
Attention Disorder or Not, Pills to Help in School - 001sky
http://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-children-prescribed-pills-to-help-in-school.html?ref=ushttp://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-children-prescribed-pills-to-help-in-school.html
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paulsutter
ADHD as a binary diagnosis seems odd to me. It seems within a normal range of
spectrum that we're all on. Modern schooling and white collar work are so
radically different from the environment where we evolved that it's surprising
how well we've adapted.

Clearly ADHD medications work, which is wonderful. But why do we need to label
people with a "disorder" in order to give them the meds?

Why is psychiatry so dead set on binary yes/no diagnoses, and labeling
everything as a disorder? Is that the consequence of having to code records
for insurance? Something related to prescription laws? Or is it an underlying
mistake in psychiatry to think there is one right way to be, and other states
are wrong?

~~~
WildUtah
_Clearly ADHD medications work, which is wonderful. But why do we need to
label people with a "disorder" in order to give them the meds?_

The drug war paranoia makes it necessary. So does the bureaucratic system that
allows only people with an official diagnosis to obtain any kind of
medication, even mood modifiers that are inherently subtle and personal.

Well, it doesn't prohibit all kinds of medication. Lots of people who are
using adderall (also known as amphetamines, benzedrine, or dexedrine -- a
popular self-administered medicine until the 1970s) and the like would be
using truly dangerous tobacco and liquor if amphetamines were not available.

It's not about insurance. The pills themselves are very cheap to make and most
formulations are not under patent.

As long as we need to put people in jail for using these substances, we're
going to need a way to mark whose use is legitimate and whose isn't. Measuring
who has health insurance and a good stable relationship with a doctor is a
good way to tell whom to imprison and whom not to.

Methamphetamine incidentally is different from adderall only by a single
methyl moiety and has almost indistinguishable clinical effect in matched
doses, though meth has longer lasting side effects due to the hydrophobic
methyl group allowing the medicine to persist longer in fatty tissues.

~~~
grimboy
I think one of the differences with Methamphetamine is that it can and
generally is smoked which gives a much quicker onset and rush which makes it
more addictive.

~~~
malandrew
Not exactly. Only one form of methamphetamine is psychologically active, the
dextrotatory enantiomer. It's different from dextroamphetamine in that it
contains a methyl group that makes it more lipid-soluble, which helps it cross
the blood-brain barrier more easily and protects it from being broken down by
MAO enzymes.

Dexedrine is the brand name for dextroamphetamine, the dextrorotatory stereo-
isomer of amphetamine.

About 75% of Adderall is dextroamphetamine. The other 25% is composed of three
other amphetamine salts.

The main reason methampetamine is smokeable is because it is sold on the
street in fairly racemic crystal form (i.e. it contains both the active
dextrotatory and levorotatory forms). If adderall, dexedrine and other
prescription amphetamine salts were sold in the same form, free of the inert
binders, they'd be smokeable too.

------
carterschonwald
This article conflates a lot of mental health topics via the lens/story of
single family that unfortunately has a wide range of behavior difficulties.

Risperdal is mentioned in the same breath as the standard ADHD precriptions.
This is an anti psychotic which is meant to be prescribed to help manage
recurrent aggressive / violent behavior and has a huge slew of side effects.

In contrast, most prescription stimulants used to treat (actual) ADHD have no
side effects that persist after the cessation of taking the medication.

Likewise, it is well established fact that ADHD medications such as Adderall
and Concerta are only effective when coupled with behavior therapy of some
sort.

The larger picture behind this is that these adhd medications when taken at
their recommended dosages help to make it easier to enter a focused state (as
in the metaphorical sense of reducing the activation energy for a chemical
reaction), and so direct efforts to develop the habits/ behaviors that are
difficult with unmanaged ADHD are needed to attain any long term value out of
ADHD medication.

point being: nothing new in this article, just lots of anecdote and a story
built out of a single families mental health issues. Like wise the statistic
that relevant diagnoses are increasing + a handy quote from a single doctor
does not establish a systematic trend that should call to question the
validity of a health condition.

this is also separate from the question of whether a school system designed
around the time of the industrial revolution is still appropriate today

~~~
calydon
I think you nailed it in your last sentence. Where are the articles that point
out how industrial 'batch' education is no longer serving kids of the present
(the future)?

~~~
Ygg2
Well, as the article says, it's cheaper to medicate children than to change
the environment. That includes the educational system.

------
spodek
I know techy types who like technological solutions and probably felt they
benefited from using such drugs are overrepresented on this site, but did no
one else register the defeatist, victimhood justifications for using the
drugs?

Trying to solve a social problem with technology misses the point. I highlight
these two quotes:

From the article: “I don’t have a whole lot of choice,” said Dr. Anderson, a
pediatrician for many poor families in Cherokee County, north of Atlanta.
“We’ve decided as a society that it’s too expensive to modify the kid’s
environment. So we have to modify the kid.”

 _We have to modify the kid???_

Also from the article: “We are effectively forcing local community
psychiatrists to use the only tool at their disposal, which is psychotropic
medications.”

 _the only tool???_

Modifying human beings because we have no alternative? If you ask me, the side
effects of this approach are not just the potential side effects of the drug
on the individual, but complacency in not addressing the problems' causes,
creating dependency of a social class on a drug, teaching children to take
drugs to solve problems, creating a belief we have no alternatives,
perpetuating a system that bores children and punishing them for their
boredom, and so on.

Does nobody else wonder what other unintended consequences such a policy might
create, independent of the drugs' safety or not?

~~~
icegreentea
This is kind of reflective of health care in general actually. The system in
use (this isn't just the United States by the way, it's most of the Western
world) is that we live in some state of 'healthiness' for most of our lives,
where we do not interact regularly with health professionals (not just
doctors) - except perhaps a pharmacist to fill some regular prescription.

Our interactions are clustered -after- we are deamed unhealthy. Only once the
need is most urgent do try to become 'healthy' again. This predictably leads
to a culture that favours drugs and surgery as solutions. This is so engrained
that health care practically IS synonymous with drugs and surgery. This bias
exists in everyone, from the health care professionals, to those who are sick,
to those to who are healthy, to those who would lead us. We all have it.

The 'unintended consequences' of such a policy are the problems facing nearly
all 1st world health care systems. Surging costs, potentially unsustainable
growth, constant doubts of effectiveness (and actual questionable
effectiveness in some areas), and in general, a culture that more or less
treats staying healthy as a bang-bang control system.

------
bemmu
Just checked what the attitude on Adderall is here in Japan. From ministry of
health site
([http://kouseikyoku.mhlw.go.jp/kantoshinetsu/gyomu/bu_ka/shid...](http://kouseikyoku.mhlw.go.jp/kantoshinetsu/gyomu/bu_ka/shido_kansa/documents/qa_bringmedicines_070618.pdf)):

"Nobody can bring any medicine containing Methamphetamine or Amphetamine
(Adderall and so on) into Japan. If you are found with any medicine containing
Methamphetamine or Amphetamine illegally in Japan, you can be arrested as a
criminal on the spot, immediately, without a warrant in principle."

~~~
anigbrowl
Japan had an amphetamine epidemic in the 1950s, and has had a major down on
them ever since. Asian countries in general seem to treat drug problems as
something foisted on them by western imperialists, a belief for which there is
_some_ historical basis; but it has also become a convenient narrative that's
preferable to the loss of face involved in admitting that any of one's
citizens might have a tendency towards abusing drugs or be disenchanted with
the status quo.

~~~
dschiptsov
Drug problem is not a political, but social one. It is connected with lower-
class unemployment and general despair. Take a look at modern Russia - it is a
disaster.

~~~
guard-of-terra
Modern Russia seems to suffer more from alchohol than from drugs.

"War on drugs" seems dubious at best since according to official statistics my
sub-division of Moscow has 7 times more alchoholics than it has drug addicsts
(20000 vs 3000 if you're wondering, taken from a newspaper, don't think the
number is any accurate but tend to believe the ballpark)

Efforts are made to make alchohol harder to buy with mixed result (but "mixed
result" is one step better than "no result" we see from the worldwide war on
drugs)

~~~
dschiptsov
It is all much more complicated. Alcoholism affects mostly adult population,
while drugs is mostly problem of adolescents. Sure, young are also getting
drunk routinely, but it affects them much less, and habit isn't that strong.

A typical adult in Russia has so ruined, that he needs very small dosage and
it affect him so heavy, transforms to almost an animal state. Young also have
less tendency to abandon everything and just drink for weeks - they has much
deeper social ties.

Drugs, on the other hand, creates fast and much stronger addiction, they also
changes the mind, the attitude towards the world and life itself much deeper.

Another important factor is that dopers die very quickly, and you cannot see
them suffering on the streets as you could see drunks whenever you happen to
look. Usually, only close relatives have involved in a tragedy and it doesn't
last too long - a year, on average, while drunkards could survive for
decades..

So, problem is here. "War on drugs", is, of course, way to steal more money,
not to offer any help with causes.

Government is involved because it affects their interests. A totalitarian
state needs a cheap, unskilled workforce to build an assets and create wealth
for the top-tier, but it need them sane and healthy. They cannot recruit sick
slaves to serve in Army or to work on a construction sites. That is why there
is a this "war on drugs" posters on the every wall.

And of course no body cares what older population does. If they going to die
from alcoholism - that good for the government - less pension spending.

This is just a very rough outlook.)

~~~
guard-of-terra
Drugs can create fast and much stronger addiction, but I can't say I see it
actually happening much. Neither there are statisics suggesting that it
happens at scale. Of course, some addicts presumably exist, but not enough to
convert the problem from political one to social one (in observable Russia at
least).

It still seems the main reason for war on drugs is mining government money and
political leverage.

------
veb
What annoys me with this, is are we going to get kids going through school,
graduating from University, while taking amphetamines and then coming into the
software industry and working 18 hour days without breaking a sweat?

If so, where's _my_ option to get these meds? Oh wait, I can't because I'm not
ADHD, and because I wasn't "diagnosed" as a kid, it won't happen now.

I really hope the older programmers in our industry won't have to compete with
people-on-drugs in the future... but it'll happen won't it?

~~~
bluedanieru
Aren't racetams a superior alternative anyway, and more easily available?

~~~
masterzora
Superior how? Last I checked there was 0 solid research linking them to pretty
much any effect whatsoever.

~~~
pdog
Racetams, and in particular piracetam, have been studied in an extensive
number of clinical experiments. Their effects aren't poorly understood.

<http://scholar.google.com/scholar?q=piracetam>

You might want to filter the research by time to get more recent studies, but
there's a vast body of knowledge built over decades.

------
lucvh
What attention is being paid to the potential long term effect of these
stimulants on the serotonergic & dopaminergic systems of these young people's
brains? Prescribing such powerful neurotoxins to young people who's brains are
still very much in a developmental stage seems risky to say the least.

~~~
Synaesthesia
<http://www.erowid.org/experiences/exp.php?ID=67797>
<http://www.erowid.org/experiences/exp.php?ID=22166>
<http://www.erowid.org/experiences/exp.php?ID=47529>

------
susanhi
Some of the more hazardous side effects of adderall: • Dangerous increase in
blood pressure • Tachycardia or a high pulse rate • Irregular heart rate •
Difficulty breathing • Chest pain • Allergic reaction that includes swelling
and redness in the eyes or throat • Migraine headaches • Syncope or losing
consciousness • Blurry or double vision • Seizure activity and excessive and
uncontrollable shaking • Extreme nervousness and paranoid delusions • Mood
swings that include hostility and severe aggression • Depression

~~~
tdfx
Also note that during college I was a 6'2, 210lb guy who experienced these
effects from adderall with as low as a 10mg dosage. Some kids are prescribed
2-3 times that amount. Luckily for me, I decided it wasn't worth the side
effects and I'd rather deal with any attention problems on my own. I feel
sorry for the kids who never had the choice.

------
sebastianmarr
I find it interesting to what lengths parents go to improve their children's
grades. The fact that grades indeed go up after taking those pills just make
this worse: people believe to see "measurable" success.

“We’ve decided as a society that it’s too expensive to modify the kid’s
environment. So we have to modify the kid." - To me that is the gist of the
article. We failed to provide an enjoyable learning experience for kids, so we
have to make them enjoy it.

~~~
smegel
Or we just switch off the bits inside them that yearn for enjoyment in the
first place. Our kids are either academic robots or suffering from a disorder
of being human, and thus imperfect.

------
dschiptsov
Pills are for the symptoms, not for the causes. The same holds for depressions
and anxiety disorders.

Cognitive-behavior therapy is the way to re-train, re-program, unlearn a wrong
habit.

There are sub-conscious habits, of course, which we cannot "see" without a
training.

~~~
jamesbritt
How is a neurochemical imbalance a wrong habit?

~~~
dschiptsov
It is an effect, usually of flawed behavior. It is not hard-wired or even
inherited.

One might have some genetic predisposition, say, a sensitive Amigdala or
whatever it is, but even then it is possible to behave in such way that you
will keep the level of arousal very low.

It doesn't mean you will not get aroused quickly, it means you will not stay
in a permanent overload of stress hormones, but return to a calm and relaxed
state very quickly.

Unless you have any organic damages or trauma or infection, your mental states
and habitual emotional patterns could be successfully altered.

~~~
jamesbritt
_It is an effect, usually of flawed behavior._

I'd love to see some peer-reviewed citations on this because, honestly, it
sounds like New Age wishful bullshit.

~~~
dschiptsov
Actually, it comes from very old ages.

Is there any peer-review of Tibetan medicine?)

------
lnanek2
I wouldn't be surprised if he loses his license for saying this. I've seen
other doctors lose theirs for prescribing it too much. The government is
really strict on this one, even mandating production limits.

------
throwaway9549
I've lived my whole life with untreated ADHD, and experienced issues all
across life because of it, not just work or school. It took many months to get
the proper treatment for it (i.e. medications), and perhaps it's a good thing
it's that difficult.

But if I encounter anyone who has the "everyone has trouble focusing" crab
mentality that I've had told to me, even by psychiatrists themselves, I'll
punch them square in the jaw.

------
ernesth
I have already seen this Simpson episode
<http://simpsons.wikia.com/wiki/Brothers_Little_Helper>

Since 1999, the name of the drug was changed but the debate seems exactly the
same.

------
guard-of-terra
I see the main problem of said pills in the following: Schools are boring,
horrible and pointless experience. But if you're drugged enough you may just
ignore that and happily buzz along like a zombie. Which in turn will lead you
to not becoming angry with this crap, and not using yourself to change schools
in the future.

Drugs for children seem to breed conformists. And conformism is bad because it
ignores problems until they overhelm and crush the society.

------
wavesounds
"All the medicated geniuses"

