mix up these things all over the place, in some cases talking about ADHD kids, and in some cases talking about kids taking ADHD drugs.

If the study really only studied kids with some verified accurate ADHD diagnosis, it would be nice to know that.

While, back when I was diagnosed 27 years ago, kids taking ADHD drugs and kids with ADHD were likely much the same group of people, they haven't been for a long time.

How would you know if you have been taking them since you were 7?

http://www.aasa.org/SchoolAdministratorArticle.aspx?id=5642

article on the feminization of schools. boys (even those without learning 'disabilities' are not set up to succeed in 21st century school systems.

Science reporting in the news sure is broken. Do enough studies and eventually you'll happen upon one that gives the wrong (and newsworthy) answer, just by chance.

Here are some studies asking the same question that weren't mentioned, and their reported effect on academic performance (in order of my encountering them on scholar.google.com):

1. http://psycnet.apa.org/journals/pha/9/2/163/ (positive)

2. http://psycnet.apa.org/journals/ccp/70/2/320/ (positive)

3. http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.1993.... (positive)

4. http://psycnet.apa.org/psycinfo/1993-46419-001 (positive in short term, neutral in long term)

5. http://link.springer.com/article/10.1007/BF00925819 (positive)

I stopped there, but I think the trend is obvious. One thing I think is worth noting is that the short-term studies very directly measure academic performance by actually observing the patients. The long-term study cited in TFA - and I suspect most other long-term studies - relied on questionnaires instead. It seems probable to me that the problem here is that questionnaires are simply too noisy an information source to obtain a statistically significant result, given the additional noise created by overdiagnosis.

ADHD is both over-treated as well as under-treated. Some children might not need medication, but others suffer from the effects of untreated ADHD.

It often looks as if the side effects of Ritalin are overstated, and the negative effects of untreated ADHD are understated. ADHD has been linked to Depression and poor social life.

I am currently prescribed Concerta 54 mg and take it in spurts. Why spurts? A love-hate relationship. While I am on Concerta, I excel at my job. Unfortunately, Concerta tends to super-enhance my "logical/work" side while hampering my "interpersonal/compassion" side. My girlrfriend cannot stand me while I am on my ADD medication: I am far too distant and non-communicative with her. I know she is right, I can't deny the truth: I neglect her to focus on logical tasks instead.

It seems I cannot maintain a healthy, intimate relationship with my girlfriend (or likely any other person) while on ADD medication. In addition, my performance at work is abysmal without medication: I find any and every distraction around me when not medicated. How can I balance my work/personal life with ADD?! This frustration is driving me crazy! =(

I went from failing math classes to a straight A student and AIME competitor after starting concerta in high school. I'm very surprised at the results of the study. I didn't like the medications either since it made me feel very strange and I couldn't sleep at all so I tried for a long time to convince my parents they weren't doing anything.

I'm aware that I act very different while on medication, people around me can very easily tell whether I forgot to take meds that day.

The data used in making this statement is utterly skewed. I defer to Kuhn to explain why - how many variables were accounted for in any study supporting this conclusion? This doesn't have to be epistemologically far removed - there are real variables I'm sure were not accounted for. For example, the DEA has been on campaign for 2 years to subvert the FDAs authority - where exactly did funding come from and by whom? Also, one has to consider the rapidly shifting economic climate we live in - certainly that would have an effect on performance if it is weighing on a student's mind... Problems with the scope and geolocation of participants are clear. And the article writer forgot to address what is placed at the end of every published scientific study - it's limitations and how the study could have been better. And then there still are all those epistemological problems (infinite variables) still sitting there, glaring....

I wouldn't say they boost grades, but they did allow me to actually finish my homework (or start, in most cases)

What sort of parents don't put their kids on medication even though it makes their lives easier?

One they are probably hippies, but two I'd say they are quite invested in their child.

Which to me could mean they put in enough extra effort to keep their kids grades high.

I'd view the study cautiously.

What's the point in this? Of course the stuff doesn't boost grades by itself. It enables kids and adults to work for school or university or whatever like someone "normal". It doesn't increase your motivation, it increases your ability.

It's possible that ADHD drugs don't boost grades, on average, because grades are a strong function of the home environment. Thus, improving a child's focus without improving their home environment won't magically improve their grades. Work is work and there is always something more stimulating a child could be doing in an unstructured environment. ADHD is heritable, so it's possible some parents don't themselves have strong study skills or discipline, value grades, and/or have self selected to take the easy route (drugs) before trying the hard route.

A couple questions for those that have been on any single medication for a sustained period: 1 Have you found that you need to increase your dosage at a stable rate to maintain the same effectiveness? 2 How are you now when you are off the medication e.g If you are on vacation and do not need to 'buckle down' do you still feel a need to take the medication just to feel like yourself? Thanks in advance for any replies.

Outside of a tiny percentage of people with a problem serious enough to warrant medication, the point of the drugs is to make kid easier to manage.

Maybe not, but I can code 10x better on Adderall. If I had this in high school, I'd have gone to MIT.

> If its drugs demonstrably improve attention, focus and self-control, why wouldn't grades improve as well?

Because academic performance depends far more on luck than on skill. That's why the whole standardized testing is silly. It precisely measures pretty much random variable.

Nope, then good grades wouldn't be repeatable!

If a kid is taking the meds just for the grades, that's wrong. But ask the parents/teachers if they are paying attention and remembering instructions better if they do (which often have a impact on grades).

The same way a better engine oil don't help distracted drivers.)

Of coures not. Those drugs don't address the root cause.

Which are unknown, might be (currently) unfixable, and more than likely are completely irrelevant.

One of the reasons Cognitive-Behavioral Therapy states is for it being effective is essentially ignoring the "root causes" (that may as well be already gone) of problems in favour of actually fixing it.

They may be unknown to you, but that doesn't mean the causes themselves are unknown.

In order to find the root cause of a phenomenon, you must point out the phenomenon concretely enough - you need to know what you are diagnosing. That's the first step.

Then we need to look at cases.

It's foolish to try to say the causes are unknown without discussing these concrete matters.

No but they do boost Pfizer's stock price!

Placebos are a billion dollar business!

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