
Doctor: ADHD, as currently defined, does not exist - onedev
http://time.com/25370/doctor-adhd-does-not-exist/
======
Pxtl
I feel like this headline is terribly irresponsible. People with mental health
issues suffer from a stigma associated with them, as well as denial of their
suffering.

Going out with both guns blazing to say their condition _does not exist_ \-
not that it's a symptom of a larger problem, or that it's a gross
oversimplification of a number of unrelated diseases, but instead the crude
headline "doesn't exist" \- that only makes the situation worse.

There are many people out there who need stimulant medication to function
properly in their lives for very good reasons. Yes, their attention deficit
may be a symptom of a complex problem, but the fact is that _it exists_.

Unless you have a better idea how to treat it, I don't see what this kind of
article accomplishes beyond making it harder for anyone to take the condition
seriously.

~~~
pessimizer
Saying that a certain medical condition doesn't exist isn't a denial of the
suffering of people who suffer, it's a denial of the label that's been placed
on that suffering.

As long as an attack on bad science continues to be interpreted by a segment
of sufferers as a personal attack, sufferers groups will never exist as
anything other than tools for drug companies to subvert the scientific
process.

~~~
Pxtl
Imagine reading an article on punctuated equilibrium with the headline "Darwin
is Wrong". Technically true, but WTF? Or a discussion of potential side-
effects of the H1N1 vaccine with the headline "Vaccines Kill People".

Just because it's _true_ doesn't mean you don't need some tact.

Also, I notice you've assumed I'm a sufferer. You might want to put away the
"jump to conclusions mat" and maybe just try having a little empathy?

~~~
pessimizer
>Also, I notice you've assumed I'm a sufferer.

Where did you notice that?
[https://en.wikipedia.org/wiki/Illusion_of_transparency](https://en.wikipedia.org/wiki/Illusion_of_transparency)

------
richardlblair
Some folks are missing the point.

Both the definition of ADHD and the treatment plan for it (in North America)
are broken. In France, just 0.5% of children suffer from ADHD (opposed to ~5%
in North America), and with those children they find the root cause of the
issue and deal with that. They tend to shy away from medication. This is, more
often than not, the proper treatment option for behavioural issues.

People need to realize the DSM, in its current state, is a massive cash cow
for Big Pharma. When it comes to ADHD specifically, they needed a bigger
market, welcome Adult ADHD.

Finally, I realize a lot of people suffer from attention issues. I don't
disagree that these things need to be dealt with, but a catch-all diagnosis
isn't really the way to do that. I'm much more interested in finding the
actual problem, and fixing that.

~~~
conradfr
I'm French, have ADHD and had to discover by my own at 28 years old that it
was an existing condition. I guess (hope) it's better recognized nowadays but
still I suspect it's underdiagnosed and also you only have access to Ritalin
and Concerta as possible medication with many restrictions to fulfill a
prescription.

Yet it's often presented in the media as "the obey pill that Americans give to
their children".

As a coincidence there is currently a shortage of Concerta until mid-April ...
great.

~~~
richardlblair
By no means am I saying that ADHD isn't a thing, shouldn't be treated, and
doesn't require drugs in some cases.

I'm sorry to hear about your circumstances, and hope things are going alright
for you now.

------
com2kid
The article is dangerously mistitled.

That multiple actual mental health conditions exist that all have been labeled
ADHD is well known by the research community. There are multiple causative
factors that can lead to ADHD symptoms, and what have traditionally been
referred to as different subtypes of ADHD respond to different types of
treatment.

This is hardly news! It is also where there are multiple treatment strategies
for ADHD, until we get a better naming scheme in place (and make no mistake,
the lack of proper names impacts both communication and how we think about the
problem), we are stuck with using the catch all term ADHD. (Though some people
have split into using ADHD-PI from primarily inattentive, it often doesn't
respond to stimulant treatment at all.)

Now I fundamentally disagree with the author's final assertion that "everyone
is misdiagnosed" is pure BS.

Primary evidence is that there are structural brain differences in people who
have ADHD. The portion of the brain responsible for self control is
dramatically smaller. Arguing that "it isn't real" when there is literally
missing brain matter is disingenuous at best.

Next up, people with untreated ADHD have _THREE TIMES_ the rates of auto
accidents.

Now, maybe, just maybe, ADHD isn't real at all, and instead psychologists have
spent their time and energy coming up with the best auto insurance risk test
ever!

But I doubt it.

------
bryanlarsen
My suggested title/tldr: ADHD is a symptom, not a disease.

It's an interesting article, but that title is going to derail conversation.

~~~
darkarmani
But that's always been the case. They don't understand the root cause or have
a definitive test for the symptoms (except recent qEEG tests).

------
hyperion2010
Terrible title. Especially since there are actually people who believe that
the title is true in the literal sense. The fact that we can further subdivide
something based on etiology or any other criteria doesn't mean that it does
not exist.

~~~
MBCook
It's amazing how many people here are skipping the qualifier in the title,
taking it as "ADHD does not exist".

~~~
watwut
That is the title of both the original time.com article and the book written
by its author. The qualifier "as currently defined" is only on HN.

~~~
MBCook
Oh, you're right.

That's odd considering how rigorously titles on HN are changed to match the
original.

------
JohnBooty
This article is so potentially harmful, even if it's more nuanced than the
hyperbolic "ADHD Doesn't Exist" title would suggest.

The reality is that -- whatever the underlying cause -- a lot of people
struggle with attention span issues, and that these issues cause a lot of pain
and unfulfilled potential.

Even if ADHD medications are overprescribed Band-Aids, people benefit from
them. We should try and find better diagnoses and treatments, but it makes no
sense to blast people by telling them their condition "doesn't exist."

If I have one complaint about the way we treat ADHD it's a lack of education
for patients. The medication is only one part of the solution and in my
personal experience it's nowhere near the biggest piece. Diet, environment,
sleep, and exercise are just as crucial... but these are things I figured out
on my own, not anything my doctors mentioned.

    
    
      Firstly, addiction to stimulant medication is not 
      rare; it is common. The drugs’ addictive qualities 
      are obvious. We only need to observe the many patients
      who are forced to periodically increase their dosage if   
      they want to concentrate. 
    

This true but disingenuous at best because it omits perspective in a way that
borders on maliciousness. Adderall causes only a very mild dependence
according to all studies I've ever read. The FDA and my personal experiences
agree. I've discontinued my Adderall on a number of occasions (by responsibly
tapering it down to 0mg over several days) and it was no problem.

To compare it to something most of us are familiar with: I found Adderall much
easier to discontinue than caffeine, a thing I've never been able to quit.
(I've never smoked, so I can't compare with nicotine)

And to all those who say ADHD is a matter of "willpower..."

Maybe. For some.

I always told myself that too. I was born in 1976 so I went through school
here in the USA right before they started diagnosing ADHD left and right and I
was labeled a procrastinator instead. I never even really heard of ADHD until
I was out of school.

After four years in college, which were a mix of promise and opportunities
torpedoed by procrastination, I worked 10, 12, 14-hour days to finish work
that I was more than talented enough to finish in 5 or 6 hours. My happiness
suffered, health suffered, and relationships died.

Then I finally admitted that maybe it was a little more than a willpower
issue. If it a matter of lacking willpower, why was I at the damn office
trying to work long after everybody else had left? Whatever the hell my
problem was, it wasn't work ethic.

So I sought treatment... at the age of 32. And while medication was only an
imperfect yet valuable part of the solution, my life has been on track again
for a number of years.

~~~
siphor
To play devils advocate, I think its possible that ADHD as a title is more
harmful. Letting people fall into a self-fulfilling prophecy that may or may
not have occurred otherwise.

You say you were more than talented enough to finish said work in 5-6 hours
but couldn't. To me that sounds like you thoroughly did not enjoy it and thus
got distracted and 'procrastinated'. Why did you choose to work in an office
if it was making you so unhappy?

It sounds like the drugs helped you live your life in an office setting, and
is helping you get your life on that specific track.

I personally think there are a lot of societal pressures that makes one feel
forced into a situation where they do not thrive.

But everyone around says that `you` have a specific problem. Why can't it be
the other way around, everyone else doesn't fit to you?

These drugs seem to work great to make you live like everyone else. But why is
that good? More boldly, why are the ADHD symptoms bad? Some of the most
successful people probably exhibit these symptoms.

~~~
spacedmountain
I've found the opposite. About 6 months ago, I began to suspect I had ADHD. I
went for help, and was diagnosed about a month ago. I haven't used it as an
excuse, on the contrary I am now able to understand and catch my symptoms in
the framework of the disorder. Maybe an analogy is trying to run while having
different length legs. Once you realise this reality, you are able to
understand, compensate, and adjust.

I do think there is a component of ADHD treatment that is trying to 'fit in'
to a society that doesn't think the same way the person with ADHD does. But
there are big impacts on people's lives independent of society. And its not
easy to always be "different", disruptive, and/or inattentive to people around
you.

~~~
JohnBooty
I feel the same way. And congratulations on your progress!

------
bpm140
The author could have just as easily written "Cancer, as currently defined,
does not exist" or "Arthritis, as currently defined, does not exist".

In all of these cases, the the catch-all phrase is used to describe a handful
of similar symptoms that stem from a wild variety of causes.

This is why we won't be curing cancer any time soon. We may cure a specific
type of cancer, but we're going to have to cure each type of cancer in a
specific a relevant way.

If the author wanted to say "ADHD is actually a catch-all term for a variety
of root causes that would be better treated with specificity" I would be all
over that. But, hey, page views.

------
skywhopper
The author appears to have a philosophical issue with the DSM itself, more
than a useful argument. One could make the same complaint about many of the
conditions defined in the DSM. The DSM faces an insurmountable challenge in
attempting to taxonomize mental issues. In "reality" next to none of the
syndromes and disorders there "exist", except in terms of collections of
symptoms and treatments, and assumptions about what's "normal".

Honestly nothing he says goes against anything anyone who's done even a
cursory study of ADHD will already know. But he leaves out a lot that folks
without much familiarity with ADHD won't already know, such as that many
people with ADHD take medicines other than stimulants: anti-depressants, blood
pressure medicines. A lot of drugs have been found to address the underlying
problems, and each class works differently in different people.

The fact is that, like every other aspect of brain chemistry and function, we
understand very very little about ADHD. That doesn't mean that it doesn't
exist or that people with the disorder should stop taking medicine that works
for them. It means we need to study it more to find out how to better describe
and explain all the intricate connections between behavior, diet, genetics,
environment, sleep, screens, family, school, work, weather, vitamins, and
drugs interplay to create what we now call ADHD.

~~~
mrxd
> The author appears to have a philosophical issue with the DSM itself

I find that hard to believe. He argues that some cases of ADHD are caused by
bipolar disorder and depression, which have DSM definitions.

------
Millennium
It might be better to say that the current definition of ADHD is grossly
inadequate. The problems start from issues as basic as treating ADHD as one
monolithic "thing," when in fact it is a symptom that can arise from many
different diseases, some of which respond better to different medications than
others, and some of which do not respond to medication at all. By treating
them all as a single disease, we do almost all of their sufferers a grave
disservice.

~~~
MBCook
> It might be better to say that the current definition of ADHD is grossly
> inadequate.

Isn't that why the qualifier ', as currently defined,' is in the title?

EDIT: watwut pointed out to me elsewhere that the qualifier is only on HN and
not in the original title.

------
MikeTLive
QUOTE "For my second group of patients, who have severe attention issues, I
make them undergo a full evaluation to find the source of the problem.
Usually, once the original condition is found and treated, the ADHD symptoms
go away."

And, when the original condition is the required 14 or so traits of ADHD,
which using your "over 20" treatments do not solve, do you decide this is non-
ADHD with ADHD Symptoms ?

asshole.

------
clienthunter
This man is peddling a book. I'm not saying that precludes his correctness but
it does mean that the more analytical of us should apply a little more salt to
our appraisal of his motivations than a journalist might.

~~~
JeremyMorgan
Exactly what I was thinking.

------
scott_s
Counterpoint: "ADHD and Brain Chemistry", by Steven Novella:
[http://theness.com/neurologicablog/index.php/adhd-and-
brain-...](http://theness.com/neurologicablog/index.php/adhd-and-brain-
chemistry/)

Also, except on the same topic from the podcast "The Skeptics Guide to the
Universe":
[http://www.youtube.com/watch?v=-MLdvKzLl6k](http://www.youtube.com/watch?v=-MLdvKzLl6k)

------
ChikkaChiChi
Experts like this jackass and Andrew Wakefield should be held accountable for
criminal misconduct when the publish crap like this.

Sensationalistic 'findings' that lack a concise scientific method that have an
ulterior motive are harmful to those people that expect information from
experts to be presented without bias.

------
lolwutf
Horse shit.

There's lots of very well-vetted science supporting the problem of ADHD and
attention span disorders. Ditto for the pharmaceutical interventions that are
the main-line treatment for them (amphetamine is one of the most well-studied
drugs in existence).

Sad to see Time sinking to clickbait headlining.

------
darkarmani
> "It’s time to rethink our understanding of this condition, offer more
> thorough diagnostic work, and help people get the right treatment for
> attention deficit and hyperactivity."

What condition? Doesn't the title say this condition doesn't exist? This
article is just trying to sell his book.

Besides the fact that qEEG has shown differences in activity in adults that
identify with having ADHD.

~~~
nickff
Article authors often have no input on the how their piece is titled, so I
would not be so quick to judge the journalist.

~~~
darkarmani
That's the title of the guy's book.

------
eam
Pretty funny. Just yesterday I was at Barnes and Noble checking out some
Malcolm Gladwell books in the psychology section and right next to them was a
book with the title _ADHD Does Not Exist_. I didn't get a chance to take a
peek at it because I was too occupied reading the first couple of pages from
Gladwell's _Blink_ which was pretty captivating.

------
ajcarpy2005
In my research, ADHD seems to be basically inflammation[1] of the brain.
Think: bacteria, free radicals, active immune response, underactive detox and
circulation, etc.

Some approaches which are most useful seem to be: Magnesium, Green Tea &/OR
L-Theanine, GABA, SAMe, Milk Thistle, Fish Oil, Cholesterol, Vitamin D
(Sunlight), etc.

I would say there is no silver bullet. But I would say unambiguously that
vitamins and minerals and occasionally herbs are low hanging fruit compared to
a pharmaceutical approach. Drugs aren't used as "building blocks" in cells or
biochemistry. Drugs modulate various activity in our body which can help but
typically is not without some kind of side effect or not as affective as
providing enough of the "raw materials" our body needs.

Attention Deficit Hyperactive Disorder definitely exists although the way it's
predominately treated really doesn't help solve the deeper causes of the
disorder.

[1]
[http://www.ncbi.nlm.nih.gov/pubmed/24240495](http://www.ncbi.nlm.nih.gov/pubmed/24240495)

~~~
JohnBooty
I don't doubt that inflammation is one of the myriad things that can cause
attention issues.

One thing to realize re: supplements is that, by biological design, it's
_really_ hard to get chemicals into your brain simply by digesting them.

There are a lot of steps between eating something and it winding up in your
brain.

I mean, the very first thing that happens to ingested items is a bath in the
insane mixture of acid and bacteria that is your stomach. A lot more has to
happen before it even reaches your brain-blood barrier, which is a thing
specifically designed by evolution to keep things out of your brain.

~~~
ajcarpy2005
The mechanisms of action that I'm referring to don't depend upon physically
transporting molecules into the brain. Also, as it turns out, even
inflammation in your gut or elsewhere changes the signals that the nerves send
to the brain. And levels of neurotransmitters in the brain are absolutely
impacted by what's going on in the rest of the body...regardless of the BBB.

What specific point are you trying to make about the Blood-Brain Barrier? And
stomach acid? Sorry but neither of those things somehow render the foods and
chemicals we ingest meaningless! Your HCL won't somehow break down Magnesium!
Even Vitamins will mostly make it through intact.

I'm not a scientist but I don't get my information from Men's Health magazine
either...I research reputable scientific studies and make reasonable
connections.

~~~
JohnBooty

      Sorry but neither of those things somehow render the   
      foods and chemicals we ingest meaningless!
    

Nobody's saying that. The things we ingest have a profound influence on us.

However, the connection between our brains and the things we inject is
extremely circuitous. "Reasonable connections" often don't apply, and things
we do might often have the opposite effect of the one we intend.

All that said, I think personal experimentation with supplements (within safe
limits) is a very good thing. I have tried a bunch!

------
nerdo
Is ADHD considered a disability? If so, looking at the timeframe (2008-2012),
and the population segment (young adults), this could be the product of a
backdoor welfare program, where ADHD diagnoses are the fig leaf employed.

~~~
lilsunnybee
I don't think so, as far as receiving financial assistance for mental health
conditions in the US. In fact except for developmental disorders and
conditions involving psychoses (schizophrenia), I've heard that it is quite
difficult to get any sort of assistance, regardless of how severely your life
has been affected, without a good lawyer at least.

------
sizzle
I remember reading an interesting hypothesis of adhd being an evolutionary
trait/advantage, anyone know anything about this? I have not been able to find
it.

------
shittyanalogy
A doctor? Intelligent discussion doesn't start with "one guy thinks".
Authority is not a reason for scientific conclusion.

------
NextUserName
Modern civilization has certainly invented ADHD. It used to be that if you had
ADHD, you probably weren't a banker, lawyer or politician. You certainly would
not work in a cubicle and rot away all day. You also lived 15 years longer
than your sedentary counterpart. You would do a more physical job. Physical
work often creates the necessary stimulation that so many of these _ADHD_
cases need.

The argument that _it just isn 't fair_ that someone's mind is more suited for
a desk job than someone else, so we should put them on equal footing by
administering drugs the rest of their lives is a flawed and slippery slope
mentality. Do we say the same the same thing for aspiring athletes who weren't
born with the muscle mass to play pro football? "Lets make things fair and
pump this kid full of roids so he can be an all pro linebacker"...

Severe ADHD sufferers I agree should be given medication, but the majority
That I personally know (some of whom I worked with before and after meds)
should just have changed careers. They still have problems while on the meds
and also have to deal side effects from the mind altering drug they are using.
Those I know who have either pursued alternate careers, or switched are much
happier overall.

Imagine that, doing what traditionally, naturally was done leads to greater
happiness... Wow

~~~
JohnBooty
Physical work isn't necessarily easier for those with ADHD than desk jobs. In
high school and college I had some physical jobs. Those jobs are often menial,
and the monotony and repetition are really the opposite of what those with
ADHD (especially those with ADHD and high intelligence) are "naturally" suited
for.

    
    
      Do we say the same the same thing for aspiring athletes 
      who weren't born with the muscle mass to play pro 
      football?
    

We don't "pump them full of steroids" because unlike the (admittedly
imperfect) ADHD treatments we have now, muscle-building steroids have negative
side effects that greatly outweigh their benefits.

We _do_ give them the best medical care possible. If an aspiring athlete
breaks a leg or has plantar fasciitis, we treat those things. We don't just
say, "guess you weren't meant to be an athlete."

    
    
      It used to be that if you had ADHD, you probably weren't a
      banker, lawyer or politician. 
    

Yeah, and if you had bad eyesight, you were probably steered away from those
professions as well.

And if you were left-handed people assumed you were under demonic influence or
something.

And if you were dyslexic people assumed you were stupid.

I'm glad people like me are winning against people like you.

~~~
NextUserName
> _Physical work isn 't necessarily easier for those with ADHD than desk jobs.
> In high school and college I had some physical jobs. Those jobs are often
> menial, and the monotony and repetition are really the opposite of what
> those with ADHD (especially those with ADHD and high intelligence) are
> "naturally" suited for._

You simply had the wrong type of physical jobs. There are physical jobs that
are mentally challenging as well.

> _We don 't "pump them full of steroids" because unlike the (admittedly
> imperfect) ADHD treatments we have now, muscle-building steroids have
> negative side effects that greatly outweigh their benefits._

OK then change steroids to HGH.

> _We do give them the best medical care possible. If an aspiring athlete
> breaks a leg or has plantar fasciitis, we treat those things. We don 't just
> say, "guess you weren't meant to be an athlete."_

Apples to oranges. Bones heal naturally. ADHD does not go away by "resting".

> _Yeah, and if you had bad eyesight, you were probably steered away from
> those professions as well.

And if you were left-handed people assumed you were under demonic influence or
something.

And if you were dyslexic people assumed you were stupid.

I'm glad people like me are winning against people like you._

I see you are missing the point. How about this. In 20 years, 90% of people
working in office jobs are taking ADHD medication Only 5% of them really have
ADHD, but the rest have learned that they can concentrate longer and be more
productive by using it. Now those with ADHD are no better off (on a relative
scale) than those before these medications were invented. They often cannot
compete with their non ADHD counterparts and lose their jobs (just like before
ADHD meds came around). As a side effect, now billions of people on earth are
taking a drug everyday that alters various things in their mind. They no
longer think naturally and with the rational that they were born with. You
think that this is good? This is where we are heading.

Like I said in another post, in those I know who changed careers VS those who
take drugs every day, the ones who changed careers are far happier and have
better quality of life mentally and physically.

Don't you want to be happier? Blame yourself and this system which has nudged
you out of your natural path.

~~~
JohnBooty
I think you're hinging a lot on this incredibly faulty belief:

    
    
      [Users of ADHD medication] no longer think naturally and 
      with the rational that they were born with. You think that 
      this is good? 
    

So which chapter of Scientology do you belong to?

Stimulants are, of course, psychoactive substances and nobody denies that, but
you're blowing this so far out of proportion that you have zero credibility.

I bet you have lovely opinions about antidepressants and antianxiety
medication as well. I suppose those people, too, should also just find lines
of work that value depressed and/or anxious people just like Xenu intended.

~~~
NextUserName
> _I think you 're hinging a lot on this incredibly faulty belief:_

First of all, this is not MY belief alone. It is listed among the side effects
on the side of the box. Further studies have pretty much conclusively agreed
that these drugs do affect reason and rational.

> _I bet you have lovely opinions about antidepressants and antianxiety
> medication as well. I suppose those people, too, should also just find lines
> of work that value depressed and /or anxious people just like Xenu
> intended._

These are proven to be even worse of course. The sad thing is that many people
who are on them do not need to be. This is like taking morphine when you have
a broken leg and continuing to walk on it so it cannot heal, vs setting the
bone and casting/resting it.

Also funny you should mention depressed people changing lines of work. A high
percentage (over 10%) of people put on antidepressants have been found to have
very low levels of vitamin D (something they never would have had if working
outside). Many of them were also overweight and very out of shape. Many others
were also later diagnosed with S.A.D. Something that people working outside
rarely experience.

Antidepressants and ADHD drugs are often given as a quick fix. There are often
alternatives that can fix the actual problem rather than mask the symptoms.
That is all I am saying. You don't seem to be able to accept this fact, so out
conversation must end here.

------
a3voices
Did ADHD exist when people were hunter-gatherers? If not, it is not a real
disorder in my book.

------
NextUserName
Lets get half the population on ADHD Drugs, then the other half on Anti-
depressants. Then we as individuals don't actually have to deal with any
personal challenges, not even controlling the growing, intrusive and
overreaching power of government.

