
Overselling A.D.H.D. - okket
http://www.nytimes.com/2016/08/28/books/review/adhd-nation-alan-schwarz.html
======
anexprogrammer
As someone in my 5th decade, with lifelong ADHD (though given my age it did
not exist in my youth, and was only diagnosed relatively recently), I'm wary
of backing away from treatments until we actually do have real viable
alternatives.

It took far too long to get ADHD widely recognised, and even now it's often
more likely to be received with humour than real recognition. Much more
research, especially on other possible treatments and therapies, is needed
before we turn too zealously against the only treatment actually shown to
work. We have a long history of over diagnosing and overdoing pretty much
everything.

I've only ever managed it with limited success. There's little doubt that the
_drugs can work._ Despite some evidence of over-diagnosis and over-
prescription there are many people who have had their prospects transformed as
a result. I suggest the ADHD label is being significantly over applied because
real awareness, even in the medical profession, is still abysmal. Doctors
don't have time to look at home circumstances, or parents and other factors
that might affect behaviour. Awareness coming from some TV comedy skit however
is high.

I don't actually care that we don't yet have full understanding of how the
drugs work, or that OMG they're amphetamines. I _often_ wonder how things may
have turned out differently for me had I encountered more GP awareness and
less ridicule, or even earlier self-awareness or teen diagnosis and treatment.

If we are too successful "exposing big pharma" and overdiagnosis in the minds
of GPs and the public, lives will be ruined once again. Let's not throw the
baby out with the bathwater here rather than seek wider understanding.

~~~
engx
Why do people on meth enjoy cleaning? There is little difference between meth
and Adderall. Taking any type of stimulant even coffee helps people do menial
tasks and be more optimistic while doing them.

Maybe millions of people are effected by some problem of distraction and lack
of focus. But to suggest there's some biochemical reason for this that's cured
by amphetamines seems like pseudoscience to me.

Drugs do work. If you want to take amphetamines to improve your work
performance, go for it. But to suggest that it's a disease seems disingenuous.

There's something like 16 million Americans who take Adderall, which has
drastically increased in used (300%+ from 2008-2012). Another poll said 35% of
college students had said they'd tried Adderall.

The science of ADHD is ambiguous. The science of moderate uses of amphetamine
or methamphetamines for improving work performance is easier to understand.

~~~
PhasmaFelis
Imagine this: you're an adult professional, sitting at your desk looking at a
freelance work assignment that needs to be done by tomorrow, weeping with
frustration because you've been staring at it for eight solid hours, trying
and trying to begin, and you can't because focusing on anything important is
like trying to grip a handful of water.

Because you ran out of your meds.

This is what my life is like. If that doesn't sound like a medical condition
to you, then I don't know what you're thinking. If you think I haven't tried
everything else imaginable to deal with it, you're mistaken. The only thing
that works is amphetamines. There's definitely downsides, and if someone
showed me a better solution I'd love to try it. But, so far, there isn't one.

Maybe some people take the meds who don't really need them. That's a shame.
You don't get to sacrifice my career just to keep some people from getting
high.

~~~
sseal
three things:

1\. You do not enjoy your work, and thus have no motivation.

2\. Maybe you should not do the work and suffer the consequences.

3\. You have built a mental dependency that you must take amphetamines to
"focus", and this hinders your real ability to focus.

All of those things ^^^ I have experienced at one point or another in my life.
You can focus, you have to make yourself. There is no other way. You do not
need medication... But maybe you do, I highly doubt it though.

~~~
PhasmaFelis
> _Maybe you should not do the work and suffer the consequences._

I've done that. A lot. It sucks. That's why I take medication.

> _You can focus, you have to make yourself. There is no other way. You do not
> need medication..._

I don't understand why people can't quite believe that mental illness is real.
You would never tell a diabetic or an asthmatic that they shouldn't have to
take medicine every day. But if someone's clinically depressed, or has ADD, or
any of a hundred other mental conditions, people just assume you're imagining
things or being lazy.

~~~
wvenable
It is hereditary too. I've seen how in past generations, children with these
kind of conditions were just labeled as trouble makers and got no help and
eventually failed out the system.

Just simple understanding and acceptance that this is a condition, medication
or not, makes a huge difference. And yet here we are still arguing it.

------
jrapdx3
Since I've had the responsibility of managing the treatment of at least a
thousand adults and adolescents with ADHD, it's a subject I've studied quite a
bit. And as the medical literature attests ADHD is probably among the most
researched of all medical conditions and its reality is unquestioned based on
the scientific literature.

When people say "I don't believe in ADHD" I point out it's not like believing
in Santa Claus, the reality isn't changed by our "belief". Might as well say
"I don't believe in cancer", it's not going to make it disappear.

The fact is that ADHD has been shown to affect 4 to 5% of American adults and
5 to 8% of children. When the same diagnostic criteria are used, populations
of other countries show comparable prevalence. This means it is a much more
common disorder than usually considered.

The key issue in my estimation is the level of disability ADHD can produce in
adults. Studies show devastating adverse outcomes in virtually all domains of
functioning. People with ADHD fall far behind peers in educational achievement
and employment, and far exceed peers in rate of divorce, motor vehicle
accidents and injuries, greater rates of general health conditions and larger
health care costs.

Furthermore, despite the availability and relatively low cost of effective
treatments, among adults with ADHD only about 1/5 receive treatment. The total
costs to the economy of untreated ADHD very likely is on the order of $100
billion annually in the US alone.

Bottom line is ADHD is a very common and disabling condition with a high cost
burden to the individual, family and nation as a whole. We underestimate the
impact of ADHD in all these domains at our peril.

~~~
leereeves
If I could ask a question that may sound like a challenge but it is not meant
as one:

How does ADHD lead to divorce, motor vehicle accidents and injuries, and
greater rates of general health conditions?

Is this correlation still present after controlling for confounders like
education and economic status?

~~~
falcolas
The two biggest factors that I can come up with would be the lack of ability
to control attention, and the inability to consider the long term
repercussions of actions.

If you can't force yourself to keep attention on the road, you're going to
crash. If you can't think about how that daily pint of ice cream will affect
you beyond "it tastes good now", you're going to gain weight.

~~~
tstrimple
And when your eyes continuously glaze over when your wife is talking to you,
it can lead to marriage difficulties.

~~~
falcolas
Sorry, sweetie, what were you saying?

Heh, yeah. I've said that a few too many times. I'm just glad she understands.

------
flogic
I'm generally not fond of this sort of article and this one is no exception.
They present a case that drug companies like selling drugs but we knew that.
What they don't do is present a good case that ADHD is actually overdiagnosed.
The world in general is not very good at accepting psychological conditions.
ADHD is commonly regarded as "youth", "laziness", or "lacking discipline".
Watching a loved one fight to focus continually is just heartbreaking. We
still have quite a number of cases where people are stuck fumbling without
help.

~~~
soylentcola
Yep. Dealt with this my entire life. Teachers, doctors, and counselors
suggested I see someone regarding a possible ADD diagnosis all through school
as my supposed "brilliance" (their words, not mine) came along with a
seemingly unbeatable tendency to zone out in class, constantly talk to other
kids when I knew I was supposed to be listening, and flat out forget to do
major assignments while I just sort of daydreamed or got sidetracked the
moment something else came along.

But my father didn't believe in ADD or at least thought it was overdiagnosed.
By god, when he was a kid, there was a name for my behavior and it was lazy,
careless, or just plain selfish. So all of those recommendations were ignored.

It took me dropping out of college, going off to work in dead-end, unrewarding
and un-challenging jobs while avoiding contact with my folks out of a mixture
of shame, resentment, and anger to finally motivate me to see a counselor who
eventually referred me to a psychiatrist.

Got put on a mild dosage of stimulant medications, got myself about $15k in
loans to enroll at another state university, finished my degree with no lower
than a B in any class, and finally got myself into something of a career path.
It's been weird because I always felt like I'm 10-15 years behind where I
should be but then I remind myself that there is no "should" and I'm thankful
that I've improved my quality of life.

Medication (and stimulant medication) isn't a panacea and there are obviously
tradeoffs but I think that for a very real subset of people, the avoidance of
it out of some misplaced ideas of pill-pushers or lack of "grit" is a real
shame that causes some very real problems.

~~~
koverstreet
And these kinds of experiences are why ADD deniers fill a lot of us with rage.
Their willful ignorance is hugely destructive and damaging to the people
they're able to influence.

------
rayiner
The point about changing the kid instead of the environment is an important
one. If attention deficit is defined as a kid having trouble coping with the
standard 7-hour school day (more like 9-10 including homework) where he is
expected to sit still and work on boring and non-essential worksheets, then
the condition isn't over diagnosed at all.

And if we're not willing to change that environment--and I don't think we are
--then we should medicate the kids so at least the experience is tolerable and
they can have some success with it. Given that artificial stimulation to cope
with the modern workforce is universal (espresso shots, liters of coffee,
energy drinks), they might as well start getting used to it.

~~~
forgotpwtomain
> And if we're not willing to change that environment--and I don't think we
> are--then we should medicate the kids so at least the experience is
> tolerable and they can have some success with it

And as a result traditional response has been amphetamine-salts for children
as you say. But I completely disagree that this is something we _should do_.

For one I think we don't have good enough science to know how potentially
dangerous or helpful ADHD drugs really are. Is it going to help them adjust
later, or will it be harder? Are they going to be dependent on amphetamines
their whole life? Evaluation of drugs which are primarily targeted at
emotional and behavioral problems is difficult enough in neutral conditions,
since it is hard to control/evaluate/quantify results. Yet the conditions we
are dealing with are totally _not-neutral_.

Basically big pharmaceutical companies fund lots of research - if the research
doesn't support their product they can shelve it and fund some other studies
until they have research which does. It's an awful field with too much money
and lots of dishonest science.

Secondly, using medications to treat ADHD (because that makes money for their
producers) is as you pointed out making us avoid the cultural / environmental
problems which cause this issue. But I disagree that this is inherently from
the 7-hour school day as you point out. Kids went to school for 7-hours 50
years ago as well, but ADHD diagnosis and medication use has been constantly
increasing. [0]

A large factor to this is the increasing amount of stimulation that kids today
are actively exposed to that they weren't in the past (I can't remember
references of the top of my head, I'll try and find one though). Basically if
you grow-up with 4-6 hours of TV or video games per day, yeah it's hard to sit
down and read a book. Obvious right? And your recommendation is _really_ to
give amphetamines to 7-year olds? Rather than limit consumption of mediums
that are inappropriately over-stimulating for large durations?

[0]
[http://images.slideplayer.com/18/5690061/slides/slide_2.jpg](http://images.slideplayer.com/18/5690061/slides/slide_2.jpg)

~~~
scottmf
>we don't have good enough science to know how potentially dangerous or
helpful ADHD drugs really are.

We have nearly a century of usage which suggests these drugs are incredibly
safe.

We medicate a _lot_ of problems which are caused/worsened by society. We need
a solution: Either we fundamentally restructure society, or we medicate.

Since we're not fundamentally restructuring society any time soon, medication
is our best option and we have a lot of data suggesting stimulant medications
in these doses are pretty damn safe—and certainly outweigh the negatives of
_not_ medicating (failing school, abusing drugs, other mental illness).

The real epidemic here is the pejorative use of the word "medication". The
distrust of treatment is always based on ignorance and appeals to nature,
tradition, etc.

~~~
forgotpwtomain
> We have nearly a century of usage which suggests these drugs are incredibly
> safe.

Non-industry funded long term study (30+ years) citation _needed_.

> We medicate a lot of problems which are caused/worsened by society. We need
> a solution: Either we fundamentally restructure society, or we medicate.

I think this is a false dichotomy, not backed by any credible research and is
a clever way for the pharmacy industry to sell drugs instead of society
expending effort on alternative solutions.

edit (To clarify): Specifically you are jumping from "lot of problems which
are caused/worsened by society" to a polarized choice of "medicate" or
"fundamentally restructure society". But it should be clear that there is a
whole field of available approaches which aren't "fundamental restructuring"
which can attempt to alleviate such problems and unless research has
enumerated and depleted all other available gradual options, this again, is a
bogus dichotomy.

~~~
scottmf
We have real data which heavily backs the case for medicating.

You have emotion and conjecture.

>Non-industry funded long term study (30+ years) citation needed.

What do you want? You're suggesting all these studies are funded by pharma cos
and the scientists are falsifying data?

If you're not going to believe any of the data and stick to your own emotions
on the subject there's no point discussing this.

Until you have anything besides personal feelings and unfounded beliefs we
should obviously stick to what we're doing. Anything else is dangerous and
unscientific.

~~~
forgotpwtomain
> We have real data which heavily backs the case for medicating.

> You have emotion and conjecture.

No, I asked for you to provide a reference to a credible study, you have
failed to do so. There is no need or place for ad-hominem attacks here. Who is
'we' btw?

> You're suggesting all these studies are funded by pharma cos and the
> scientists are falsifying data?

What I wrote explicitly was:

>>> if the research doesn't support their product they can shelve it and fund
some other studies until they have research which does.

Are you claiming this is not true? Or that this does not happen?

On a side-note: standards in psychology research are much lower than in hard
sciences, so the conflict of interest is exacerbated.

> Until you have anything besides personal feelings and unfounded beliefs we
> should obviously stick to what we're doing. Anything else is dangerous and
> unscientific.

Per chance, despite the immature nature of your tone - you are actually a
researcher who has worked on many studies supporting what you claimed above
and your research has been funded by pharmaceutical companies.

Has really not a single study with a source of funding which is not
pharmaceutical company been able to replicate your results? I would consider
that deeply suspicious in any field; and on the _contrary_ to argue that it's
_not_ , _is dangerous and unscientific_.

~~~
scottmf
Of course it has.

[http://www.europeanneuropsychopharmacology.com/article/S0924...](http://www.europeanneuropsychopharmacology.com/article/S0924-977X\(12\)00198-8/abstract)

------
dforrestwilson1
It's no coincidence that young males are more likely to exhibit ADHD symptoms.
My school attempted to convince my parents several times that I needed
medication because I disrupted the class.

While I am not proud of my prior misbehavior, I'm thankful that my parents had
enough medical knowledge to refuse to put me on pills.

~~~
beelzebubble
There are many who genuinely suffer from ADHD and their parents did not allow
them medication due to ignorance. And they have the exact opposite story to
tell.

~~~
goda90
It's a tale of ignorance all around. Overzealous diagnosis leads to problems
which leads to mistrust. People who get misdiagnosed suffer, and those who are
properly diagnosed, but assumed to be misdiagnosed also suffer.

------
sseal
I am kind of disappointed with the people reporting that they have been
"suffering" with adhd or add. I was prescribed add/adhd medication from 5th
grade until 12th. It wasnt until I started practicing yoga was I able to make
myself focus.

I had always, my entire life, HATED taking "my medicine". It changed me, it
made me just like everyone else. Now that I am in my later 20's I take pride
in the fact that I am "ADD". It is disappointing that people with this gift
listen to society and somehow think they are not normal. Take some time and
read about benefits of having add/adhd, it will surely put you in a better
state of mind.

I will say there are edgecases of people that truly have issues, but I beleive
your average add/adhd patient could do without it.

Another thought. We are bashing these kids that have problems conforming to or
being a part of our schooling standards. Why do they have to conform, why are
more schools not conforming to the add/adhd children? Why must we have to
change our natural state of mind? It doesn't make sense to me that we have to
take drugs and alter the natural way we were made because we are outspoken in
class, or dont want to listen to a teacher lecture.

Rant is over.

------
hellofunk
I've always been skeptical of ADHD diagnoses, thinking that it was widely
over-diagnosed and a problem in American culture more than anything, and not
as commonplace in reality. My googling took me to this article which suggests
I am wrong:

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525089/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525089/)

~~~
leereeves
I'm far from an expert on this, but I've always thought that the symptoms
(inattention and/or impulsivity and hyperactivity) are only maladaptive in
modern culture, where young people are expected to spend long hours sitting
quietly at attention in school.

Is that a disease, or a flaw in modern culture?

~~~
jackgavigan
The article addresses this issues: _One clinician quoted in the book more or
less admits defeat: “We’ve decided as a society that it’s too expensive to
modify the kid’s environment. So we have to modify the kid.”_

~~~
leereeves
The article briefly mentions the issue then moves on.

But is it true that "it’s too expensive to modify the kid’s environment" or
simply that established powers make more money by "modifying the kid"?

~~~
Vraxx
In a way, those can both be true simultaneously. Just from the assumptions
that the "established powers" make more money by modifying the kid implies
that even if modifying the kid's environment cost $0, it would "cost" them
lost profits of modifying the kid.

Costs are relative, and I think the point remains that the kid's parents are
relatively powerless to alter the kid's environment significantly enough to
solve the adhd problem. Thus, the decision of the cost/benefit analysis of
modifying the environment vs modifying the kid falls to the "established
powers", also known as, collective society.

~~~
leereeves
By "established powers" I meant the people with enough political power to
influence educational and medical policy.

As long as everyone with significant influence is comfortable with the status
quo, there's little pressure to search for other options, even if many parents
might prefer another option.

------
scottmf
Why single out ADHD? What about over-diagnosis of depression and other mental
illness? This kind of nonsense is fodder for those who believe ADHD and other
disorders aren't a serious problem. What's the solution to overprescription
which doesn't deny safe, life-changing drugs to those who need it?

"People deserve a wide range of treatment options"? Insightful. There _is_ a
wide range of options, but stimulant medications are significantly more
effective than anything else.

If faking symptoms for drugs is the concern here... why? How much effort
should we really put into weeding out fakers at the expense of those in need?
Stimulant medications used properly are incredibly safe and improve
attention/focus in healthy people. Maybe it's time certain people stop forcing
their outdated moral ideals on the rest of us.

------
crack-the-code
While I do think that ADHD is a real condition, I don't think that the
solution is to medicate children with a very serious life changing drug that
alters the core aspects of a child's personality and behavior.

The true solution is to revamp our country's education system and provide a
framework that can accommodate the wide variety of personalities that come
into the classroom. Instead of forcing children to think one way, we should
let them think the way they NATURALLY think, and flourish with their native
mindset.

I strongly recommend this eye-opening video for those of you who haven't
already seen it:
[https://www.youtube.com/watch?v=zDZFcDGpL4U](https://www.youtube.com/watch?v=zDZFcDGpL4U)

~~~
AStellersSeaCow
"I don't think that the solution is to medicate children with a very serious
life changing drug that alters the core aspects of a child's personality and
behavior. ... Instead of forcing children to think one way, we should let them
think the way they NATURALLY think, and flourish with their native mindset."

This is wildly inaccurate and ignorant, and basically perfectly sums up why
the problem isn't being treated effectively.

1) The drugs aren't serious and life changing and they don't alter core
aspects of your personality. People seem to confuse the effects of mild
stimulants like ritalin and adderall with the effects of powerful
antidepressants like prozac (I blame South Park, et al). Stimulants can have
negative side effects, but they're more along the lines of what you'd expect
from too much coffee: loss of appetite, hyperalertness and sleep problems, in
extreme cases twitchiness and cardiovascular problems. These are well-
understood, and any doctor would adjust/halt the drug if they got worrying. In
terms of personality, the person is just getting a boost to their deficient
executive function. The net result could be that they're less likely to do
things impulsively, but not that they're less likely to do things, period.

2) I'm all for letting children think how they're going to think, and agree
that our education system is far too constraining and cookie-cutter. But
there's a huge and meaningful difference between "let kids think how they
want" and "don't treat problems that are preventing kids from thinking
lucidly". Some excellent research has shown that even if parents and teachers
bend over backwards to facilitate kids with ADHD, unless they get some kind of
treatment (and medication is both much more effective and far less expensive
than behavioral therapy) they're still going to struggle.

So what people who advocate "let (kids) think the way they NATURALLY think"
are effectively saying is "let some non-negligible fraction of kids have a
dramatically lower chance of success and happiness in life rather than
acknowledge that they have a disorder and treat it".

~~~
crack-the-code
To your first point, I would strongly disagree, and actually argue that you
are the one being wildly inaccurate and ignorant. I know many people first-
hand who were affected negatively from the drugs. As an example, I once had a
very charismatic friend who was extremely bright, happy, and just fun to be
around. In middle school, he started taking medication. He became detached,
depressed, quiet, and generally dull. He would at times be himself, but
overall, other friends and I noticed a drastic [negative] change in his
behavior. To me, that is extremely serious, especially as a child where you
are forming your character and social abilities and exploring your
imagination. Another example, I have a cousin who takes the medication.
Throughout her childhood, she experienced unusual and unpleasant side effects
like headaches, stomach pain, anxiety, sleep issues, etc. Her doctors have
rotated her through different medications, but it seems there was never a
golden ticket with 0 side effects. You argue that these are negligible side
effects, like coffee. I would say that these are much worse than coffee, at
least in the extent of how they effect people, and at the same time would
argue that it doesn't even matter if the effects WERE the same as coffee. Do
you want your child to be on coffee and redbull? Not me. I know plenty of
other people who experienced the same symptoms and personality changes I
described here, and although that is not conclusive evidence, there seems to
be a large consensus on this issue (as far as the side-effects and changes in
personality). And if you think there is no chance of any long-term health
consequences derived from prolonged use of these "mild stimulants" like
ritalin and adderall, then I am going to reluctantly step back and say we
should just agree to disagree.

To the second point, you seem to be confusing my observation as a call to
blindly end the use of medication. My argument isn't that we must end the use
of medication and ignore the issue, it was that we need an overhaul of the
education system so that we can get rid of the pills and preserve the well-
being of the children. Not a practical or easy solution, I agree, but it is an
important one at the least. And of course there will be children who fall at
the far end of the spectrum, where no matter how accommodating the system is,
they will still need the assistance of medication to truly thrive. But at
least we can safely say we tried at that point, instead of assuming that these
children are all "troubled" and need big pharmamama to feed them the milk of
corporate greed.

------
ajones05
In the U.S. we force children to sit still through hours of classes, wonder
why they get distracted, and then medicate them. In other countries kids get
more breaks to expend energy and are then more attentive - e.g.,
[http://www.theatlantic.com/education/archive/2014/06/how-
fin...](http://www.theatlantic.com/education/archive/2014/06/how-finland-
keeps-kids-focused/373544/) "In every one of the experiments, students were
more attentive after a break than before a break. They also found that the
children were less attentive when the timing of the break was delayed—or in
other words, when the lesson dragged on."

~~~
sseal
I agree. How do you expect children to sit in a class room for 7 hours a day?

------
prashnts
I got my diagnosis for ADD (and a few other stuff) a little more than a year
ago when I was 19. For me, it's always been really "weird". I suppose I could
share this personal anecdote here, in a hope that people stop seeing
everything as binary. Sure, there is "big pharma" problem. I buy 150 USD worth
meds on my own to know that (insurance does not cover it). But that
doesn't/shouldn't hinder those who genuinely are in need of help, be it in
form of medication, therapy, or just plain ol' family support.

Without and before the stimulants, absolutely nothing was urgent to me. Not
showering, eating, getting work done, studying. Nope. It always came as a
surprise when I used to see other folks deciding to do something, and then
_actually_ getting it done! How is that even normal! Now, though, I realise
that that's what "normal" is.

But that's just probably what others see as laziness? I don't know. Perhaps it
is Executive dysfunction? But I am glad that I managed to get help, and ever
since that, actually able to get myself together.

Having lived in India, mental illness is still taken as a taboo, at large.
Nobody at my family, myself included, knew about even the existence of ADHD,
let alone see a psych!

I remember my parents always being told: "Your kid can do better, but he
doesn't study! If only." And this went on all the way till my second year at
University, when the night before my end-term exam, I ended up with a
breakdown because I __just could not__ manage to focus and study the material.
I ended up barely passing the paper.

Not everything has been bad, though. There's always this phase of "super
focus" for me -- I find something interesting, and then obsess over it until
it isn't interesting anymore. Channelled in right direction, I managed to
learn a __lot __in math, computer science and of course programming.

I do think that a lot of mass-education is needed with this regards.

------
ap22213
“We’ve decided as a society that it’s too expensive to modify the kid’s
environment. So we have to modify the kid.”

Unfortunately, we can't modify much of the environment without giving up a lot
of what we have. And, that's the trade-off of rapid progress - evolution is no
where near as fast. We probably should change the schools for many reasons.
But, changing them so that they're somehow more natural is probably an
impossible goal, at least until we invent more technology.

Humans have had to deal environmental diseases at every major milestone:
choosing residential over nomadic; domesticating livestock; using grain as a
primary food source; choosing urban over rural; inventing industry, the
corporation, and desk jobs; inventing dangerous chemicals for products and
fuel; inventing processed foods; inventing weapons of mass destruction. The
diseases that have come with these have been trade-offs that we have accepted.

As a sufferer of several psychological diseases, I suspect that mine are all
environmental in some way - stress, close-quarters living, giant social
hierarchies, living by the calendar and clock, being exposed to all sorts of
toxins, etc. My nature tells me that I should be out running through the
forest and chasing game - not sitting at a desk and typing on a keyboard. But,
am I going to live alone in the forest? Hell no; I enjoy what I have.

I take several psychological drugs, and they have awful side-effects. And, I
self-medicate in other ways. But, those are the trade-offs that I've chosen to
be able to do all the things that my mind conjures.

------
riprowan
I was diagnosed ADHD when I was 7 and the doctors put me on Ritalin.

This was the early 1970s when very little was known about how to prescribe the
drug to children. The doctors put me on a dose of 20mg 3X per day. It almost
killed me. I remember having an overdose in 2nd grade (at least now I know
that it was a Ritalin overdose). 60mgs of Ritalin is high even for an adult
much less a 7yo.

The teacher was required to distribute the pill to me mid-day. She would stop
class, and say, "Rip, come up front and take your 'hyper pills.'" Thusly
singled out, I would sheepishly trudge up to the front of the classroom and
get my medication to the snickers off all my classmates. It was scarring.

Also my nighttime dose was usually enough to keep me awake all night. At that
age I had night terrors which were exacerbated by the drug and lack of sleep.
I'd return to school wiped out like a zombie.

I'm sure I did present with all the classic symptoms of ADHD: inattentiveness,
restlessness, talkativeness, inability to complete tasks, constant need for
interaction, etc.. I am still this way to a degree.

I'm pretty sure that nobody really bothered to try to understand what my home
life was like. I was the only child of two raging alcoholics. They would get
drunk and fight for hours 3-5X per week until all hours of the night. I was a
terribly depressed, anxious child. And since the underlying cause of the
anxiety (my horrible home) was never addressed, I've no doubt that to this day
I carry around a form of PTSD from my childhood.

I'm sure there are many people from great homes with no external factors
driving their ADHD. However, I know in my case, I suffered greatly from an
untreated trauma, and was simply medicated so that I wouldn't disrupt my peers
at school. It also didn't help that I have ~140IQ and found school absolutely
tortuously boring until I finally got into an honors program in my high
school. My peers were still struggling to read books aloud while I was knee-
deep in LoTR.

How can we blame young children because they can't sit still and quiet day in
and day out while absolutely nothing interesting ever happens? How is it that
after years of being unable to complete homework assignments, nobody ever
really started questioning what was happening at home?

Looking back, it is absolutely shameful how this was handled.

Treating behavioral problems in small children must begin with understanding
and treating the possible behavioral problems of the adults first, otherwise
it's just compounding the damage.

Interestingly when I got old enough to start using marijuana I quit the
Ritalin. I found myself quite able to study on weed and my grades in college
positively reflected my increasing marijuana consumption. My first year in
college I used none, thinking that this would be best for my schooling, and I
performed poorly. Thus discouraged, I figured that if school was going to go
badly I might as well get high. My grades went from Cs and Bs to Bs and As and
onto the Deans Honor Roll. I took my senior final in probabilistic modelling
thoroughly blazed and broke the curve for the whole class.

Also interestingly, I cannot take other typical anti-anxiety meds. Anything in
the benzo class, for example, causes terrifying complete amnesia even at low
doses.

All anecdotal, I know, but I also know a lot of other people with more or less
my same story.

~~~
NovaS1X
I know exactly how you felt.

I was diagnosed with ADHD, OCD, and tourettes quite young, my mother and
father separated when I was very young, and my mother had the habit of moving
to a new town every 2 years. All of this lead to a less-than-stellar
experience in school. I eventually made it onto the short-bus. As you were
ridiculed as an individual in class, I was ridiculed by group association.

I don't know if my "IQ" was up there , but I was the kid making web-pages
while my class-mates were doing the word-processing class. Obviously this
meant I'd get terrible marks in class as I'd never get around to doing the
work but that's the over-reaching theme of my experience in high-school.

So. Bored. Every. Day.

Except I didn't listen. Nope. When I was interested in something you could bet
I'd be in the top-of-the class. If I wasn't, I'd probably not even finish it.
Unlike you, who got though it, between my home life and everything else I
didn't even finish. I dropped out in grade 10.

However I never really did have trouble focusing. I focused on what was
important to me and now I'm in a place in my life where I'm happy and working
in a skilled, knowledge-based career making great money for my age and I'm
doing the things I've always wanted to.

------
adrusi
Its important to note that in addition to supply-side forces increasing
diagnoses, there are demand-side incentives as well.

I don't know how many parents are eager to put their kids on speed, but there
are also accommodations provided by schools that they might very much want
their kids to have. Like having the option to turn homework in late, or
getting extra time on tests. Its worth noting that the option to turn homework
in late is probably useless or worse for actual cases of ADHD, since it just
moves the consequences of actions even further into the future, for people who
have a deficiency in the ability to handle loose feedback systems (as opposed
to tight feedback systems where consequences are immediate).

------
cmrdporcupine
Wish this article was not paywalled.

I believe I am "ADD" (not hyperactive) myself, and so is my 8 year old
daughter, at least so far.

But I do not want her to get that label, and for the school system to label
her that way, because the last thing I want is for them to demand that we
medicate her.

When we are talking 5% or 10% of the population, from my perspective
"disorder" starts being the wrong word to use. That is a significant enough of
a percentage of the population that the classroom/workplace should adjust to
_them_ not the other way around.

Somehow I've made that happen for my own life, with a lot of frustration. I
just need to figure out how to make it work for my daughter.

------
Floegipoky
We don't have to give up modern education to meet the basic biological needs
of children any more than we need to give up our jobs to be healthy adults.
Initiatives like [http://standupkids.org/](http://standupkids.org/)
demonstrate pretty clearly that there are plenty of obvious, easy ways that we
can address these needs. The obvious answer as to why we haven't tried them
yet is money. But that seems like a lazy explanation, because American schools
are some of the best-funded in the world. I think it's really a reflection on
how we in the West view child-rearing in general. I read a really interesting
interview a few months back discussing Freud, where the psychologist being
interviewed was basically saying that Freud's model was implicitly based on
the shame he felt about his childhood self, how the relationship between
therapist and subject is derived from the relationship between parent and
child, and that every time Freud was speaking to a subject sitting in a chair
in front of him, he was talking to his 8-year-old self. Ironically we tend to
see the natural reaction of a child as somehow wrong. If a child can't sit in
a chair for 3 hours, the child is wrong, rather than the idea of sitting in a
chair for 3 hours. So as the article points out, the conversation begins as
"How can we modify the children to fit the environments we've built for them"
rather than "How can we modify the environments we've built for children to
fit their needs?"

------
reactJS
I started taking these stimulants like vyvanse in college about five years
ago. Although I can exhibit symptoms from time to time, I do not think at all
that it is medically necessary for me. After trying them once, it made things
a lot easier, and besides a few episodes, the good effects have been able to
balance out the bad. I do get very worried occasionally though that I will
have to suffer long term consequences. I am very much dependent though now
this fear has not yet been strong enough to get me to stop.

------
mcculley
The article briefly mentions "hyperkinetic infants" and doesn't address the
well known effects on neonates by the consumption of caffeine by pregnant
women
([http://www.ncbi.nlm.nih.gov/pubmed/3420441?dopt=abstractplus](http://www.ncbi.nlm.nih.gov/pubmed/3420441?dopt=abstractplus))
and the way advertisers market sugar and caffeine to children.

------
PragmaticPulp
Note that the author directly acknowledges the existence of ADHD in the book.
His concerns are directed toward the pharmaceutical industry's push to
increase sales of stimulant medications. From the article:

    
    
      Schwarz has no doubt that A.D.H.D. is a valid clinical entity that causes real
      suffering and deserves real treatment, as he makes clear in the first two 
      sentences of the book: “Attention deficit hyperactivity is real. Don’t let 
      anyone tell you otherwise.” But he believes that those who are disabled by the 
      condition deserve a wider range of treatment options than an endless litany of 
      stimulants with chirpy names like Vyvanse and Concerta.
    

In my experience, I think most patients, parents, and clinicians would readily
agree that ADHD is over-diagnosed and over-medicated. It's surprisingly common
on internet forums and threads like these to find people insisting that ADHD
is over-diagnosed _in others_ , but that their own case of ADHD is genuine. Or
parents who believe that stimulants are over-prescribed in general, but that
their own child's case is an exception.

Clinicians feel this pain perhaps most directly. Few patients or parents
arrive at the clinician's office seeking a diagnosis for their attentional
symptoms without already having self-diagnosed themselves or their children as
having ADHD using online tests, often from the pharmaceutical companies. Even
fewer patients are open to alternative suggestions for addressing their
problems, having already decided that they want a prescription for stimulants,
and they want the exact stimulant formulation they saw online or heard about
from their friend. It's an uphill battle for the clinician to argue against
this, as denying patients the medication they've decided they need for
themselves is a recipe for angry complaints that increasingly-busy clinicians
don't really have time for.

The pharmaceutical industry knows full well that their target market tends to
self-diagnose and decide what they want before ever stepping foot in to the
doctor's office, and their marketing material is geared to maximize that
effect. The ADHD information on the Vyvanse website, for example, reads more
like a horoscope than a list of symptoms. From the Vyvanse website:

    
    
      Kids may make careless mistakes in schoolwork, have difficulty remaining focused in class, and seem not to listen when spoken to directly.
    
      Teens may avoid homework and may be easily distracted by many things, including unrelated thoughts.
    
      Adults may forget to keep appointments, pay bills, or return calls and avoid completing forms or reviewing paperwork.
    

Unfortunately I don't know what the solution might look like, as the blame is
shared by patients, parents, clinicians, insurers, and pharmaceutical
companies alike. The fact that we allow companies to market diagnoses and
medication directly to people represents a massive conflict of interest, as
this incentivizes them to appeal to the widest audience as possible.

Better education of patients and parents would go a long way toward dispelling
some of the myths around ADHD. It's entirely normal and expected for teens and
children to not want to do their homework and to be distracted at times, just
as it's unrealistic to expect adults to never miss an appointment, bill, or
phone call. Kids naturally want to play video games or browse YouTube instead
of doing their homework. At some point these issues reach the level of ADHD,
but that level is much higher than most of the population would like to
believe when it comes to themselves or their children.

------
discordianfish
I don't want to add anything further beside asking people who are about to
comment how it's not a real disease to read the comments here, written by
people who have ADHD or which friends and relatives struggle. Listening to
them and whether it helps is much more relevant than any opinion or vision of
a world without need for Ritalin.

------
krinchan
I've observed this whole drama unfold first hand. Having been born in the
early 80's, I grew up on Ritalin and most of my classmates did too.

I actually _do_ have ADHD, but I'm unmedicated for well over 15 years now.
This is completely by choice; every time a new doctor sees my medical history
they basically ask in a rather pushy manner, "Ya want some pills for this?"

I didn't grow out of ADHD, but I have had to learn a lot of coping mechanisms.
I can't work with silence, I always have to have music on. If I don't, I start
wandering around the internet and getting nothing done.

Pair programming is basically God's Gift to ADHD. All of my team knows that
they are encouraged, and appreciated if I'm driving and they're like, "Whoa
you are WAAAAAY off on some tangent here. Our card says to do X, let's do X."

To-Do lists and journaling are a way of life. Note taking during meetings is
simply a must. If I don't, my short term memory gets really slippery and I
start interrupting people with questions and thoughts lest I forget them in
the next 20 seconds.

But the point is, while I have all sorts of weird hoops to jump through, they
really aren't things that normal, non-ADHD people don't do. I just rely on and
need them far more than non-ADHD people. Yet every doctor wants to give me a
prescription for my ADHD. This is extremely ironic give a later point in this
comment.

Meanwhile, while medication isn't an answer _all the time_ , sometimes it is
really the only option. Taking the medication is hell.

I know a group of people I grew up with who can't get through a workday
without prescription stimulants. Then, they have to try to handle kids
sporting events, social events, etc. on the weekends without it to try to keep
their tolerances down. Still, those tolerances don't quite reset fully. Almost
everyone in that group has to take regular PTO every 6 months and go off them
for two weeks. They can't work. They can't clean the house. They can't care
for their kids. It's pure misery. Sure, they may run off to a resort, but
they're mostly just doing that so they can drink and sleep their way through
withdrawals while their other half handles the kids.

In same group, there are a few that actively struggle to take their medication
as prescribed as opposed to eating a 30 day supply in 10 days. We're talking
getting the day's doses each morning from a significant other with the rest
kept in a lock box that only said SO has the key.

Also, it's insanely embarrassing and stigmatized to get your medication filled
when you're an adult. Pharmacies will be out of Ritalin when you show up to
fill your prescription in the morning. "I don't know when we'll have more in,
sorry." Then, a few days later you'll hear that same pharmacy filled your
friend's daughter's prescription in 20 minutes a few hours after you left.

So on one hand, you have Big Pharma pushing the diagnosis and medication on
children who are still neurologically developing. On the other hand, you have
an informal cadre of pharmacists that think it's okay for kids to take this,
but if an adult is taking it they're some meth'ed up tweaker. So kids who
don't and probably shouldn't take these drugs are flooded with them. The
adults that need it just to hold down a job and make rent can't get it.

The entire ADHD situation is just one massive, never ending mess. I'm so glad
I'm on the lighter end of it and can side step the medication entirely.

~~~
reitanqild
> I can't work with silence, I always have to have music on. If I don't, I
> start wandering around the internet and getting nothing done.

> Pair programming is basically God's Gift to ADHD.

Just keep in mind that there is a huge variation, not every AD(H)D-er is the
same.

> Taking the medication is hell.

Then you should possibly contact your doctor, it shouldn't be that way as long
as you follow the recommandations, but sometimes even minor changes can make
major differences, even changes in dosage or even type based on the same
active ingredient.

> Then, they have to try to handle kids sporting events, social events, etc.
> on the weekends without it to try to keep their tolerances down.

This isn't R, is it?

~~~
krinchan
> Just keep in mind that there is a huge variation, not every AD(H)D-er is the
> same.

I covered this later on. The whole "sometimes medication is necessary" bit.

> Then you should possibly contact your doctor, it shouldn't be that way as
> long as you follow the recommandations, but sometimes even minor changes can
> make major differences, even changes in dosage or even type based on the
> same active ingredient.

It's less the effects of the medication and more the way that medication
impacts your life as an adult. You're often accused of not actually having
ADHD and faking it for "legal meth". Some people actually struggle with the
temptation to use recreationally.

> This isn't R, is it?

Relevant? Yes. It is. If you can't make it through a workday without your
medication, you can barely handle your social life. ADHD trying to be social
is always late, always harried, always forgets to bring the thing it promised
to bring, and much more. Trust me, I can't tell you what my plans are for this
weekend without checking my calendar and every appointment on that calendar
has a checklist of things to bring if any.

The problem is, when you go off meds, it's ten times worse than if you never
took medication. Alongside that, there are the usual stimulant withdrawal
symptoms, though to a lesser degree if you're not taking above as prescribed.

The reason people do this is because if you find something that works for you
and you take it daily, you'll be well past the maximum dosage in a few years.
Then you'll have to change medications and that medication may not work as
well or the same way. You also may end up with withdrawals.

Furthermore, you really do need a reserve of pills. The only way to get that
is to skip doses. The legal structure around Schedule II drugs is fuzzy. Most
pharmacists will only allow you to refill your medication 30 days from the
fill date of a 30 day prescription to avoid liability. If you try to fill it
and something goes wrong, you could be up the creek on a Sunday with a week of
work ahead of you. Insurance, pharmacists refusing to fill a prescription
because they suspect you're abusing (which is literally as little as, "I
thought they looked strung out"), family emergencies, and everything else
under the sun can cause this.

Also see the bit about pharmacists refusing to fill prescriptions. This does
actually happen, a lot.

Being prescribed a Schedule II substance is bad enough, but pharmacists and
pharmacies tend to take adults and ADHD medications to the furthest limits
legally possible to make your life a living hell. Imagine if schizophrenia
medication was that difficult and strict to keep a steady supply of. They have
trouble getting a refill and it's completely within the realm of possibility
they could lose their job (or worse).

Same thing with people with serious, debilitating ADHD.

~~~
reitanqild
>> Just keep in mind that there is a huge variation, not every AD(H)D-er is
the same.

> I covered this later on. The whole "sometimes medication is necessary" bit.

I was just thinking about the ways to cope, music/sound, pair programming. I
know not every ADHD-er prefer pair programming.

>> Then you should possibly contact your doctor, it shouldn't be that way as
long as you follow the recommandations, but sometimes even minor changes can
make major differences, even changes in dosage or even type based on the same
active ingredient.

> It's less the effects of the medication and more the way that medication
> impacts your life as an adult. You're often accused of not actually having
> ADHD and faking it for "legal meth". Some people actually struggle with the
> temptation to use recreationally.

That's a shame if you ask me and you have my sympathy here.

>> This isn't R, is it?

> Relevant? Yes. It is. If you can't make it through a workday without your
> medication, you can barely handle your social life. ADHD trying to be social
> is always late, always harried, always forgets to bring the thing it
> promised to bring, and much more. Trust me, I can't tell you what my plans
> are for this weekend without checking my calendar and every appointment on
> that calendar has a checklist of things to bring if any.

I know what you mean.

> The problem is, when you go off meds, it's ten times worse than if you never
> took medication.

This is where our experiences differ

------
sn41
There are books like "The Shallows" which make a case that the internet is
shortening our attention spans. Could this lead to someone developing ADHD?

~~~
atemerev
No. Modern understanding is that it is hereditary and only can be amplified by
environment, but it is either you have it, or you don't.

------
joe_momma
What are the ADHD rates of children in countries with better school systems
like South Korea or Sweden?

Are other countries even diagnosing these symptoms as much as the USA?

------
reactJS
I challenge someone to provide evidence enough to scare me into stopping. Go
ahead, save my life

~~~
phkahler
>> I challenge someone to provide evidence enough to scare me into stopping.
Go ahead, save my life

From TFA: Schwarz traces the Icarus-like trajectory of Richard Fee, an
aspiring medical student who fakes the symptoms of A.D.H.D. to get access to
drugs that will help him cope with academic pressure. When he eventually
descends into amphetamine psychosis, his father tells his doctor that if he
doesn’t stop furnishing his son with Adderall, he’ll die. Two weeks after
burning through his supply, Fee hanged himself in a closet.

Are you sure your supply will never be disrupted?

~~~
krinchan
To be honest that's stereotypical of someone who was taking far, far more of
their pills than prescribed. Most people, while they're prescribed a 30 day
supply, skip pills on the weekends and vacations to maintain lower tolerances.
They typically "save" those pills for one of three reasons:

1) The pharmacist at your pharmacy randomly decides you're a tweaker and you
have to spend 2 weeks finding a new pharmacy.

2) PARTY TIME!!!

3) Pulling an all nighter and surviving the next day.

Without the book handy and the whole medical school bit, I'd say it was 3,
except it was more like a couple-dayer without sleep.

------
scottmf
>Psychiatrists are not that much different from witch doctors

I wish you had said this several comments ago.

We have nothing to discuss here.

~~~
dang
I agree that that was an inflammatory statement that went over the top, but
please keep internet tropes of rudeness off HN. They send bad signals into the
community.

We detached this comment from
[https://news.ycombinator.com/item?id=12345614](https://news.ycombinator.com/item?id=12345614)
and marked it off-topic.

------
chris_va
I get really skeptical whenever someone uses the term "Big Pharma". 99% of the
time the person using it is selling something (hey, look, a $28 book).

How dare a pharmaceutical company sell a product? How dare doctors decide to
prescribe medicine? While that was slightly melodramatic, here is a quote from
the article:

 _Schwarz has no doubt that A.D.H.D. is a valid clinical entity that causes
real suffering and deserves real treatment, as he makes clear in the first two
sentences of the book: “Attention deficit hyperactivity is real. Don’t let
anyone tell you otherwise.” But he believes that those who are disabled by the
condition deserve a wider range of treatment options than an endless litany of
stimulants with chirpy names like Vyvanse and Concerta._

... Great, so it all boils down to the pharma companies not creating enough
drugs for ADHD? But it's their fault that there are too many drugs? I am not
particularly impressed, and to me it feels like the author is just
manufacturing conflict for the sake of selling a book.

~~~
pyre
The quote says:

 _> a wider range of treatment options than an endless litany of stimulants_

Notice the "than an endless litany of stimulants" part. Saying something like:

> so it all boils down to the pharma companies not creating enough drugs for
> ADHD?

afterwards almost seems like you are intentionally misconstruing this.

Is it not possible that the author wants "Big Pharma" to spend time
researching alternative treatments rather than just cranking out "yet another
stimulant?" Is it not possible that the author wants more non-medicinal
treatments to be explored?

\---

That said, I think that "Big Pharma" has earned its negative moniker. Just
look at the front-page story from yesterday about EpiPen prices being jacked
up to the point where people may not be able to afford them. I don't think
that being against price gouging a "captive audience" in a way that possibly
threatens their health is the same thing as being against "a pharmaceutical
company selling a product."

~~~
dragonwriter
> Is it not possible that the author wants "Big Pharma" to spend time
> researching alternative treatments

Or _society_ to do that; relying on Big Pharma to spend money directly
contrary to Big Pharma's interests doesn't seem like it makes a lot of sense.

~~~
pyre
Whether you consider the opinion right or wrong is beside the point that I was
making (that the parent to my post seemed to be "tilting at windmills").
Saying that the author has an inconsistent position of "there are too many
drugs" and "there need to be more drugs" seems like a poor reading of that
sentence.

~~~
chris_va
I understand the point you are making, but in reality drugs will get developed
based on their likely risk/reward ratio only.

If you want more diversity, unless there is a non-market force (which honestly
shouldn't be needed here, there is high demand), pharma companies will just
keep picking at the lowest hanging fruit.

Eventually, they'll get up to the non-stimulant variety, but developing an
entirely new class of drugs is a Herculean effort with very low likelihood of
payoff. To make it work, you need more data on the disease (e.g. more time),
and some luck out of academia (which is where 99% of drugs come from anyway).
They will also need a lot of money to do it, so anything they can produce in
the meantime is essentially on that track. Thus, the wording "even more
drugs".

------
coldcode
I tried to read the whole article but couldn't sit long enough. Perhaps I need
a drug.

