Hacker News new | past | comments | ask | show | jobs | submit login
Doctor: ADHD, as currently defined, does not exist (time.com)
106 points by onedev on Mar 17, 2014 | hide | past | web | favorite | 137 comments



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.


> Unless you have a better idea how to treat it

Actually, if you read the article until the end, it proposes a better idea to treat it: Do not lump together all the conditions that lead to the symptoms together. Treat them as individual conditions with different causes and administer appropriate treatment - don't just hand them pills because it's simple.

I sincerely doubt that stimulants are the best treatment we can give those people. They may help in the short term, but they're highly addictive and your body develops a tolerance. What are you going to do once those people are tolerant to medication? Wave your hand in the air, tell them "bad luck, you developed a tolerance, now have a nice day". Medication may be required in some cases, but it's often only the beginning of a treatment. You need to solve or at least tackle the complex problem to really help them - and assigning a simple label doesn't always help.


I've personally known someone who has taken Ritalin type meds for 20+ years and did extremely well on it. In addition, my research indicates that tolerance to ADHD meds is uncommon and typically a person can be kept on one dose for years.


See, I'm under long-term medication myself, for an incurable, but treatable condition. Long term medication is a last-ditch remedy and that's for a reason. It's generally speaking a PITA. Where ever you go, you need to take your medication with you. Depending on what you get, you might have to take it on schedule. Depending on what you get, the pharmacy round the corner needs to order it and the stuff needs a prescription. Most stuff has side-effects, mine is mildly liver-toxic which means that I need to go have blood tests about every 8 weeks. I need to go to the doctor every 4 weeks for the prescription. When I travel longer than 4 weeks I need to jump through several hoops to get a larger amount. It's much better than without treatment, so if a friend asks me how I'm doing with the medication, I'd say "extremely well", but mainly because without medication it's extremely bad.

Yes, medication helps and it's sometimes the last remedy when nothing else helps. But I think that not labeling all conditions that lead to ADHD-like symptoms as ADHD and rather try and find a more nuanced understanding of the problem is helpful, especially in a case where a condition is often diagnosed on children where parents read stuff on the internet and run from doctor to doctor to doctor trying to get a prescription for ritalin, since they're certain that the kid matches those 5 relatively generic symptoms.


I think medication for ADHD should be avoided unless it is necessary.

I also have read statistics on how ADHD is treated in children which very much trouble me - there it seems to be highly overdiagnosed and treated.


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.


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?


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

Where did you notice that? https://en.wikipedia.org/wiki/Illusion_of_transparency


> As long as an attack on bad science

The bad science is this book that pretends to have evidence on its side.


This guy is putting on his white overcoat and trying to look like a scientist, but he doesn't actually cite any real research in favour of his claim, and instead uses anecdotal evidence ("Usually, once the original condition is found and treated, the ADHD symptoms go away" and such) rather than statistics to support his conclusion and sell his book.

This isn't to say he's incorrect in his conclusion, he just isn't supporting it very well. I would hope the book has referenced stats but this article isn't very promising. He's not too far removed from a pilot claiming his story about a flying saucer must true because he was in the airforce.

For the record, I've been diagnosed with ADHD and have plenty of anecdotal evidence that it's for real, but may be suffering from confirmation bias.


Yes I agree, in fact I think it is particularly concerning that these op'eds are getting picked up by more recognized news outlets. He wrote an almost identical piece for the daily mail last week.

http://www.dailymail.co.uk/health/article-2577814/The-eminen...

this is clearly just self promotion


It sells.

Do you have an alternative? Do we regulate what the news is allowed to say? How do we prevent such poor quality journalism?

News is entertainment (sadly, and mostly worthless), expecting it to be anything else these days is foolish.


As a sufferer of various mental things, I feel like the suffering and problems can be real, and the diagnoses and explanations still carry a heavy bullshit component.


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.


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.


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.


> In France, just 0.5% of children suffer from ADHD (opposed to ~5% in North America)

That's false. You are grossly misquoting the article.

"the percentage of kids diagnosed and medicated for ADHD is less than .5%."

Diagnosed AND medicated. The French are very much against medication for any mental condition. They also don't share the same method to diagnose, and their methods for treatment are less than desirable.

So, combining those cultural attitudes toward treatment and my experience with French doctors and pediatricians (whose first suggestion for autism treatment was literally "put him in a home and forget about him"), holding them up as a shining example is only done by those in ignorance.

http://www.psychologytoday.com/blog/here-there-and-everywher... http://www.psychologytoday.com/blog/suffer-the-children/2012...


I think the author of the Time article can hardly complain if people are missing the point, since his article and book have the deliberately inflammatory title of "ADHD Doesn't Exist."

  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.
If I was going to design a "cash cow" in the pharma market... well, I certainly wouldn't know how, but I wouldn't pick a diagnosis where one of the most popular drugs (Adderall) is cheaply available in generic form and can only be produced in restricted quantities due to fed regulations because it's a controlled substance.

  In France, just 0.5% of children suffer from ADHD 
  (opposed to ~5% in North America)
Replace "suffer from" with "are diagnosed with." Remember, there are countries in the world where 0.0% of children are diagnosed with ADHD, and there are countries where depression and homosexuality "don't exist" because they're not recognized.

It certainly seems likely that it's overdiagnosed in the U.S., but we can't learn anything concrete by looking at diagnosis rates in other countries.

  I'm much more interested in finding the actual problem, 
  and fixing that.
Amen to that, but telling people their condition "doesn't exist" (the author's words, not yours, obviously) is harmful, not helpful.


No. The sufferers still suffer. They're just called "lazy" instead.

I too hope we can find a better solution one day, but I have all sorts of hopes for mental health treatment.


Off the top of my head, roughly 7% of kids in the US have ADHD and roughly 4-5% of adults have ADHD.

20% of boys of a certain age have currently been diagnosed with ADHD.


If the definition of ADHD includes 20% of all boys, then I'm inclined to believe the definition takes in too many kids. If 1 in 5 kids has it, then it is normal behavior in that age range.


I don't in anyway shape or form think 20% of boys should be diagnosed with ADHD. I think something is seriously wrong with our society if this is happening.


This. So much this.

But, think of all the children we can get hooked on ritalin! Think of the lifetime of revenue (for big pharma)!


I wouldn't trust France when it comes to pediatric statistics.


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.


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

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


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).


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.


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


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.


Oh, you're right.

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


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.


> 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.

Thank you. These two paragraphs are a perfect counterpoint to the uninformed claims I hear about ADHD all the time, so I'll probably mention them the next time I hear people claim that ADHD 'doesn't exist'.

I think the only real problem is that ADHD has always been improperly named[0]. The actual condition itself has very little to do with attention. The condition is named not after the cause, but after a symptom - and worse, after a symptom that is not even characteristic of the condition. Not all people with ADHD actually exhibit attention issues as their primary symptom, or even at all.

It's like referring to depression as "Excessive sleep disorder". Well, sure, excessive sleep is oftentimes a symptom of depression. But taking stimulants won't (necessarily) help, and trying to force people to "just wake up" (or, more commonly, "just be happy!") isn't a solution.

It's no longer socially acceptable to tell dyslexic people that their condition doesn't exist and that they are "dumb". So why is it socially acceptable to tell people with ADHD that their condition doesn't exist and that they're "just lazy"?

[0] Previously it was called ADD, and before that it was oftentimes classified as auditory processing disorders, etc.


I don't like that it's classified as a disorder. It's a different style of cognitive activity, with its advantages and disadvantages.


Sorry but that sounds like an after-the-fact rationalization rather than a sensible statement, especially given the piles of evidence that inflammation causes ADHD. I mean, sure, a chronic infection can teach you something but that doesn't mean we shouldn't fix it.



It's not a "gift" or an "advantage", but it's not necessarily a disadvantage either IF the individual learns the proper coping strategies and can structure their work/life in a way that can make the ADHD less of a liability. It takes hard work.


Learning to overcome disadvantages doesn't cease to make them disadvantages.


Ok, well how about this: I don't ever remember what happens in meetings. Because of this, I learned to take really good notes. As a result of my coping strategy, I always have a distinct advantage over people who don't have ADHD. I can look at my notes from 6 months ago and tell you what we talked about in a meeting.

I don't really think of it as a "disadvantage" because it's really just about knowing your personal limitations. One of mine is that I can't remember shit. Some people struggle with complex math problems (which I would say is a bigger weakness than memory issues which are easily solved with an iPhone and a notebook.) It doesn't have to be a weakness if you manage it.


Not being able to keep a complex math problem in ones head would be a memory problem as well, would it not... before my age 34 diagnosis - forget math all together... my working memory was abysmal; now I am completing 2nd year IT: ComSci. I have a chance, thanks to that "demon" stimulant medication, and a environment, where I am not told I am "lazy" any more. This article, while seemingly accurate, leaves out the obvious rare case of actual ADHD.


> I don't like that it's classified as a disorder. It's a different style of cognitive activity, with its advantages and disadvantages.

I'm sure the same can be said about all of the disorders like depression or anything else.


What are the advantages?


People with ADHD tend to be very fast thinkers -- indeed this is part of the "problem" because while we're having a conversation with someone, we've thought through every consequence of what you just said before you finish your sentence. Because of this, we tend to get to "outside the box" type solutions much more quickly than others because we can effectively execute parallel tasks in our minds and come up with an answer to a complex problem quickly. The issue then comes in translating the issue in a way that can be communicated with others; so much so that when someone with severe ADHD seems to be very pensive in thought, they're likely just trying to work through how to verbalize what they've been thinking since before you finished talking.

Another hallmark of ADHD is actually the ability to "hyperfocus", which is almost an autistic-like quality. If I'm working on something I'm intensely interested in, I can work on it all day long and not notice that I forgot to eat both lunch and dinner. This happens whether stimulants are involved or not. It comes off as a lack of attention because, well, you ignore everything else unconsciously. When "hyperfocus" happens, you can lose tracks of large periods of time (we're talking 6 hours go by and it legitimately feels like 15 minutes.)

I do agree that it's not so much a "disorder" as it is just a different way of functioning. It's advantageous in some lines of work (a lot of software developers tend to be ADHD because of the hyperfocus) and disadvantageous in others. There are coping strategies, but it's no different than the types of things non-ADHD people have to learn how to do -- the strategies just end up being a little different and focused more on reminding us to do things.


Disorder is maybe a harsh word, but my issue is that it runs counter to how I want to act.

I want to do x, but I don't do it. It's really hard to explain to someone who doesn't feel the same way. It's not just a procrastination, it's a complete inability to adhere to a rational set of priorities.

For most people task avoidance is due to stress or fear. For me it was simply that it disappeared from my head while I did something else less important. Then later I realized that I didn't do what I wanted to, and tried to understand why.

Parts of the day would disappear into nothing. I wasn't avoiding work, or even procrastinating as many people would view it, I was just unable to see that mental priority list for a time.

Then there's the periods of seeing that mental priority list, but being unable to commit to any single task to the extent that nothing gets done. If there's giant pressure or stress behind something, it could force me to act, but otherwise nothing.

"Hyperfocus" is kind of true in that when you unhinge from that mental priority list you stop feeling the distractions, but the problem is you don't exactly get to choose what you want to focus on. The other problem is, that condition only lasts for a while and then you're left listless and useless. So sure, you can spend a few hours writing responses up on HN instead of working, process all that dopamine superfast, and then sit around trying to remember what you were trying to do when you sat down at your computer in the first place, until some crisis pushes you to action.

You talk about it like it's great, but I think you're misrepresenting it. It doesn't make you an incredibly quick thinker, you don't necessarily "think through every consequence of what you just said before you finish your sentence" what is more realistic is we think through some things unrelated to what was just said, sometimes this might lead to an alternate line of reasoning, a "thinking outside the box". Sometimes it just means you have no idea of what was actually just said because you were thinking about whether when they said they had been working all last night that they maybe got Pizza when they were working last night, and whether they liked anchovies on their pizza because your Dad used to put anchovies on his pizza and you never really liked them. You know, they were so salty, and the little bones got stuck in your teeth. But it's kind of cool that you can eat those little fish almost whole, unlike Tuna, which while it comes in tiny little cans is actually a pretty big fish.


  Then there's the periods of seeing that mental priority list,  
  but being unable to commit to any single task to the extent that 
  nothing gets done. If there's giant pressure or stress behind 
  something, it could force me to act, but otherwise nothing.

  "Hyperfocus" is kind of true in that when you unhinge from that 
  mental priority list you stop feeling the distractions, but the 
  problem is you don't exactly get to choose what you want to 
  focus on. 
Get out of my brain! Yeah. This! Eerily accurate description of how I feel a lot of the time.

  It [ADHD] doesn't make you an incredibly quick thinker, you 
  don't necessarily "think through every consequence of what you 
  just said before you finish your sentence" what is more 
  realistic is we think through some things unrelated to what was 
  just said, sometimes this might lead to an alternate line of 
  reasoning, a "thinking outside the box".
Yeah, I agree with this. I think that people with high intelligence and ADHD often conflate the effects of one with the effects of the other.

Being smart makes you think ahead; having ADHD makes you think sideways. Together, they can be a real doozy, huh?


wow you articulated this really well, I'm going to start explaining it like this to people. thank you


Are you sure that "hyperfocus" is a symptom of ADHD?

I'm a developer, depending on how well rested I am I can go into that zone for 12 hours, sure, but I've always been like that since I was a child and if I want I can focus on subjects that don't bring me pleasure at all, it's all a matter of determination (edit: for me).

Observing children at my wife's kindergarten that allegedly have ADHD, it's quite the opposite of being able to hyperfocus. Such children can't focus for 5 minutes on a single thing. Like, if you ask them to draw something, or to play a game, or if you read them a story or whatever, there are children that once past the 5 or 10 minutes mark lose their focus completely and shift their attention to something else, being a constant struggle to win back their attention.

Or maybe these are in fact 2 different disorders? It does take motivation on my part to focus on things that I don't like. Plus I think doctors are too quick to prescribe medication to children, which is my only problem with an ADHD diagnostic - as focus is also a matter of training (i.e. the interest for hearing stories or drawing stuff doesn't develop overnight) and parents, from lack of time, prefer to succumb to giving their children drugs instead of reflecting on their interactions at home.

So you know, I've got a mixed feeling about this - on one hand I've seen children and even grown men that can't focus on anything at all, so I'm sure ADHD is real, on the other hand it's often misdiagnosed and those drugs may in fact do more harm than good in many cases.


> Are you sure that "hyperfocus" is a symptom of ADHD?

Yes. The name is a misnomer. It's a kind of executive function disorder. The ability to prioritize and focus at will on what is needed. Hyperfocus means that other things that might need to be a priority are being dropped. Hyperfocus is only good when it is on the right things.

> it's all a matter of determination.

That's good for you, but what about the people that can't no matter what level of determination? Determination isn't a solution to erectile disfunction so why is it a solution to adhd?

> on the other hand it's often misdiagnosed and those drugs may in fact do more harm than good in many cases.

Isn't that true in almost all treatments? In how many cases have medication caused more harm than good?


So I wasn't saying that it's a matter of determination for people with real problems and wasn't in no way proposing it as a solution.

I was trying to suggest that there can't be a one size fits all - some people are fat because they practice impulsive eating at midnight and/or when upset and some people are fat because their metabolism is seriously malfunctioning (e.g. people with diabetes or a predisposition to diabetes). Can you agree that we've got at least these 2 categories? Can you see how these 2 categories require different types of treatment?

In regards to treatments sometimes doing more harm than good and my problem with an ADHD diagnosis from my experience in talking with people diagnosed as such is that the diagnosis itself is often without any hint to the root cause, being often about the symptoms. For example a magnesium deficit can lead to ADHD symptoms. If a person with a magnesium deficit takes drugs that don't treat this deficit, it's easy to see how the treatment can do harm.


Well, trying to diagnose ADHD in a 5 year old is witchcraft at best -- kids at that age just naturally have no attention span. It's not ADHD when you're 5, it's being a kid. I was diagnosed young, and let me tell you: the meds are no fun for the kid. You're amped up on pills all day then when you come home you're a zombie. It likely results in a lot of depression issues for kids who don't really understand what's going on.

When unmedicated, an adult with ADHD literally cannot focus on a subject that is uninteresting. You try, then OOH SHINY. You can try cutting out distractions, great! You get 5 minutes of work done then you have to pee. Then you notice a magazine on the table. Then 3 hours of this later, you remember that you originally had a task you were trying to complete.

It goes beyond simple procrastination: short term memory is a real issue in general, especially about doing things. It doesn't matter how hard you need to focus, you'll constantly be distracted, and when you get distracted, you forget what you were originally supposed to be doing. Likewise, you may then hyperfocus on something that is interesting to you and end up playing around with an Arduino for 4 hours without realizing it. You know how you have a nagging feeling you were supposed to do something? That's pretty much life for an adult with ADHD. A constant feeling that you're forgetting to do something. But you can't remember what it is.

It's hard to explain the difference between ADHD "hyperfocus" and just being "in the zone"; but I'd have to say it's the in-the-moment perception of how time passes. Most people when they're "in the zone" make a conscious decision to stay there: with ADHD it's almost an accidental thing where you enter a trance and only leave it when your task is done or when someone smacks you across the face.


A typical ADHD complaint is that the "hyperfocus" happens but the problem is that you can't choose what you want to focus on.

  Or maybe these are in fact 2 different disorders?
Sure. Even with our woefully incomplete understanding of things, there have been recognized subtypes of ADHD for quite some time, as well as recognition that there are a great many things (situational depression, clinical depression, etc) that can affect one's focus.

And yes, diagnosing little kids with ADHD and giving them medication sounds horrifying to me.


Six years old when they start school are expected to focus for 10-15 minutes. Kindergartner loosing attention after 5-10 minutes sounds to be exactly where he is supposed to be.


Yes, that's my opinion as well, but there is a lot of variation in the same age group. That number was pulled out of my ass btw, I only observed the differences while being there as a volunteer for various activities and from my wife's stories. And because of this variation, I think people are too eager to diagnose children with ADHD. And this is also a pity, since there may in fact be children with real problems that can't be separated well from children that are simply being children.


It's hard to generalize, but when paired with intelligence and so forth, ADHD symptoms like restlessness, curiosity, "not fitting in" etc. can work as positives.

It's often been said that these can be beneficial traits in entrepreneurs.


> when paired with

No. The other traits are themselves beneficial. Do not confuse their success in spite of their ADHD with success because of their ADHD.


> I think the only real problem is that ADHD has always been improperly named[0]. The actual condition itself has very little to do with attention.

I think it should be called "executive function disorder."


Too broad; Asperger's is also considered an EF disorder. While there are many similarities (people in support groups for either tend to call the other "cousins") they are very different in presentation.

Yes, it is an EF disorder, but one of many on the spectrum of EF disorders. That said, I can think of no better name at the moment.


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.


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.


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


I don't feel that Adderall even remotely makes me "like everybody else" - I feel it has some benefits toward reducing a specific difficulty I have and that those benefits outweigh the minor downsides.

  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?
I certainly don't blame you for making this assumption, since I didn't flesh out my (not terribly interesting) story. And I also agree that there are a lot of upsides that come with ADHD, though of course it's hard to tell which positive personality traits are /due/ to ADHD and which are coincidental.

However, the truth is that I actually tried starting my own business I was passionate about /before/ even considering an ADHD diagnosis!

Just like you said, I decided my inability to focus in an office environment was due to a lack of motivation. (And that was partially true, it turned out, but wasn't the whole story)

So I started my own business. Now, at the time, I didn't think about ADHD very much at all but my opinion of it was that it was a thing they over-diagnosed in kids so they could sell a bunch of pills and basically make excuses for boring teachers and ineffective parenting.

After a couple of years creating the business it was pretty clear I was hitting the limits of my ability to focus even when doing "the fun stuff" like writing code for a thing I was passionate about. And don't forget that running a business also requires a lot of deadly boring stuff too - taxes, regulations, paperwork, etc.

It was at that point I started looking at a lot of things and decided maybe exploring the ADHD thing made sense after all.


You're asking a lot of loaded questions. These drugs allow me to do what I want to do. Why isn't that good?

People who try to claim that ADHD symptoms are good are probably people who aren't diagnosed with ADHD (and let's not get started with OCD).


I agree the article is potentially harmful. The paradox is that people who DO NOT have ADHD easily get hooked on meds but people who DO have ADHD hate taking meds. Saying ADHD doesn't exist is cruel and shows how badly it's misunderstood. The newer drugs that have countermeasures that prevent snorting/abusing should change the debate. Older meds that can be easily abused should be taken off the market. Then let's see who wants to abuse them? Anyone with any proximity to ADHD kids knows getting them to take their meds is a chore, they enjoy just being themselves and perhaps the bigger questions is WHY DO WE HAVE TO MEDICATE PEOPLE TO MAKE ENGAGE IN AN EDUCATION SYSTEM THAT SUCKS?! EH? I'm proud I don't sit still and do what I'm told, I don't think that's an illnes... so in that sense they are right ADHD doesn't exist! (steps down from soapbox, exit stage right) :)


> Saying ADHD doesn't exist is cruel and shows how badly it's misunderstood.

I didn't get that from the article at all.

He's not saying people don't have problems, he's saying the label ADHD is doing a disservice. It's not a condition, it's a symptom.

If we had a label called "breathing problems" and just lumped all lung-related stuff in there, it would be problematic too. That doesn't mean no one has lung problems, it means we need more narrow diagnosis such as pneumonia, cancer, cystic fibrosis, bronchitis, asthma, etc.

The article is completely right. Any disorder that fits 90%+ of the population is too broad. Either it needs to be split into multiple disorders or the criteria need to be tightened.

This is a categorization article, not a "there's no such thing as ADHD they're all faking it, work harder slackers" article.


I won't dispute that the definition of ADHD as it exists in clinical guidelines is entirely too broad. I do think that there is a "condition" that exists in a smaller subset of the population that is described by the guidelines of ADHD, and it's not a sleep disorder or anything like that (in fact, my ADHD is far worse if I sleep too much.)

But the article is potentially harmful because it discounts this population and pretends that there's nothing there. The author says "there is no such thing as ADHD" without allowing for the possibility that there actually is, but it's far too broadly applied and needs to be tightened up.


I think you're wrong there - ADHD is generally associated with a higher risk of abusing drugs than for people without the condition. (And myriad other conditions, including getting in car accidents).

And as someone with ADHD I never hated taking the medication. It was, like for the OP, a great experience that let me do a lot of things I didn't think I was capable of doing.

I do hate taking too much of the medication, granted. Accidentally doubling my dose is always something that I really regret.


There's a little hole in your argument. You've lumped "meds" in with "drugs". And sure, they fit into the broader category. But let us, for the sake of argument, say that "meds" is a term generally used for substances that effectively treat a problem/condition, while "drugs" (at least as it seems to be used here) is a much more general term.

People will self-medicate when they can, and they will use anything that reduces the symptoms they perceive as problematic even when those substances have detrimental effects elsewhere in their lives. Taking into account only correlation, there are abnormally high numbers of people with chronic depression or dysthymia among alcoholics and those addicted to other CNS depressants (like barbiturates), of people with bipolar disorder among cocaine addicts, and of schizophrenics among people who even the most pro-weed activists would say use an, um, immoderate amount of hallucinogens.

So it is unsurprising that people who have something like ADHD (for want of a better label) may find relief for the symptoms they feel in some substance that at least gives them the perception that the problem is ameliorated (whether or not it actually helps functioning). And since the problem reduction is imperfect or short-lived, there is apt to be a bit of overuse or compensation for diminishing returns (rather like the "sunk cost" phenomenon). There is nothing to suggest that medications that actually work tend to be abused among that population (accidental missing or doubling notwithstanding - I do that with my Parkinson's meds occasionally, and it ain't fun when I do).

As a long-time recovered addict, I have no trouble saying this: the biggest problems with medications that you actually need is that they only do what they're supposed to do. (Post-surgery morphine was a complete bust, and it went away before I could rely on it for anything but high-level pain.)


If ADD/ADHD is a matter of willpower, then maybe that is true, but willpower is a neurological resource. Exercising willpower diminishes that resource, you can see that in studied conditions like decision fatigue.

If some people have too little of this resource to function in a normal capacity, why then should people argue against a drug that helps buoy this resource.

If doctors found a better way to treat the condition, neurogenesis or something, then fine, do that instead. But right now, we're in a position where some people, whether through genetics, traumatic stress, brain damage, or just diverse brain chemistry, don't function as well as others. We also have medication that can keep that "willpower" hanging around in your nucleus accumbens.

What bothers me is the pseudo-scientific idea of a mystical "Willpower" that just manifests itself in "good" or "strong" people, as though there's a moral component. It's like running a race with one leg, and being told "Stop using a prosthetic! Just use 2 legs! Everyone else is!"


Amen. It's funny how as a society we've come to accept certain mental issues as things rooted in brain chemistry and others are still "willpower" issues; issues of personal quality.

I think that at this point, nearly everybody in the civilized world accepts dyslexia as a neurological thing and not a issue of "willpower" or low intelligence. It wasn't always that way, though - that's a pretty recent development.

I hope we can see (and contribute to) ADHD getting there in our lifetimes.


So I agree this article is kind of a mess, the title misleading. This is the nature of ADHD. It's a magnet for people wanting to cry "overdiagnosed"!

However, tolerance is a big question. Taking an ADHD medicine for the first week or so after not taking any for months prior is a pretty profound experience. But that tapers off. And leaves one to wonder... is my condition still improved?

I have seen very few studies (though the ones I saw were positive, indicating positive effects even a year out). I've heard of doctors prescribing drug holidays to minimize tolerance (and also heard this was no longer current practice from an expert in the field).

It's an area I'm always somewhat concerned about. I've read anecdotal stories suggesting that one becomes tolerant and experiences less of certain effects (such as appetite loss, and the 'buzz' feeling) but not others (such as attention span).

I will say that as physical effects go dependence is not an issue. But it is for mental ones - without the medication I'm just exceptionally tired and hungry, and almost entirely useless for anything that requires focus.


  > I've heard of doctors prescribing drug holidays to 
  > minimize tolerance (and also heard this was no longer current 
  > practice from an expert in the field).
When you say "drug holiday" do you mean temporarily reducing your dosage, or temporarily stopping the medication entirely?

I can't speak for current practice in general, but I've had a couple of doctors and a nurse practitioner recommend tapering down my dose a bit on days when it's possible (ie, days off from work, etc) in the last few years.

I don't know if everybody would respond this way, but a lot of feel doing that helps stop tolerance/dosage creep, which was definitely a thing I experienced in the beginning. After some experimentation it seems like the way to go for me. I've been steady at a prescription of 15mg/day for a few years. Some days I take ~10mg and some days I take ~20mg.


I've written a book on ADHD (Adult ADHD: What You Need to Know). I specifically looked into the tolerance questions. The doctors I found who are experts in the field and have treated a very large amount of patients say developing tolerance is unusual.

*Minor edit


Thanks for writing a book. I haven't read your book, but I've found Delivered from Distraction to be a godsend. You can't help but read that book and either feel comfort for yourself or a better understanding of someone else who you just realized has ADD.

http://www.amazon.com/Delivered-Distraction-John-J-Ratey-ebo...


What in unusual? Any sort of tolerance?


Edited to make more clear, thanks!


So I'm with you. I also suffer from attention span issues. It's been a terrible thing to have to live with at times.

But I have to ask an honest question: do you have a deficiency for which you need treatment? Or do you have a personality type which might make you unsuited for certain types of work? Or -- more likely -- do you have a tendency for a type of personality attribute expression which varies depending on various external stimuli?

I think it's perfectly fine that something like ADHD is a naturally-occurring personality trait and/or state of mind for which we might need medication to overcome. At the same time, I'm not too happy with characterizing it as a disease or dysfunction. I think we are taking people who are acting in a completely normal fashion and telling them something is broken about them. That ain't right.

In other words, you both might be right. It's not an either-or situation. As we continue to develop our knowledge of the brain, it's a terrible mistake to create some artificial "perfect" personality and mind that any deviation from is a disease. Very. Bad.


Why is it ok, if its 'natural' or a native trait? My eyes are bad; should I go around without glasses to prove some ethical point?

No, ADHD exists, my family exhibits it (3 generations now and counting), and it can be harnessed, treated or ignored with wildly differing outcomes.

Harnessing and treating it are vastly preferable to ignoring it.


I would argue that the vast majority of people diagnosed with ADHD don't fit the DSM V criteria for a disorder. They're experiencing "an expectable response to common stressors", and probably not "reflecting an underlying psychobiological dysfunction" - they're human, humans are often distracted, this is not a disease until it gets to the level where it absolutely begins to destroy your life, and even then it's probably reflective of something else going on rather than a primary disease.

The key to anything as a disorder in the DSM is that it:

Features

A a behavioral or psychological syndrome or pattern that occurs in an individual

B the consequences of which are clinically significant distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning)

C must not be merely an expectable response to common stressors and losses (for example, the loss of a loved one) or a culturally sanctioned response to a particular event (for example, trance states in religious rituals)

D that reflects an underlying psychobiological dysfunction

E that is not solely a result of social deviance or conflicts with society

F that has diagnostic validity using one or more sets of diagnostic validators (e.g., prognostic significance, psychobiological disruption, response to treatment)

G that has clinical utility (for example, contributes to better conceptualization of diagnoses, or to better assessment and treatment)

Other Considerations

H no definition perfectly specifies precise boundaries for the concept of either “medical disorder” or “mental/psychiatric disorder”

I diagnostic validators and clinical utility should help differentiate a disorder from diagnostic “nearest neighbors”

J when considering whether to add a psychiatric condition to the nomenclature, or delete a psychiatric condition from the nomenclature, potential benefits (for example, provide better patient care, stimulate new research) should outweigh potential harms (for example, hurt particular individuals, be subject to misuse)


  But I have to ask an honest question: do you have a deficiency for which
  you need treatment? Or do you have a personality type which might make 
  you unsuited for certain types of work? Or -- more likely -- do you have 
  a tendency for a type of personality attribute expression which varies 
  depending on various external stimuli?

  I think it's perfectly fine that something like ADHD is a naturally-
  occurring personality trait and/or state of mind for which we might need 
  medication to overcome. At the same time, I'm not too happy with 
  characterizing it as a disease or dysfunction. I think we are taking 
  people who are acting in a completely normal fashion and telling them 
  something is broken about them. That ain't right.
I love the way you put this, and I agree with a lot of what you said. BUT I also don't think what you say is incompatible with treating focus issues as a problem that can be helped by medication.

For me, learning about ADHD was very liberating!

It wasn't a diagnosis that told me I was fundamentally broken as a person; it was exactly the opposite.

I had a lot of love and support growing up in the 80s and early 90s, don't get me wrong. But I also got a lot of negative reinforcement and had come to think of myself (as a certain book title suggests) as "lazy, stupid, or crazy" (ok - maybe just lazy or crazy) when it came to focus and procrastination issues. I never even considered ADD/ADHD because as far as I knew, it was a label for hyperactive kids and I was never hyperactive.

Those are very broad terms, you know? I really felt like there was fundamental shit wrong with me. I grew up believing in hard work but had the hardest time doing homework and taxes and things I didn't want to do.

So learning about and eventually being diagnosed with ADHD really helped the way I feel about myself. Instead of feeling broken on some fundamental level, I came to feel like I had a pretty specific thing to deal with; one that could be helped by medication and proper sleep/diet/environment/exercise.

Edit: I also want to address this one specific thing you said:

  Or do you have a personality type which might make you unsuited 
  for certain types of work?
I can't think of a single line of work that doesn't benefit from an increased ability to focus.

Even entrepreneurs, who are often famously ADHD (or ADHD-like, anyway) in their restlessness and curiosity, need to focus on the mundane stuff sometimes.

And it's not like medication erases those positive ADHD traits either. The fact is that stimulants leave your body pretty quickly, and with something like your Adderall dosage from day to day. If you're responsible and take a little bit less on the days you don't need it, you can take a little more on the days when you need it more. You can tailor the effects a bit depending on your needs on a particular day.

(Note: The medication is far from perfect; it's not for everybody and is not a cure-all. Biologically, stimulants are a very crude way to address one's focus. In my experience, proper sleep/diet/exercise/environment are more important than any medication I've tried.)


I agree. It's the stigma that I'm talking about. Medicating yourself to adjust your ability to focus in order to perform your job? Like I said, count me in for that.

As a society we're going to have to accept that people are different, and that people may need various medications to adjust their performance capabilities to do various things. That doesn't make these people broken! Simply because you are taking some chemical to do X doesn't mean that you are disabled.

This is going to be a big leap for society. Up until now it's all been "If you need drugs, it must be because there's something wrong with you!" Well, not really. We're all "broken" in various degrees....


Yeah. The stigma is a terrible thing, possibly the worst thing about it.

I never, ever mention ADHD in a workplace[1]. Too many misconceptions, and too many people willing to assume that you're trying to make "excuses."

If I have a specific need, such as having a quiet work area for concentration's sake, I don't ever shy away from making my case for it. But I never present it in the context of "having ADHD."

[1] Although perhaps future employers will Google me and see this discussion. :)


I think the article is trying to say that ADHD is an umbrella term used for a range of symptoms, rather than 1 disorder. I can imagine this being true for at least some of the cases, but it didn't provide much in the way of evidence. Although it does have a sensationalist headline, it's asking for a better look at ADHD rather than saying it should be ignored.


If you do any reading on ADHD, I think you'll find that everyone who knows anything about it would agree with this. ADHD is defined as a collection of related symptoms, with the full admission by everyone involved in the definition that the causes are varied, that most of the symptoms are exhibited by everyone to some degree, and that effective treatments likewise vary greatly.

In other words, ADHD is no different than any other mental disorder, except that the drugs have effects people like, even if nothing's wrong with them.


But isn't that a problem? Shouldn't we try to split ADHD up into smaller more specific disorders so that we can better study/treat it?

If lumped all together, that seems to only help cause over-diagnosis (because the symptom list is so large) and makes it harder to study (because two very different conditions may be manifesting in very similar ways).


Actually, it is split. There are three types of ADHD - predominantly hyperactive-impulsive (PH), predominantly inattentive (PI), and combined (C). There is also Sluggish Cognitive Tempo, which seems to be related to ADHD-PI, but there is less research on it.

Additionally, people who may seem to have ADHD may in fact have OCD, anxiety, depression, or other disorders. And vice versa. Or they may have a combination of one or more of these with ADHD.


I was not aware of that.

As someone outside all of this (I've never had to deal with it, so I only have a passing familiarity) it sounds like the term ADHD needs to be removed from use as it's only causing more confusion. The various facets should have their own name.


So I sought treatment... at the age of 32.

Hi John, I'm curious if you tried any of the following before trying medication:

1. No TV

2. No Video Games

3. No Internet aggregators (slashdot / digg / reddit/ hn / etc)

4. Meditation

I am a colossal procrastinator and frequently unfocused person that had a much less successful academic career than you due to that. So far I've been going through periods of trying the above, thinking that medication is an absolute last resort. So far I haven't had to go there but I'm curious as to what things you may have tried before going to medicine?


You obviously do not understand how this even works. With my kind of ADHD. Okay here set a remminder to do this, except with your reminder, you forget to remember the reminder.

"Remind yourself! But I forget to remember!" It just doesn't work in the space planning/organizational structure that normal people use to cope with their problems, and their stupid fucking instructional ways to suggest otherwise just give other people with armchair opinions more safe-guard to continuously allow people to have shit opinions.

People with ADD, are much more likely to engage in drug abuse, criminal behavior, and under-perform. It is a societal COST to not help them out.


Well my anecdote: Before technology, I procrastinated just as much, by spending many hours walking outside. I can't say technology improved things, but it's certainly not the root cause. Can't say I tried meditation, it seems like pseudoscience. I haven't tried medication yet either, but I'd really like to.


Thank you. Every time I set down my wallet, keys, phone, and pocket equipment and whenever it's time to pick everything up. I lose everything. I have lost my wallet + cash roughly 6-9 times this year so far and probably like 4k cash.

I always miss deadlines and forget everything, I was diagnosed with ADHD with a child, but went along with the narrative that I was just lazy, or didn't have discipline, or was just an underachiever(even though everyone would insist I was very smart), some of my friends when I graduated high school going to MIT/Princeton told me. "Dude, cmon you should be here with us, what's going on?".

So I resolved many times so far to try harder and that I was just lazy, and gained many times extreme inspiration, inspiration that almost all in my life say they've personally never experienced, but always I would lose my path. I would just, forget... then one day on the bottom of depression and people around me picking up on my anxiety issues, people around me kept picking up on observations of me and recommended I try to get professional help.

I know now I actually have this fucking thing, and that for me it's so bad that even if I know that some task is due that will cause me impending doom in a matter of a few days on even 3 hrs. I will always just get distracted, or forget some deadline. Over, and fucking over again, but if I actually remember to take this stupid fucking medication that i'm given. My life is normal again and I can actually achieve the performance my peers/teachers/community has always expected of me.

Through fucking countless suffering and being told i'm a lazy piece of shit, dumbass kid is always late to class even though I arrived to school early because I got distracted. I found that i'm not always like that. I have PLENTY of emotional baggage, and my personal life is 40x crazier than what i'm allowed to post here(Friends in prison in recent years).

But this DISORDER, however ill-specified it is or what everyone's fucking problem it is. Taking my medication daily or SOMETHING will help me achieve. So when I'm not distracted i don't crash into the fucking car in front of me or the side pavement of the freeway to check my phone impulsively over and over again.

Lol. You people have no fucking idea what you do to me with your armchair bullshit opinions, and you have NO idea how much it's hurt me over the years. I can't tell you how many times I haven't had the attention spamn to notice my tire is flat or THIS, OR THAT. Is happening. Some times, I just get distracted by whatever activity that I forget to eat for like 2-3 days straight, and thus at 5'7 am roughly 100~ish pounds.


The book below is pretty awesome. The other wrote two different books: Driven to distraction and delivered from distraction.

http://www.amazon.com/Delivered-Distraction-John-J-Ratey-ebo...


For every one of you who takes the meds route, there are others who change careers, jobs, or learn exercises and methods to stay on task better. This has been the traditional way to deal with these problems.

I am not saying that I would not do any different if I were in your shoes, but changing your career to match your brain sure sounds more natural, and that is usually a good thing.

It is sad how science and technology has made normal people have a medical condition. A couple of hundred years ago you would have been a farmer rather than a banker. Now you are on mind altering drugs the rest of your life.


Lets just be really clear about one thing, focus related drugs have been pretty common in academia and highly intellectual professions for decades now. Similarly, drugs like Ritalin are legal in Israel and can be had by anyone if they just get a script from a doc (no need for a diagnosis). In the long run I think we as a society need to grow up about this stuff, as use of some of these meds in moderation is fine either for light occasional use by those without severe focus issues, or prescription based moderate use by those that have ADHD.

Instead of sitting around and writing articles about 'omg millions of college kids and high intellectual work professionals take drugs, holy shit no one has ever taken drugs to create things before!', we just need to get real and be responsible about the reality. Don't stigmatize it, and allow people to responsibly explore the option with their doctors and see what works. Now if you disagree with this approach, you must argue that the health effects of moderate use is too severe, or the medication gives people an unfair advantage.

As far as changing careers, sure, that's an option an individual can explore. If they feel like they can deal with life acceptably with some medication, what's wrong with that? Are they assholes now? Frauds? Phillip K Dick was a anphetamine abuser (which no one advocates), but incredible writer. I would never dare suggest someone limit their potential if there are options they can reasonably try.


>Phillip K Dick was a anphetamine abuser (which no one advocates), but incredible writer. I would never dare suggest someone limit their potential if there are options they can reasonably try.

This is very telling and I believe that it defines pretty clearly the rift between our convictions on this.

In the near future, we will have the ability to augment our brains via drugs and implants to make us many more times smarter and more productive. We are starting down this path already. Where does our humanity end up after all of this. There will certainly be a tradeoff.

I believe the present and future of humanity is better off letting us reason with out own natural brains vs enhanced/inhibited (enhanced/inhibited always go together because there is always a tradeoff, even if eventually the only side effect is an imbalance of abilities). I am not saying that I never condone the use of ADHD drugs and Antidepressants, but when they are handed out like candy - I see that as being a problem. Clearly you do not, but that is the difference between us.


A couple hundred years ago I would have been essentially blind because a lack of these "unnatural" glasses. There's a good chance I'd be dead because of "unnatural" vaccines and antibiotics.

No, technology hasn't made normal people have a medical condition. We already had a medical condition. Science and technology allows us to understand that, and to improve our lives beyond just "give up and get another job".


You have to draw a line somewhere don't you? otherwise we've eventually got Gattica.

Does wearing glasses modify the logical center of your brain like Ritalin? How about we start genetically engineering humans to be smarter, stronger, etc. How about we give all short kids hormones so they can be as tall as the rest of their classmates, it's only fair after all. Vaccines do something that nature also does, it is just in a more controlled way, antibiotics are used to save lives so they have a different consideration, again though the thing that I want to underline is that altering the brain's chemistry and behavior is bad.

Some things like modern agriculture seem like good ideas at some level. Tons of food can be achieved cheaply, but it has side effects of pollution and toxins/antibiotics ending up in our bodies, the cycle of life and our ecosystem is damaged. The same with factories. They can produce amazing amounts of goods, but they can also destroy the earth.

Systematically altering thoughts and minds because they don't fit into office jobs well is something that will end up with consequences (it already is starting too).


One, who the hell cares? Just because something is natural doesn't make it good. If you want natural, go live in a cave and risk dying whenever you get a cut or a tooth infection. There's nothing wrong with improving things.

Two, again, it's a real condition that seriously affects quality of life. Your argument is about as reasonable as telling crippled people they shouldn't have wheel chairs, or depressed people they shouldn't take anti-depressants, or otherwise blind people have glasses, etc. It's absurd and offensive.


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.


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.


> 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.


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.


> 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.


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.


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.


Exactly what I was thinking.


Counterpoint: "ADHD and Brain Chemistry", by Steven Novella: http://theness.com/neurologicablog/index.php/adhd-and-brain-...

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


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.


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.


> "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.


He isn't denying that ADHD doesn't exist but instead he is saying that it exists as a symptom of other ailments. His title is a bit inflammatory, but that doesn't disprove his argument. The article is much better than you are giving it credit for.


> but that doesn't disprove his argument

His argument is ridiculous. ADHD is defined as symptoms and we don't have a full understanding of the underlying cause. Everyone knows that the drug treatment only treats the symptoms. If his argument is that we are only treating the symptoms then he hasn't added any knowledge. If he knows the "cure" why doesn't he make the claim: "I know how to cure ADHD?"


He can't "cure ADHD" because it is a symptom of many different things. He has to diagnose the patient and determine the underlying cause. He gave a list of potential causes that included vision problems, iron deficiency, and sleep problems. I imagine each of these have their own cure which in turn fixes the symptoms of ADHD. You are implying that ADHD only has a single cause, the author is disagreeing with you.


You and the author are both talking as if ADHD exists which counters his book title. I'm not the one making the bold claim -- the author is in his title.


The claim is that ADHD __as currently defined__ does not exist. That's very different from "no one is suffering from these clusters of symptoms".


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


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


The book has the same title.


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.


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


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.


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.


  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!


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.


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.


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.


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


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


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.


>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.


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.


>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.


> 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"...

Except that isn't the argument. Just like we don't try and save premature babies to try and "be fair" and we don't treat suffers of diseases to "be fair." There is no slippery slope argument here. The onus is on you to prove that there is in fact a slope and then to show how slippery it is.

> Physical work often creates the necessary stimulation that so many of these ADHD cases need.

Who are you to tell sufferers the best way to treat their condition? Don't you think it is best for people to get a say in their treatment?


The slippery slope is obvious. More and more people today are put on drugs to deal with problems that used to be dealt with naturally and without side effect. Secondly, more and more average people who don't really need these medications still get on them because they enhance their concentration and productivity. They give them abilities (an edge) that only a few in the general populace naturally have. Why is this bad? because these are mind altering drugs that people will take every day forever.

This type of behavior modification has always had (and always will) consequences.


> More and more people today are put on drugs to deal with problems that used to be dealt with naturally and without side effect.

You mean like HIV/AIDs, cancer, autism, epilepsy? Of course there aren't side effects if you aren't treating.

> more and more average people who don't really need these medications still get on them because they enhance their concentration and productivity

You are begging the question. First you are assuming their is some growth to the number of people being treated that don't require treatment. Secondly, you assuming that they are bad because they are "mind altering."


>You mean like HIV/AIDs, cancer, autism, epilepsy? Of course there aren't side effects if you aren't treating.

I can see that you cannot even reason logically and understand simple comparisons. No comparison can be made between trying to naturally cure HIV/AIDS and someone with a short attention span while sitting at a desk all day switching to a more suitable job.

>You are begging the question. First you are assuming their is some growth to the number of people being treated that don't require treatment. Secondly, you assuming that they are bad because they are "mind altering."

This is not my assumption. It is a proven fact. The criteria for diagnosed ADHD has changed so dramatically over the last 20 years, a person who is suffering from stress or sleep deprivation (with side effects of a lower attention span and concentration abilities) is commonly diagnosed with ADHD and put on meds.

This conversation is done. I refuse to try and reason with an illogical and senseless person.


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


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.




Guidelines | FAQ | Support | API | Security | Lists | Bookmarklet | Legal | Apply to YC | Contact

Search: