
The Drugging Of The American Boy - Larx-3
http://www.esquire.com/features/drugging-of-the-american-boy-0414
======
ryanmarsh
Next can we talk about SSRI's? My little brother was prescribed Paxil as an
adolescent. Now he's in prison for murder. Now Paxil is not allowed to be
prescribed for adolescents and children but my brother will die in prison. He
behaved exactly how kids prescribed this medicine behave, in a murderous rage.

~~~
chewychewymango
So long as the chemical imbalance myth is perpetuated and one in ten Americans
are on anti-depressants, all SSRI prescriptions are sacrosanct. Sadly, society
isn't ready to have this discussion.

~~~
fit2rule
True, that. Its really hard to talk down addicts from their high.

~~~
ErikBjare
It seems the only one who can talk down the addict is the addict itself, and
even then the odds aren't great.

------
curiousDog
To me, as an adult, getting a diagnosis on ADHD was a godsend. However, after
a couple of years, I see the drug's affects waning. I can also see how
damaging this dependency creation can be for children.

Fortunately, when I was a child back in India, ADHD was virtually unknown
(probably the case today as well). Most of the time, my parents chalked off my
inattention to "lack of discipline" and were happy as long as my grades were
good. I found the coursework very easy (despite studying for only 1-1:30 hrs a
day) and topped most of my classes.

University here in he U.S wasn't hard either. My problems started once I
started working. Couldn't code continuously for more than 15-20 mins at a
time. Things got boring very quickly once I got the "aha". I couldn't hold a
lot of program state in my head. I was always searching for that "flow" people
often talked about.

Adderall really helped me. I use it very sparingly these days (especially on
days that I have to code some important pieces) though.

Bottomline, looks like this is purely genetic and fixing the dopamine pathways
isn't exactly like curing malaria, you can juice things up but the brain will
want more. Parents can choose to give it to their children but they'll suffer
some time down the road. I'd rather let the kid enjoy childhood and help him
in other ways (exercise, note-taking, engaging activities etc) and put him in
a reasonably good path to success. Let them take drugs if necessary once
they've wised up as adults.

~~~
ddoolin
I actually was never diagnosed with ADHD as a child or an adult. I exhibit a
similar coding pattern as you did, and still do, since high school. I get
bored very, very quickly and kind of live off of the "aha" moments, from one
to the next. It's not that it's not genuinely challenging or interesting to
me, but I just can't focus much of the time. This is true for just about
everything I do these days. Thoughts and ideas come, I act on them, and they
leave again just as quickly as they came. It definitely makes it hard to get
much of anything done at work or home, despite having quite an agenda at
times.

I've only taken Vyvanse offhandedly (without Rx) and it worked miracles for
me. I quickly learned to ration it and use it sparingly as you do, partly
because of the negative effects on my appetite and general well-being. I'm
still debating going to see a doctor but I think they might write me off as an
addict since I'm in my 20s but still quite young and a lot of kids come out of
college abusing the stuff to get through exams and maybe never really drop the
habit.

~~~
jpendry
This sounds an awful lot like imposter syndrome, but with your own health
instead of programming ability.

See a doctor. Be honest. Let them do their job and then trust their diagnosis.

~~~
ddoolin
Honestly, I had to look that one up and I do recall reading about that last
week via a post linked on HN actually and telling my coworker that that didn't
describe me much at all. In both my health (physical fitness) and other
accomplishments , I can say I take them very well, and have an ego a large
portion of the time because of them.

I should definitely go see a doctor anyway, if not just to make sure that this
isn't all in my head.

~~~
silencio
> I'm still debating going to see a doctor but I think they might write me off
> as an addict since I'm in my 20s...

> Honestly, I had to look that one up...that didn't describe me much at all

When I was 18 and two years into college, I started to realize that everything
non-drug-related I had done with my parents and therapists in the past wasn't
working as well as it used to. Not quite a couple years later I was super
tired from having bronchitis for six months, and everything imploded around me
because I had no energy left to do anything. The new therapist I saw during
then thought that I was being ridiculous by thinking of myself as a drug-
seeking addict when drugs I had never actually tried before were the one thing
I really needed at that point. I was so convinced I was in the wrong that I
had been crying for over thirty minutes straight about it to her.

tl;dr impostor syndrome with my own mental health.

I'm in my mid-20s now and nobody that knows me thinks of me as an addict. I
don't know what I would do without Adderall at this point - and that's in
combination with a decent amount of behavioral strategies/techniques too.
Sure, there are lots of people out there that abuse it, but I am just a total
mess without and there's no way I'm making excuses up to keep on being a mess
because of what other people do. Seek help because maybe you do have a
problem, and you may come to realize that dealing with a known problem (or
knowing that you don't have one) is like night and day compared to what's
going on right now.

------
wmgries
My third grade teacher apparently had every boy in her class tested. As a boy,
and frankly as a boy who was independent, mouthy and unlikely to do work in
school unless I wanted to, I'm glad I had great parents and a great
pediatrician. My pediatrician had my parents and teacher run an experiment: my
mom would choose a pill with active ingredient or a pill with nothing in it,
and my teacher, without knowing which I took that day, would record notes on
my behavior. Turns out, no correlation between the two.

I don't doubt there are people in this world for who ADHD is a real thing. But
I think we are too quick in the modern age to drug without thinking. Parents
demand antibiotics for illnesses which are just small bugs... guess what, now
we are having problems with drug resistant bacteria. Lawmakers,
administrators, and teachers (in that order) want to turn classrooms in to
machines which churn out educated people like clockwork. Turns out, humans are
animals, not machines, so we load everybody with some stimulants to make
children just sit still.

I'm not anti-medicine in any way. I have personally seen Ritalin work on a
friend who actually had ADHD growing up. And I have also seen another friend
buy Vyvanse illegally so he could study for 15 hours a day. I believe in
prescription drugs. I just don't always believe in the prescription.

~~~
prutschman
I like the idea of the experiment! Is it generally accepted that one would see
same-day behavior changes when switching between an ADHD drug and a placebo?

~~~
wmgries
That's a good point, I'm not sure. The friends I've seen use the drug as a
study aid certainly respond to it quickly but the scientific rigor of the
experiment didn't much matter: I think my parents were skeptical that I really
had a problem anyway, and lo and behold, I'm an adult now and I never did
actually have a problem. When you tell the parents of every boy in the class
their kid has ADHD, the claim becomes pretty weak.

------
eruditely
Why don't you read a fucking ADHD support forum and wonder whether the
suffering caused by poor executive functioning/nervous system disorder is
real?

Why didn't they mention how many more times you are likely to die in a
vehicular accident than non-adhd users?

[http://scholar.google.com/scholar?start=10&q=adhd&hl=en&as_s...](http://scholar.google.com/scholar?start=10&q=adhd&hl=en&as_sdt=0,5)

Google scholar for ADHD, why don't you realize that these ADHD articles are
more akin to anti-vaccination articles?

~~~
DerpDerpDerp
Your response doesn't actually address the article, which acknowledges that
ADHD is a real condition, but suggests that fewer than 1 in 5 boys have it,
and that a large number of misdiagnosed cases is bad, considering that they're
given serious drugs because of it.

In fact, the only number it suggests as being inaccurate (based on an old
study) is 25% of cases - that 1 in 4 cases is misdiagnosed. However, given the
number of total cases, that means something like 5% of boys are being given
serious drugs for potentially no reason.

I think that deserves serious consideration, and not your knee-jerk, strawman
response.

~~~
gress
Also it's worth pointing out that if 1 in 5 boys have it, it's not a disorder.
It's part of the normal range.

~~~
joeyo
I'm not sure if it's that black and white. Roughly 25% of deaths in the US are
due to heart disease. Should we not intervene because heart disease is part of
the normal range?

~~~
amirmc
I agree that it's probably not that black and white but a comparison with
heart disease isn't a fair one.

The grandparent post does make a point. If such a large proportion of the
population has a 'condition' is it really a condition or perhaps just how we
(as a species) are? Especially in the case of something that's
psychiatric/psychological.

For example, I've heard estimates that around 10% of the population is
homosexual and for many years people wanted to 'fix' them. Around 10%-12% of
people are left-handed and (I believe) that historically this was also
something that people tried to 'fix'. I doubt many of us think twice about
these anymore.

To a sibling comment that suggested what if 1 in 5 boys were born deaf, I'd
say that the world would be a _vastly_ different place. So different that we
may not even entertain such a question. If, instead, 1/5th of boys were
_beginning_ to be born deaf, there would be a medical emergency.
Unfortunately, in the case of things like ADHD it's difficult to know if we've
always been this way or if there's really been a change.

~~~
aianus
Being gay or left-handed doesn't inherently impact your quality of life. Not
being able to concentrate on anything does. So even if it were part of the
normal range we should work on fixing it, like we do for myopia.

~~~
amirmc
_Being gay or left-handed doesn 't inherently impact your quality of life._

It does if everyone else is telling you that you're abnormal (and need to be
'fixed'). That was the point of using those examples.

 _Not being able to concentrate on anything does._

Only if society has defined as valuable the ability to do only one thing,
without distraction, for whatever period of time. Therefore, anyone who cannot
do this must be 'broken' somehow.

 _So even if it were part of the normal range we should work on fixing it,
like we do for myopia._

The first part of your sentence doesn't make sense. If it's 'normal' then by
definition it isn't broken (and therefore doesn't _require_ fixing). For the
myopia example, most people 'fix' it by wearing glasses or contacts, which are
non-permanent and do not mess with brain chemistry. Indeed, some people I know
with myopia only bother with glasses when driving and cope just fine without
for the rest of the time. Of course, measuring the _degree_ of myopia is very
easy so drawing a line between 'has some difficulty' vs 'severely impaired' is
a lot more clear cut. In one case, we can consider glasses as an
_augmentation_ to something that is normal, whereas in the other we've fixing
something that's broken.

I'm not suggesting that ADHD isn't a problem. Merely that we should exercise
some caution before we label some things (people?) as broken, when perhaps
they are not.

~~~
aianus
_It does if everyone else is telling you that you 're abnormal (and need to be
'fixed'). That was the point of using those examples._

That's why I used the word 'inherently'. People telling you you're abnormal is
not inherent to those conditions.

 _Only if society has defined as valuable the ability to do only one thing,
without distraction, for whatever period of time. Therefore, anyone who cannot
do this must be 'broken' somehow._

ADHD doesn't interfere with your life because other people are making fun of
the fact you can't sit still. It interferes with your life because it's very
difficult to be productive in any way if you can't concentrate for whatever
period of time and being productive is what's valuable to society.

I have mild myopia and I don't feel any resentment to my optometrist for
labeling me broken. I'm just happy he augmented/fixed me so I can read signs
at a distance. And unless/until we have proof that prescribing Adderall is so
dangerous that it's not worth the gains, then I don't see a problem treating
it the same as contact lenses.

 _I 'm not suggesting that ADHD isn't a problem. Merely that we should
exercise some caution before we label some things (people?) as broken, when
perhaps they are not._

Well, clearly they thought they were broken somehow when they went to the
doctor with concerns about their attention spans, no?

~~~
gress
> It interferes with your life because it's very difficult to be productive in
> any way if you can't concentrate for whatever period of time and being
> productive is what's valuable to society.

By this reasoning, anything that reduces productivity _as currently valued by
schools acting a proxy for employers_ is a candidate for treatment.

Examples include: questioning authority, emotion, and passion for things whose
value has not yet become apparent.

Other problems include the notion that schools today have the ability to judge
what kind of people we will need to be in the future.

------
chimeracoder
Instead of just talking about the dangers of a false positive, let's talk
about the dangers of false negatives - of ignoring ADHD in children who do
actually have it. ADHD is very treatable, but untreated, it can easily lead to
other comorbidities that are much more difficult to treat (such as depression)

The most dangerous part of this is that it seems to imply ADHD is over-
diagnosed in men (boys), when it's just as possible that ADHD is under-
diagnosed in women (girls).

Girls diagnosed with 314.10 (Attention Deficit Disorder, predominantly
hyperactive-impulsive) tend to exhibit fewer "traditional" symptoms of
hyperactivity than boys with the same diagnosis. This isn't to say that the
diagnosis is wrong - it's just that hyperactivity manifests in many ways -
physical restlessness, "bouncing off the walls", etc. is only one.

> The interesting thing is I never asked any of these people whether ADHD is
> real. But their defensiveness is understandable. ADHD isn't strep
> throat—there's no culture, no test. To find out if you have it, or if your
> son has it, or if your daughter has it, you just need a human being to say
> so—a physician or a psychiatrist—and that makes some people skeptical

This describes the _entire_ field of psychiatry. While there are certainly
some people who are who would distrust the field, I would be very wary of
throwing the baby out with the bathwater.

And of all disorders, ADHD is actually significantly easier to test for
systematically than most psychological/psychiatric disorders (such as
depression). The main problem is that the tests to do so are very expensive
(well into the thousands of dollars), and most insurance plans won't cover it.

> Ned Hallowell once famously said that stimulants were "safer than aspirin,"
> a statement he has since backed off of. ("That's almost a preposterous
> statement for anyone to say," says Saltarelli.)

So, we have a complete lowbrow dismissal of what is actually a very reasonable
statement. In the end, it's impossible to compare _any_ two drugs for safety
because there are so many factors that come into play, but to the extent that
one can make a pairwise comparison, this is actually a very well-supported
statement.

~~~
foolinaround
> ADHD is very treatable, but untreated, it can easily lead to other
> comorbidities that are much more difficult to treat (such as depression)

This claim needs citation.

The overall point is that the cost of the false positive overweighs the cost
of the false negative

~~~
torkins
Which article did you read? Not only was there no discussion of the cost of
false negatives, there was very little treatment of the actual cost of false
positives, just a nebulous assertion that its bad for kids to be on pills.

I would say the point of the article is here is a list of reasons why it might
be over-diagnosed, some people on both sides of that, 50% puffed up with human
interest pap about the Boy Whisperer

~~~
rsync
"... of the actual cost of false positives, just a nebulous assertion that its
bad for kids to be on pills."

It's bad for kids to be on pills.

~~~
lotu
Speaking of needing citations.

------
ScottWhigham
For those who don't know Esquire, it's basically a supermarket tabloid-for-men
style magazine. It's not a science mag, so for anyone to get too upset about
it is, well, just not really smart. [0]

That said, the horrific FUD writing style is insulting. The comments by HN
users - I can't even identify with the people here.

 _Now imagine that he is suffering like this because of a mistake... If you
have a son in America, there is an alarming probability that this has happened
or will happen to you._

Absolute bullshit. Total and utter crap. That does not happen. I have two ADHD
kids and it was (a) my choice to take them to a doctor, (b) my choice of which
doctor they went to, and (c) my choice as to whether there was a diagnosis of
ADHD. It's farcical for me to read the opening paragraphs of this "article"
and its presumption that doctors are evil and really just want to incorrectly
diagnose kids. Atrocious.

[0]
[http://en.wikipedia.org/wiki/Esquire_%28magazine%29](http://en.wikipedia.org/wiki/Esquire_%28magazine%29)

~~~
Camillo
> (c) my choice as to whether there was a diagnosis of ADHD

Wait, what?

~~~
ScottWhigham
Did you not understand or did you have a legitimate follow-on question?

~~~
Camillo
It sounds like you specifically arranged things so that you got the diagnosis
you wanted.

------
frozenport
I don't believe in ADHD but I suspect the drugs do something with utility. How
does society confront pills that make people more efficient?

------
davyjones
[http://en.wikipedia.org/wiki/Vitamin_R_(Leading_Us_Along)](http://en.wikipedia.org/wiki/Vitamin_R_\(Leading_Us_Along\))

"The song was written about a friend of the Loeffler brothers, who was
misdiagnosed with ADHD, and developed an addiction to Ritalin. As a result, he
would often do crazy and odd things, such as drive around aimlessly for hours,
determined to hear a specific song on the radio."

:-(

------
joesmo
ADHD isn't real. It didn't exist in many previous generations. Surely, the
behavior of children hasn't changed much over the last few generations so how
come this "disease" didn't exist previous to the current couple of generations
and how come it still doesn't exist in many places on the planet? Could
foreign kids somehow be better? Of course not. As the article points out, this
is a ploy by pharmaceutical companies to get children hooked not only on ADHD
drugs but on drugs in the future.

What do these kids do when they turn 18? I asked on pediatrician I respected
what she does for the children. Does she taper them off? Does she transition
them to other doctors? Does she transition them to other medicines? Nope.
"That's not my problem," she said. Of course not. In a culture where doctors
are not responsible, where making hundreds of dollars an hour is "not enough"
to have them actually perform their duties in full, duties such as making a
full investigation into their patients' cases, and spending more than 10 or 15
minutes before "diagnosing" them with a condition they do not have and putting
them on drugs for essentially the rest of their lives, only in such a culture
is ADHD real.

When it comes down to it, it's the responsibility of the parents to keep their
kids off drugs. The body doesn't care wether you're snorting amphetamine or
Adderall because Adderall _is amphetamine._ Parents who allow their kids to be
"diagnosed" with ADHD and allow them to take drugs are encouraging their
children to take drugs. They are unconscionable parents. Any child can make a
mistake and start doing drugs, but now we have whole classes of drugs that are
encouraged. Some drug abuse and addictions have become ingrained in life. Do
you think the children will stop because they've now turned 18? Do you think
they'll stop at Ritalin or Adderall when those things stop working? Addiction
knows no bounds.

How many more lives will have to be ruined before people realize the
psychiatric industry and the doctors pushing these drugs are only doing it for
the money, money they do not need? Talk about about scummy drug dealers. Yeah,
we're looking at the multi-billion dollar corporations, the "psychiatrists,"
the DSM writers, and the rest of the doctors who can't even be bothered to
spend ten minutes with a patient before deciding on a horrific fate for them.
When will people learn that the medical industry cannot be trusted, that the
hippocratic oath is bullshit, and they need to be responsible for their own
selves and their own children? Those parents allowing their kids to be put on
this should be put in jail next to the child murderers they irresponsibly
strive to be.

~~~
silencio
My parents didn't want me on ADHD meds - which is hysterical because my father
very obviously has undiagnosed symptoms of ADHD too - so I didn't get any and
had to rely solely on behavioral techniques and societal pressure until I
picked my own damn therapist. Me at 16 in college with dinky checklists
compared to me at 25 right now with the same checklists and Adderall is like
night and day.

As much as I love my parents, I occasionally get angry when I think about what
could have been compared to what happened because they didn't like the idea of
me being on drugs (like I wasn't on other drugs). Not missed opportunities
that were impossible to begin with, but a lot of reachable goals and dreams I
had that I tried working my ass off towards and it just wasn't happening
because I spent just as much time struggling with myself as I did working
towards said goals. I'm trying to play catchup still, years later. I suspect
there are some goals that I will never be able to do anything about now
because there was some age/time component to it.

Speaking of other drugs, there are plenty of them - yes, maybe even "dealt" by
"drug dealer" doctors that are actually terrible - that significantly improve
quality of life. Drugs are not inherently bad. It's a constant balance of
whether or not the tradeoffs are worth it, that's all. Like right now I'm
juggling 6-7 different meds and their side effects to fix my bronchitis+asthma
right now because I do not want to end up in the ER or worse, dead. Is that so
terrible? Am I a drug addict for not wanting to suffer when I have a choice to
not suffer? Even if you want to label me as such, what, are you a firm
believer in survival of the fittest? Because if we can keep people from
suffering and dying, I would do it. Screw that fittest bullshit.

~~~
unclebucknasty
I'd encourage you not to be too hard on your parents when looking back. Very
difficult decision to make and it took a lot of guts to buck the system and
pressure to medicate; opting instead for behavioral approaches.

Giving a growing brain a psychoactive drug is serious business.

Also, of course, you are looking back with perfect hindsight. What if you'd
had a serious adverse event, psychosis, or otherwise negative outcome? No one
could have known, and that was a risk your parents had to weigh. In fact, your
brain now is different than then. Perhaps your parents helped you to dodge a
devastating bullet by withholding psychoactive drugs at a younger age.

------
andyl
A few years ago teachers complained that both my boys were too intense on the
playground, 'diagnosed' with ADHD. Docs were eager to prescribe meds to make
them conform.

There is something in our society wants to redefine normal behavior as
pathology. Maybe to get you hooked and build revenue streams, maybe just to
make you more pliable.

Fuck that.

Yes there are legitimate cases. But I've only experienced people who want to
mis-apply the meds.

~~~
yequalsx
My girlfriend is a psychiatrist and we've had discussions about over
medication. One thing she said to me stuck with me and may be of help to you
in your current situation. She says stimulants work right away (unlike
medication for depression) and she said that if the drugs do work you'll see
this within a few days. If they do work then talk with a psychiatrist about
long term plans and long term health affects of the medication.

The teachers are not professionals and their opinions do not constitute a
diagnosis.

~~~
buzaga41
but what is "work"? Seems to hit the point of 'make conform'

