There also seems to be a huge divide between the US and Europe, where such disorders seem to be diagnosed way less often. It has always appeared to me that many people in the US are more easily considered mentally ill when they do not fully conform to society's expectations, and at the same time the people who suffer from severe mentally illness are less cared for in the US than in Europe. Or maybe that's just how the media portray it.
I have been to multiple (European) therapists who had just your approach and had no idea about ADHD. For years.
In the end, I knew all the techniques for getting things in order, just couldn't follow up on them, and wasted tremendous amounts of my life trying to do things. (Not to mention gaining ~30kg, because I instinctively ate a ton of sugar - which has a similar dopamine-inducing effects to Ritalin, just with calories and not as long-lasting)
After taking one pill I was able to finally get myself together.
Now after a lot of trial and error it appears that I might have been (partially) misdiagnosed. The cause of my issues may stem more from Complex PTSD, which has a lot of overlapping symptoms. Processing the source of that has given me a lot more relief from the ADHD symptoms than the medication ever did.
But even so, the only reason my mental health issues have seen any kind of progress at all was because I started taking them seriously, found people who supported me in that, and with therapists started trying things out and re-evaluating as we went along. What definitely did not help was telling myself "nah, I don't have ADHD. I don't want to be one of those people who hides behind that excuse and is medicated for the rest of his life" for years.
I'm happy that the Ritalin works for you, and I'm happy that I'm making my own progress. In both cases the solutions were only found due to not being dismissive about mental health issues being real illnesses.
So basically the reality of my life is not subject to your opinions. Stop projecting your value system onto other people's lives.
There really is no need for snarky replies like that, as I haven't even remotely talked about value systems in any conceivable way. Whether someone has a mental disorder or not does not depend on any "value system" -- or, at least, it should not, provided that there is real science behind the diagnosis. I made the remark because my father used to work as a professor of psychology and I had many discussions about such topics in the past, including the complexity of diagnosis in the field and the difficulty of classifying mental disorders, and how these classifications have changed over time and vary from country to country (for example "koro"). So I'm generally interested in the topic and know that many theories in psychology are highly problematic; some of them, such as C.G. Jung's archetypes, are even decidedly unscientific. The aim was certainly not to look down on other people or impose a value system.
Even if I have, in your opinion, indirectly insinuated that you might not have a mental disorder (which wasn't my intention), I really can't see why anyone would be offended by that.
If you could do it all over again, would you have waited until you were grown before you took medication?
Here are some of the things that went through my own mind:
- Maybe he'll outgrow it (he's fairly severe ADHD, but we went through a long process of hoping that it was just a maturity-level thing)
- Paper after article after paper sent by well-meaning family members about how ADHD is over-diagnosed. Doubt.
- Side-effects (obviously, first thing every parent thinks about)? How severe will they be in my child?
- Ritalin + suicide .
- If we medicate him at six, _will he ever learn the tools to manage ADHD without meds_? He'll potentially spend his entire childhood on meds.
- If we don't medicate him, and he's consistently labelled a 'problem child' in his class, how will that affect his self-esteem as he grows up? How will it affect his feelings about school and work?
- If we don't medicate him, and he struggles and falls behind his classmates in his schoolwork (which, even in Grade 1, he was - significantly), are we holding him back? He's a super smart kid, he just can't focus.
- If we medicate him, and it doesn't work (we have to try multiple meds), how will it affect his self-esteem to be constantly visiting psychiatrists, pediatricians, etc. A thing I've noticed: doctors have zero problems talking overly-candidly in front of my kid about his failings, as though he's not there.
- We were literally told by a doctor that once you get on the medication train, 99% of parents don't get off until at least mid-high school. Am I comfortable with that?
After that long thought process (and so much more), we put him on medication. We're going very slowly in ramping up the dosage, but he's already caught up to his classmates in school, and he seems happier. I don't know if we've done the right thing, but I do know: it's not as clear-cut right/wrong as you make it out to be.
Imagine living with a diabetes, or some other invisible issue that affects your life, and having to hear such calm opinions all the time from people around you. Telling you that your issue is not real (so - de facto - you're imagining it).
I have many of the traits in the article, and find some of them weigh very heavily. I think one of the reasons for that is that I'm easily distracted, and computers are terrible for people like me because I'm just a couple of clicks away from watching an effectively infinite collection of sports highlights, reading newspapers, looking at photos, cat videos on YouTube etc. etc. A concrete example is writing this comment when I really should have my head down in a project that I'm working on.
I think I would be much happier in a job where smartphones and computers aren't involved, like working on a nature reserve. I can't make that change quickly - I run a small business with a couple of colleagues and support a family - but I'm starting to turn the tanker towards a life like that because the effort involved in managing the bureaucracy of contemporary life takes a lot out of me. And I've actually got it pretty easy in terms of flexibility and pay, like many of us on HN.
It's rather like a milder version of RD Laing's idea that it's not people who are mentally ill, but society that's ill. I think that's taking it way too far, and there are obviously people who have extreme versions of personality types who would be distressed no matter what the circumstances - but the point stands that our psychology hasn't evolved to withstand the pummelling that it gets from the attention economy.
I've never been diagnosed with ADHD (I'm in Europe), but I'm absolutely certain I have it from all of the reading I've done on it in the past (and I recognise everything from the blog). I totally get what the GP is trying to say, and you captured it with:
> the current structure of society could be causing this distress to a personality type that previously wouldn't have done so
I have often felt like the standard world of work didn't work for me, or things that others do, like make a plan of things to-do just doesn't work for me. There are other issues that come from this also, which is working late into the evening to avoid distractions, which leads to poor time management in general, that again doesn't fit into the modern world.
I'm now a CTO of a successful software company - and interestingly what that's given me is the chance to create a way of working that works for me. I work sporadically, but when I do I blitz it (hyperfocus) and can get months of work done in days. I have surrounded myself with a collection of super smart people, but also a range of organised and disorganised. To allow the organisation to deliver, but also to allow for the benefits of the hyperfocus, which for us have lead to the big and major pieces of tech which sets us apart from our competitors.
This is obviously anecdotal, but it adds some credence to the GPs point.
I'm still sat in my house most evenings promising myself I'll do some cleaning at some point (amongst other things), and never do. I'm going to take the advice from the blog and try Todoist to see if that can motivate me to get stuff done.
I see comments here about how ADHD is related to Autism. Perhaps it is, but I wonder if it's more similar to bipolar light. It seems the hyperfocus is like mania and the endless distractions and the lack of motivation for menial tasks is like a sort of depression. I may be way off - and may be putting my foot in my mouth and offending sufferers of bipolar (which if so, I apologise), but that's how it sometimes feels to me.
In terms of organisation I have a system that's like a low-tech version of Todoist. I have these text files on my desktop set up to sync through Dropbox so I can access them on my phone too:
today.txt - Tasks specifically for today so I don't get distracted by other, later tasks.
week.txt - A list of the next seven days with specified tasks in each. If there's something that comes in which I don't need to do today, but will need to at some point relatively soon, I put it somewhere this file. At the beginning of each day I move tasks for that day into today.txt and move the day header to the bottom of this file.
later.txt - Non-urgent tasks that I look at once in a while, and move things into week.txt if I have time.
current.txt - A simple list of projects that I'm currently working on.
I have various others, and use a calendar app for meetings etc, but I've found that structure to work well. I actually find apps like Todoist more distracting than they're worth sometimes, because I get caught up in configuring and reconfiguring them, adding tags to tasks etc. Plain text fulfills my need for simplicity and clarity.
As someone with bipolar, this isn't offensive at all. It is a condition that can present very differently, as personally my manic symptoms are more severe than depressive, but much of what people describe is very similar to the milder bipolar symptoms. Ive actually been reading this thread closely looking for additional coping strategies, and will likely check out some of the to do-list apps recommended.
There are some things that are wildly different, and severe mania is very different, almost presenting more like anxiety than adhd, but the milder manic symptoms are definitely similar.
Whether the behaviours and feelings that we define as ADHD are natural or not has no bearing on the fact that people who present them can be very adversely affected as individuals. Good health is best defined in terms of adaptation to one's environment; if modern society has been built by and for the 90-95% of humans with no ADHD symptoms and that has a detrimental effect on the 5-10% of those who we define as having ADHD, then it is a legitimate and genuine disorder.
We can theorise all we want about the evolutionary origins of ADHD or whether a different society might ameliorate or eliminate the symptoms of the disorder, but people with ADHD who are born today into this society deserve the chance to live a healthy and productive life like anyone else. The fact that certain medications and therapeutic interventions are so demonstrably effective at improving the quality of life for people with ADHD means that refusing to recognise it as a genuine disorder is actively damaging to them.
Or perhaps those drugs and treatments might also provide benefits to "normal" people. The true damage being that normal people are unable take advantage of them.
The quotes around “suffering” imply that you yourself might not even know everyone around you suffers, i.e. you’re suffering by proxy, but you’re the one causing it.
Everyone can relate to specific “symptoms” of ADD/ADHD, the question is: can you control the impulses and is it affecting your ability to lead a “normal” life.
Normal here means looking after yourself and potentially other members of your family.
Honestly, in a way it’s like being in a state of arrested development. Staying a child and having your brain work against you in progressing.
Things that for many is effortless takes a huge amount of energy and leave you drained for the rest of the day.
In a way I’d like to say it’s about growing the hell up, only it doesn’t happen by itself like it should. One might need to retort to assistance, be it medical or mental excercises.
In a way I agree with what you’re saying, there are nuances to it though.
In the end, some with higher impulses and inner trouble still manage to have more control and lead a successful life when others with little disabilities are overwhelmed.
What awes me the most is how one can be willing to mess with his brain chemistry with drugs rather than arrange one's life around his traits. There are so many tools now that I can't accept "forgetting appointments" is a disability necessiting drugs.
Psychology/Psychiatry is derided on HN frequently and any time a submission comes up about ADHD or any other mental illness, inevitably people will chime in about how they feel about medicating children or that people just need to make lifestyle changes.
Why is it awe inspiring that someone might use drugs to help alleviate what they see in themselves as a deficiency? Are painkillers taboo as well? Anesthesia for surgery? Coffee or Tea? These all affect the brain chemistry but perhaps they're on your approved list of ways in which drugs are allowed to interact with people's brains?
ADHD can not be fully encompassed with the idea that it's simply unorganized people that forget appointments. You are correct that there are strategies that people can employ to tackle that particular issue. You are incorrect in separating drugs away from other tools.
You are not required to take medication for your ailments or explore recreational drugs. You can choose to eschew all these things in your life. You don't need to denigrate people that choose a different path from you, though.
"Every X knows" is usually sign of agreeing on a conclusion based on gut feelings and without verifying if the arguments leading up to them hold water.
Which claim are you referring to here?
1. Your unsubstantiated claim of ADHD being overdiagnosed
2. GP's unsubstantiated claim of "Every X knows Y"
The null hypothesis must be "ADHD diagnostic criteria has high specificity", because without that it's not diagnosis. What evidence do you have to demonstrate low specificity?
That smells a lot more like under-diagnosis.
I personally think definitely there’s something to it.
The main problem is in the name. People fixate on the attention deficit aspect of the impairment because it's right there in the name, however an attention deficit is simply one of a number of symptoms that are caused by ADHD.
ADHD is a developmental disorder that results in a generalized impairment of ALL executive functions. This includes the ability to purposefully direct attention, to modulate emotions, and to perceive the passage of time. It also impairs ones ability to hold an inner monologue, or 'voice'.
There are also other psychological illnesses that may present as "co-morbidity" with ADHD because of the detrimental effects of ADHD on ones quality of life, such as depression.
It is know that the disorder has an unusually high correlation to heredity, and no environmental causes (save one virus which may causes a similar executive function impairment). It is absolutely clear that it is an inherited disorder. It is not caused by modern society and constant interruption.
I got suggested to get tested after failing out for the second time and the testing showed very much lower than average sustained attention. I never myself thought about getting tested since I did really well at a lot of tasks and just couldn't figure out how to micromanage all the weird administrative tasks of every day life. If I didn't have to do those everything would be going amazing, but instead it's sunk me into (small) debt and a period of homelessness a few years back.
I think a lot of people in the EU (where I am) would have gotten diagnosed if tested, but we seldom test school age children who don't have a very hard time in school. If you do somewhat ok or manage it seems odds are you can go undiagnosed forever.
Half this thread is people saying, omg I just thought I was lazy, I guess I should start taking doctor prescribed amphetamines now.
I don't know how true this theory is. There is some evidence for it, because ADHD is very prevalent, but at the end of the day it doesn't matter why people struggle. What matters is that they do and we have the tools to help with that.
A big reason for the divide between Europe and the US in ADHD is that Europe usually uses the ICD, while the US uses the DSM. The DSM seems to be less strict about the criteria. It's probably also the case that many Europeans, particularly in former Soviet states were never tested.
Both are terrible solutions in their own ways.
The brains of someone with ADHD (assuming correct diagnosis) are different from NTs, akin to people with autism.
AFAIK the latest scientific research points at that ADHD is just one of the many variants on the autism gene. But I don't have a source at hand right now, so grain + salt.
With ADD I score awfully high on the spectrum...
FWIW, here are some sources I found with a quick DDGing:
As for whether ADHD is disordered, there is evidence that it was a positive adaption in more primordial settings. Greater distractability may have equated to faster response to predators or more success in hunting. However, to be a disorder, a condition simply needs to be presently maladaptive. In modern society, ADHD typically is.
Saying “oh mayyyybe ADHD isn’t real” makes no sense unless you believe all mental disorders are fake.
Even with physical diseases there are often misdiagnoses and genera oversights.
There’s definitely a social aspect to certain kinds of misdiagnoses, but medicine is not obvious in some contexts. The human body is pretty complex!
I think things like diet, food additives, busy society, and work demands make it impossible for people like us to function well.
I know for me at least, I live a pretty unconventional life so I can thrive in my own way. I’m often up very late. I’ll obsessively work on something and neglect others. I’ll be late to things. I can’t do big social environments and I definitely can not handle stuff like night clubs. I need a lot of alone time to sift through all of the data that has bombarded me. It’s taken me years to figure out. But as I craft my life to work with my oddities, I become happier, healthier, and more productive.
I think for me, a better description than mental illness is “neurodivergent.” Because if I build my life in my own unconventional way, I might be able to thrive. And then when I get put in situations that don’t work for me, I become textbook mental illness.
In the US it's extremely popular to give your kids speed if you're a bad parent so it's overdiagnosed. I will agree that it's more of a natural variation than a dysfunction. I don't really understand the details but I've heard smart sounding people comment that something or another about it's genetics implies that there is probably a net benefit to society or it would have been bred out by now.
There's physiological differences in the brain though
Seems like the OP thinks ADHD and ADD is more akin to personality disorders, which is much fuzzier and is hard to tell if it's a disorder or a 'disorder'.
I tend to see classification and diagnosis as a pragmatic means to an end. The important part of defining a personality disorder or a mental disorder in general is to nail down a set of characteristics to effectively diagnose people that suffer from similar conditions and give them access to treatment and advice that may help them relieve the impairment and distress it's causing.
Classification on this level should be largely unconcerned with whether the disorder represents some sort of fundamental deficiency of the brain or some rare personality trait that only becomes a problem due to a failure of society and social expectations. Not because social change to accommodate atypical personalities isn't desirable, but because it doesn't immediately help the diagnosed cope with the conditions they have to deal with in the present.
Because of this, the disorder-'disorder' dichotomy seems wholly useless to me, at least without a clear definitional basis.