Next can we talk about SSRI's? My little brother was prescribed Paxil as an adolescent. Now he's in prison for murder. Now Paxil is not allowed to be prescribed for adolescents and children but my brother will die in prison. He behaved exactly how kids prescribed this medicine behave, in a murderous rage.
So long as the chemical imbalance myth is perpetuated and one in ten Americans are on anti-depressants, all SSRI prescriptions are sacrosanct. Sadly, society isn't ready to have this discussion.
To me, as an adult, getting a diagnosis on ADHD was a godsend. However, after a couple of years, I see the drug's affects waning. I can also see how damaging this dependency creation can be for children.
Fortunately, when I was a child back in India, ADHD was virtually unknown (probably the case today as well). Most of the time, my parents chalked off my inattention to "lack of discipline" and were happy as long as my grades were good. I found the coursework very easy (despite studying for only 1-1:30 hrs a day) and topped most of my classes.
University here in he U.S wasn't hard either. My problems started once I started working. Couldn't code continuously for more than 15-20 mins at a time. Things got boring very quickly once I got the "aha". I couldn't hold a lot of program state in my head. I was always searching for that "flow" people often talked about.
Adderall really helped me. I use it very sparingly these days (especially on days that I have to code some important pieces) though.
Bottomline, looks like this is purely genetic and fixing the dopamine pathways isn't exactly like curing malaria, you can juice things up but the brain will want more. Parents can choose to give it to their children but they'll suffer some time down the road. I'd rather let the kid enjoy childhood and help him in other ways (exercise, note-taking, engaging activities etc) and put him in a reasonably good path to success. Let them take drugs if necessary once they've wised up as adults.
1. Thirty two percent of students living with ADHD drop out of high school compared to 15 percent of teens with no mental health diagnosis (UC Davis Health System, 2010)
2.Three times as many adolescents living with ADHD as those living without ADHD have failed a grade, been suspended or been expelled from school. (Barkley, 2000).
You're right though, let them exercise and make them note-take, that will work(while you ignore that this simply is not effective, as studied in the current literature)
"Fixing dopamine pathways isn't exactly like curing malaria", profound.
Conclusion: "Other evidence documents the long-term nature of ADHD in children and its classification as a chronic condition, meriting the application of general concepts of chronic-condition management, including an individual treatment plan with a focus on ongoing parent and child education, management, and monitoring. The evidence strongly supports the use of stimulant medications for treating the core symptoms of children with ADHD and, to a lesser degree, for improving functioning. Behavior therapy alone has only limited effect on symptoms or functioning of children with ADHD, although combining behavior therapy with medication seems to improve functioning and may decrease the amount of (stimulant) medication needed. Comparison among stimulants (mainly methylphenidate and amphetamines) did not indicate that 1 class outperformed the other."
I actually was never diagnosed with ADHD as a child or an adult. I exhibit a similar coding pattern as you did, and still do, since high school. I get bored very, very quickly and kind of live off of the "aha" moments, from one to the next. It's not that it's not genuinely challenging or interesting to me, but I just can't focus much of the time. This is true for just about everything I do these days. Thoughts and ideas come, I act on them, and they leave again just as quickly as they came. It definitely makes it hard to get much of anything done at work or home, despite having quite an agenda at times.
I've only taken Vyvanse offhandedly (without Rx) and it worked miracles for me. I quickly learned to ration it and use it sparingly as you do, partly because of the negative effects on my appetite and general well-being. I'm still debating going to see a doctor but I think they might write me off as an addict since I'm in my 20s but still quite young and a lot of kids come out of college abusing the stuff to get through exams and maybe never really drop the habit.
Any stimulant will increase your perceived ability to concentrate while it's active. That doesn't mean that it's curing anything or that you have any sort of condition. It doesn't even mean that your perception is correct, though it can be. It just means you're having a normal reaction to the stimulant.
Honestly, I had to look that one up and I do recall reading about that last week via a post linked on HN actually and telling my coworker that that didn't describe me much at all. In both my health (physical fitness) and other accomplishments , I can say I take them very well, and have an ego a large portion of the time because of them.
I should definitely go see a doctor anyway, if not just to make sure that this isn't all in my head.
> I'm still debating going to see a doctor but I think they might write me off as an addict since I'm in my 20s...
> Honestly, I had to look that one up...that didn't describe me much at all
When I was 18 and two years into college, I started to realize that everything non-drug-related I had done with my parents and therapists in the past wasn't working as well as it used to. Not quite a couple years later I was super tired from having bronchitis for six months, and everything imploded around me because I had no energy left to do anything. The new therapist I saw during then thought that I was being ridiculous by thinking of myself as a drug-seeking addict when drugs I had never actually tried before were the one thing I really needed at that point. I was so convinced I was in the wrong that I had been crying for over thirty minutes straight about it to her.
tl;dr impostor syndrome with my own mental health.
I'm in my mid-20s now and nobody that knows me thinks of me as an addict. I don't know what I would do without Adderall at this point - and that's in combination with a decent amount of behavioral strategies/techniques too. Sure, there are lots of people out there that abuse it, but I am just a total mess without and there's no way I'm making excuses up to keep on being a mess because of what other people do. Seek help because maybe you do have a problem, and you may come to realize that dealing with a known problem (or knowing that you don't have one) is like night and day compared to what's going on right now.
What does "abuse" mean in your context? "Abusing it to get by", very anti-humanistic mentality here.
"The kids with polio abused vaccines to get by"
"The kids with hunger abused food to get by"
What does "abusing to get by" even mean? You mean, USING it to get by, and thus preventing failure of the negative kind? You mean ... the desire-able outcome?
My third grade teacher apparently had every boy in her class tested. As a boy, and frankly as a boy who was independent, mouthy and unlikely to do work in school unless I wanted to, I'm glad I had great parents and a great pediatrician. My pediatrician had my parents and teacher run an experiment: my mom would choose a pill with active ingredient or a pill with nothing in it, and my teacher, without knowing which I took that day, would record notes on my behavior. Turns out, no correlation between the two.
I don't doubt there are people in this world for who ADHD is a real thing. But I think we are too quick in the modern age to drug without thinking. Parents demand antibiotics for illnesses which are just small bugs... guess what, now we are having problems with drug resistant bacteria. Lawmakers, administrators, and teachers (in that order) want to turn classrooms in to machines which churn out educated people like clockwork. Turns out, humans are animals, not machines, so we load everybody with some stimulants to make children just sit still.
I'm not anti-medicine in any way. I have personally seen Ritalin work on a friend who actually had ADHD growing up. And I have also seen another friend buy Vyvanse illegally so he could study for 15 hours a day. I believe in prescription drugs. I just don't always believe in the prescription.
I like the idea of the experiment! Is it generally accepted that one would see same-day behavior changes when switching between an ADHD drug and a placebo?
That's a good point, I'm not sure. The friends I've seen use the drug as a study aid certainly respond to it quickly but the scientific rigor of the experiment didn't much matter: I think my parents were skeptical that I really had a problem anyway, and lo and behold, I'm an adult now and I never did actually have a problem. When you tell the parents of every boy in the class their kid has ADHD, the claim becomes pretty weak.
Your response doesn't actually address the article, which acknowledges that ADHD is a real condition, but suggests that fewer than 1 in 5 boys have it, and that a large number of misdiagnosed cases is bad, considering that they're given serious drugs because of it.
In fact, the only number it suggests as being inaccurate (based on an old study) is 25% of cases - that 1 in 4 cases is misdiagnosed. However, given the number of total cases, that means something like 5% of boys are being given serious drugs for potentially no reason.
I think that deserves serious consideration, and not your knee-jerk, strawman response.
This article wasn't anti-drug from my perspective.
It warned that we're giving a fraction of those kids drugs that they don't need (which happens with other medications as well).
Neither I, nor the article, is suggesting that kids with ADHD shouldn't take pills as a treatment. It's suggesting that 1 in 20 boys is given amphetamines without a need for them, which is bad.
I'm not sure if it's that black and white. Roughly 25% of deaths in the US are due to heart disease. Should we not intervene because heart disease is part of the normal range?
I agree that it's probably not that black and white but a comparison with heart disease isn't a fair one.
The grandparent post does make a point. If such a large proportion of the population has a 'condition' is it really a condition or perhaps just how we (as a species) are? Especially in the case of something that's psychiatric/psychological.
For example, I've heard estimates that around 10% of the population is homosexual and for many years people wanted to 'fix' them. Around 10%-12% of people are left-handed and (I believe) that historically this was also something that people tried to 'fix'. I doubt many of us think twice about these anymore.
To a sibling comment that suggested what if 1 in 5 boys were born deaf, I'd say that the world would be a vastly different place. So different that we may not even entertain such a question. If, instead, 1/5th of boys were beginning to be born deaf, there would be a medical emergency. Unfortunately, in the case of things like ADHD it's difficult to know if we've always been this way or if there's really been a change.
Being gay or left-handed doesn't inherently impact your quality of life. Not being able to concentrate on anything does. So even if it were part of the normal range we should work on fixing it, like we do for myopia.
Being gay or left-handed doesn't inherently impact your quality of life.
It does if everyone else is telling you that you're abnormal (and need to be 'fixed'). That was the point of using those examples.
Not being able to concentrate on anything does.
Only if society has defined as valuable the ability to do only one thing, without distraction, for whatever period of time. Therefore, anyone who cannot do this must be 'broken' somehow.
So even if it were part of the normal range we should work on fixing it, like we do for myopia.
The first part of your sentence doesn't make sense. If it's 'normal' then by definition it isn't broken (and therefore doesn't require fixing). For the myopia example, most people 'fix' it by wearing glasses or contacts, which are non-permanent and do not mess with brain chemistry. Indeed, some people I know with myopia only bother with glasses when driving and cope just fine without for the rest of the time. Of course, measuring the degree of myopia is very easy so drawing a line between 'has some difficulty' vs 'severely impaired' is a lot more clear cut. In one case, we can consider glasses as an augmentation to something that is normal, whereas in the other we've fixing something that's broken.
I'm not suggesting that ADHD isn't a problem. Merely that we should exercise some caution before we label some things (people?) as broken, when perhaps they are not.
It does if everyone else is telling you that you're abnormal (and need to be 'fixed'). That was the point of using those examples.
That's why I used the word 'inherently'. People telling you you're abnormal is not inherent to those conditions.
Only if society has defined as valuable the ability to do only one thing, without distraction, for whatever period of time. Therefore, anyone who cannot do this must be 'broken' somehow.
ADHD doesn't interfere with your life because other people are making fun of the fact you can't sit still. It interferes with your life because it's very difficult to be productive in any way if you can't concentrate for whatever period of time and being productive is what's valuable to society.
I have mild myopia and I don't feel any resentment to my optometrist for labeling me broken. I'm just happy he augmented/fixed me so I can read signs at a distance. And unless/until we have proof that prescribing Adderall is so dangerous that it's not worth the gains, then I don't see a problem treating it the same as contact lenses.
I'm not suggesting that ADHD isn't a problem. Merely that we should exercise some caution before we label some things (people?) as broken, when perhaps they are not.
Well, clearly they thought they were broken somehow when they went to the doctor with concerns about their attention spans, no?
> It interferes with your life because it's very difficult to be productive in any way if you can't concentrate for whatever period of time and being productive is what's valuable to society.
By this reasoning, anything that reduces productivity as currently valued by schools acting a proxy for employers is a candidate for treatment.
Examples include: questioning authority, emotion, and passion for things whose value has not yet become apparent.
Other problems include the notion that schools today have the ability to judge what kind of people we will need to be in the future.
As someone who has gone through tests and been diagnosed with ADD, I think I understand the frustrations, and it definitely does not "feel" normal.
Not being able to hold onto a thought for more than 3 minutes, or having to deal with potentially being distracted by every little thing that happens around me does not feel like the normal state of affairs. Trivial tasks can take me hours instead of minutes in some situations.
Unfortunately I'm currently in a country that doesn't allow me to get medication for this (and previously I was in a country that believes that ADD/ADHD magically disappears when you turn 18), but I still have good memories of how much it helped me get through middle school and high school (I went from almost never finishing my math homework to being able to finish everything in class in only half the allotted time).
For sure - there is a wide variety of human experience, and each of us understands our own. By understanding ADHD, I was talking about the causes and the nature, not the experience.
If drugs are the only way someone like you can lead a happy life, then you should be able to use them.
What effort is being made to determine whether the etiology of ADHD is primarily biochemical (chemical/genetic), or primarily psychological (environmental/human-interaction)? Drugging to counteract ADHD symptoms makes sense only if it's the former.
So given that ADHD is, in actual fact, a neurobiological diagnosis, not a psychological diagnosis, then I guess you're stating your support for treating it with drugs?
Neurobiological sounds like psychological to me. Unless you're saying doctors are measuring things like dopamine activity or doing brain MRIs to diagnose ADHD.
There's no good evidence that ADHD is not the result of psychological conditioning. For that matter, even if you measured abnormal neurotransmitter activity or brain scans in suspected ADHD patients before diagnosing them, if you looked at animal psychology studies where pathological behavior has been induced by conditioning, I'd be surprised if there weren't abnormal brain scans and neurotransmitter activity there, too. The neurochemical/neurophysical measurements that might provide "evidence" of a non-psychological etiology are invalid if those physical aspects of the brain are themselves affected/modulated by neurological conditioning/development.
If your solution to any problematic "neurobiological" symptom that responds well to a certain drug is to prescribe that drug, because if it responds to a drug it must be a chemical/genetic problem, then everyone will be on a drug eventually. Probably several.
These are easy problems for you to solve on your own, but since you don't feel like it I'll give it a shot.
1) You don't need to speculate what neurobiological means using phonetics, it's a real word with a definition you can just look up if your actual interest is in the facts. Neurobiological actually means related to the nervous system of the body. ALS is also neurobiological, and I'm guessing you wouldn't say it "sounds" psychological.
2)If you'd bothered to look, you'd find there is actually quite a bit of study of D2 and D4 availability correlated with ADHD symptoms. Like virtually all medical diagnoses both psychological and physiological, differential diagnosis is done by combining probabilities with presented symptoms, and not with exhaustive testing. Your requirement of diagnosing ADHD with a brain MRI is the equivalent of requiring endoscopy to diagnose an ulcer.
So what you say is factually incorrect, there's plenty of evidence. That's why the scientific body of many countries including the US has classified it as neurobiological (not psychological) for years, and the bulk of the scientific community believes pharmaceutical treatment is necessary in the same way that a broken arm needs to actually be set instead of telling the patient not to be lazy.
If you want to use scare quotes and insist on unfalsifiable assertions "prove the negative 'not' the result of psychological conditioning" then you are placing your argument in the same category as climate change deniers and anti-vaccers - anti-science, anti-rigor, pro-scare quotes.
You haven't addressed the issue. First of all, you need more than a correlation to call a problem 'neurobiological'. All behavioral patterns will have physiological correlates, but that doesn't mean these are the causes.
Secondly, even if you are convinced that these correlates are causal, if you do not actually test for them, then you have to show that the diagnosis method correlates strongly with the biology. I have bothered to look. I can't find such data. Are you saying you have?
The last part of what you are saying seems to be combination of an appeal to authority and affirming the consequent: "Because the scientific community currently recommends pharmaceutical treatment, the problem must have an organic cause."
Having worked closely with psychiatrists, I can assure you that recommending a pharmaceutical treatment is rarely done because they understand the mechanism of action. It is rarely even done because they think the cause is organic rather than environmental. It is done because it is the only effective option available to them.
Psychiatrists don't have the power to change schools or parenting, but they can prescribe drugs which may improve the outcome, and so have a duty to do so. This doesn't mean that the problem is a lack of medication, or even that the cause is biological. It's that doctors can't change the environment.
Consider PTSD - which can be treated using drugs and therapy, and clearly has neurobiological correlates. The cause is war and violence, not the lack of drugs.
The literature on depression (last I looked, which was a while ago) suggests that drugs and therapy, separately, are roughly equally efficacious, with a synergistic benefit in combination.
Your response is vague apologism for irresponsible journalism justified on a minor technicality. The articles is so stupidly charitable to it's own worldview(in the sense of lying) and omitting so much from the other side that it is ridiculous.
You are wrong to think that these people deserve "serious consideration", when the article is written itself to produce knee-jerk reactions "The drugging of the american boy....", as if we had IV Heroin plugged to these kids. Article allows for the opposition, most people who have random opinions about ADHD for no apparent reason other than to have an opinion.
http://www.ncbi.nlm.nih.gov/pubmed/23382575 (Is ADHD a Risk Factor for High School Dropout? A Controlled Study.)
tells us that " Conclusion: Participants with ADHD were significantly more likely to repeat a grade"
Do you know the cost of high school drop outs or grade repeats to society? What about to the kid, who suffers massive self-esteem loss and under-values himself? Why is the author not more responsible? The modern era brings us new journalism-contrarian-chic, stylstic articles that irresponsibly lend fuel to very harmful world-views(such asADHD is not serious)
What drugs, exactly, and to which boy? Is the cost of not-treating much greater than the cost of treating? The article is merely an appeal to pop-trash trendy world-views, and does not deserve much of a response at all
You're right, as long as we fix the schools and the parents. Of which the majority have little scientific background, will use vague inprecise heuristics such as you are not disciplined enough, as opposed to the much easier solution of providing drugs so that these kids not crash their vehicles.
Irresponsible apologism over and over while not demanding the same from the author. Anti-medication pop-trash.
As I've stated before, either ADHD is real, or psychologists have found the world's best predictive test for auto accidents.
People with untreated ADHD have 3x the likelihood of being in an auto accident. 56% rate of substance abuse. Think about that for a moment.
56%. Holy shit.
These are the people who instead of getting help, were told that they are "lazy" and "needed to get up off their asses." Except that advice didn't work, what it does lead to is depression and dependency issues.
Oh then there is the fact that there are large structural brain differences.
I won't disagree that ADHD is over-diagnosed at times. I am horrified with how easily some people get an ADHD diagnosis, your general MD should not be making that call. There are multitudes of proper psychological tests for ADHD that should be chosen from, a 30 minute patient interview should not be the sole determining factor.
When you say it is a "fact that there are large structural brain differences", which differences did you mean? I may be focusing on the wrong thing. What I've found (brain size) doesn't have a clear enough difference to be used as part of diagnosis.
For example, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859218/ notes that head circumference and cross-sectional MRI measurements of brain size show that children diagnosed with autism have (on average) a larger brain size.
However, looking at the charts (for a head circumference chart, see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3869044/ ), while the data may be statistically significant, there's no clear separation between those diagnosed with autism and those with no indication of autism. Many of those with autism have a size smaller than the average of those without, and many of those without autism have a size larger than those with.
This means that head size or simple cross-sectional MRIs can't be used as a reliable diagnostic test.
Not the entire brain, just the portions that deal with self control! This is actually where the "Hyperactive" part of ADHD comes from, normally the parts of the brain that control motor skills and the parts that allow for self control grow in tandem, for children with ADHD, their motor skills outpace their self control. Their executive functioning eventually catches up, thus the myth of "children grow out of ADHD" came to be, since the "H" disappears, unfortunately the rest of the problems remain.
They appear to be about the same research program. They share the same author, Philip Shaw. From the first "We measured the thickness of the cortex across thousands of points in the brain in .. (466) children - half of whom had ADHD and half of whom did not" and from the second "They recruited 234 children with ADHD and 231 typically developing children ... they were able to map the trajectories of surface area development at over 80,000 points across the brain."
Even though they appear to be different efforts (the number of children involved are different and the years are different), there might still be some spurious correlations solely because the same people, with the same expectations and analysis technique, are involved.
Unfortunately, I am unable to read the primary literature. The first links to a paywalled journal article ($31.50), the second doesn't have a journal citation. I found http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342014/ by the same author, and published a couple of months after the article in the first link. Unfortunately, which it says there are distinguishable features, along with two reference comparisons, it doesn't give enough information to judge if those differences are truly diagnostic.
I did find http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440402/ which comments "The ADHD diagnosis rests only on these symptoms because no biological markers (e.g. genetic tests, brain imaging) have been validated [11]", but that reference [11] is from 2006, and older than the two links you gave.
A 2007 metaanalysis (so again, older than the two references you gave) at http://www.ncbi.nlm.nih.gov/pubmed/16950217 points out that at that time "Although there are many structural neuroimaging studies of attention-deficit/hyperactivity disorder (ADHD) in children, there are inconsistencies across studies and no consensus regarding which brain regions show the most robust area or volumetric reductions relative to control subjects."
To highlight the intent behind those last two previous paragraph, they are saying that there are many studies like the ones you pointed out, which show a correlation between some physical measurement and ADHD. Unfortunately, they don't seem to be consistent. Because of the well-known publication bias problem, it's likely that false positives are over-reported. It takes additional followup work to determine if those signals are really true, and if they are distinguishable enough to be used diagnostically.
This all tells me that there is no "large structural brain difference", and especially not one which has been validated as a diagnostic tool. There might be a small structural brain difference, but again, I find no evidence that identification of this difference is available as a diagnostic tool at all, even if the price were disregarded.
Again, I might be focusing on the wrong thing, but perhaps you may be misinformed? If most of your research is through the popular literature, then my earlier reference to http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440402/ ("Why Most Biomedical Findings Echoed by Newspapers Turn Out to be False: The Case of Attention Deficit Hyperactivity Disorder") may be useful:
> Because newspapers preferentially echo initial ADHD findings appearing in prominent journals, they report on uncertain findings that are often refuted or attenuated by subsequent studies. If this media reporting bias generalizes to health sciences, it represents a major cause of distortion in health science communication.
One key source of confusion when reading about ADHD is that researchers on the cutting edge of ADHD have pretty much concluded that there are multiple types of "ADHD" and that the label is overused. Unfortunately no one can agree on a proper labels to use instead...
What this means is that you get a lot of studies that have conclusions such as "well this drug worked for 70% of the test subjects but danged if we know why the other 30% were unresponsive, after all, they have been diagnosed with ADHD!"
If you really want to dive deep, I suggest this talk by Russell Barkley, https://www.youtube.com/watch?v=q3d1SwUXMc0, it does an excellent job of covering why the hell the current literature on ADHD is such a mess.
He also provides lots of compelling evidence for ADHD, but also discusses various symptom (and treatment!) clusters that defy explanation if you think of just "ADHD". There is also discussion different causes of ADHD, suffice to say the symptom rate for children born to mothers who drink during pregnancy is, to say the least, way above the norm, with ADHD in those cases being co-morbid with other disorders[0]. Finally there is some slides about genetics as well.
On a related note, it is funny, the term ADHD-PI is being used by some people to basically describe an entirely different disorder with a completely different treatment mechanism. Stimulants do nothing, but there are treatment programs that do help. On ADHD support forums, those of us who are regular contributors try to do our best to educate ourselves about ways to help people who both have "ADHD" and also "ADHD-PI".
As for the entire "ADHD isn't real" crowd, well, those of us who have it get rather pissed off. I have been reduced to tears because I wanted to do something with every fiber of my being but was unable to focus on it for more than seconds at a time.
Even with a well tweaked treatment regimen, ADHD is still a daily struggle. It is a literal fight to maintain control of myself, from pushing back against a constant all consuming addiction to anything that resembles a dopamine reward cycle[1] to having a reserve of will power[2] that resembles a water pump sitting out in the dry desert heat.
One thing people without ADHD don't realize is that for those with ADHD, the drugs work very differently. Someone without ADHD can take ADHD stimulants and stay up for 2 days straight and have razor focus. Someone with ADHD who takes the same meds, well, going back to my previous metaphor, it is like priming the pump, even with drugs it still takes a slew of self control techniques learned through years of therapy to maintain control over my life.
To live my daily life, I carry an organizer around wherever I go that I write everything down in. I then have calendar events for everything I need to do. On top of that I have my life carefully arranged such that everything I need to do is within instant quick reach, because if I have to spend even a modicum of effort to achieve what I want to do, I will get distracted on my way and forget what the hell I am after.
Thankfully little details help establish some sort of normality. My keys, wallet, laptop, badge, glasses, notebook, all sit next to each other stacked in a nice pile that I can put into/on my pockets/back/face within seconds. If I get interrupted, I will forget one of those.
Side effects of this? I pretty much have to live close to work because I'll forget my laptop at home roughly 60% of the time. (I don't carry my laptop home every day so I do not have the same years of routine built up that allow me to remember the other things I need.)
Heck yesterday I went to a friend's house to make waffles and I forgot the bloody waffle mix. (Sorta the one thing required to make waffles.)
Any one set of these symptoms in of itself is not unusual. Some people have a poor memory, meh. Some people are easily distracted, sure. But when a cluster of symptoms all comes together and has a serious negative impact on the quality of someone's life, then there is a real problem that needs investigation and help.
I guess what it comes down to is, I've both struggled with ADHD myself, and seen undiagnosed, untreated, ADHD completely destroy people's lives.
Finally, there are a variety of diagnostic criteria that can be used for testing ADHD. A full suite of psychological evaluation tests will include sections on attention and focus. People with ADHD will basically fail bomb those parts of the test. (Said tests tend to take multiple days and cost thousands of dollars to administer...)
[0]ADHD's co-morbidity with bi-polar disorder is tragically high. Thankfully this is a topic which has recently gotten a lot more awareness in the medical community, so patients are finally being properly diagnosed. Of course there is a huge stigma around bi-polar disorder, much more so than ADHD, so a lot of people who are willing to admit that they have ADHD may very well turn away or refuse to believe a diagnose of bi-polar. This typically doesn't end well...
[1]I avoid MMOs and mobile gaming like the plague. I've gotten almost addicted to MMOs a couple of times, thankfully both times I was able to write a bot to play for me and then lost interest.
Really though, I'm only focusing on your statement that there is are "large structural brain differences" in people with ADHD. I do not believe you are correct. I find no evidence for that in the primary literature, and what I've found basically says that any structural differences, if it does exist, must be small. Your responses also suggest that you haven't read the primary literature, nor understand the difficulties in interpreting the primary literature. (Which is entirely reasonable - it's not an easy skill to learn.)
As I pointed out in my earlier response, science journalism does a poor job of communicating science. Even the primary journals are subject to publication bias and other factors, which has lead to articles like "Why Most Published Research Findings Are False" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/ . If your information comes primarily filtered through science journalism and an occasional primary reference, then you may have an overly skewed view of the research results.
Based in what you've just written, you confirm by implication that there aren't large brain differences. If there were large differences, then ADHD would have a well characterized physical diagnosis. As you point out, it doesn't. It depends on psychological tests. You mention those tests take "multiple days and cost thousands of dollars to administer." But NMR or MRI scans do not take that much time nor cost that much, and would pick out "large structural brain differences", which tells me that there are no large structural brain differences that can be used as a diagnostic test for ADHD.
Then you mention 'the entire "ADHD isn't real" crowd'. I empathize with your frustrations, but that is a different topic. I am not a member of that crowd, nor was the primary reference which started this HN discussion saying that ADHD isn't real. Its argument is that ADHD is very likely overdiagnosed:
> Only one significant study has ever been done to try to determine how many kids have been misdiagnosed with ADHD, and it was done more than twenty years ago. It was led by Peter Jensen, now the vice-chair for psychiatry and psychology research at the Mayo Clinic, but at the time a researcher for the National Institute of Mental Health. After a study of 1,285 children, Jensen estimated that even way back then—...—between 20 and 25 percent were misdiagnosed. They had been told they had the disorder when in fact they did not.
It agrees with your statement that there are "variety of diagnostic criteria", and emphatically agrees with your earlier statement that "a 30 minute patient interview should not be the sole determining factor." It's horrible if someone isn't diagnosed as ADHD who would do better under ADHD treatment. It point is that it's also horrible if someone is misdiagnosed as ADHD and gets ADHD treatment even if it that treatment doesn't help, likely makes things worse by not getting the right treatment.
> Published rates of comorbidity between pediatric bipolar disorder (PBD) and attention-deficit/hyperactivity disorder (ADHD) have been higher than would be expected if they were independent conditions, but also dramatically different across different studies. This review examines processes that could artificially create the appearance of comorbidity or substantially bias estimates of the ADHD-BPD comorbidity rate ...
(The point is that if there are dramatically different results, then that may be because of artificial biases, rather than real ones.)
> "Of 707 children, 538 had ADHD, 162 had BPSD, 117 had both ADHD and BPSD, and 124 had neither. Comorbidity (16.5%) was slightly less than expected by chance (17.5%). ... The high rate of BPSD in ADHD reported by some authors may be better explained as a high rate of both disorders in child outpatient settings rather than ADHD being a risk factor for BPSD." (italics are mine)
The limited search I did of the primary literature does not seem to give the same conclusion as what you have stated. While I don't know the literature, nor the field, I will be so bold as to suggest that things you believe to be true about ADHD are actually not so well understood as you believe them to be.
> The limited search I did of the primary literature does not seem to give the same conclusion as what you have stated. While I don't know the literature, nor the field, I will be so bold as to suggest that things you believe to be true about ADHD are actually not so well understood as you believe them to be.
Again I'd encourage you to watch the linked to video. ADHD has many subtypes, co-morbidity differs based on subtype. There are some important genetic links as well.
I am asking you to tell me how you came to your conclusions, specifically that:
1) there are "large structural brain differences" between those with and without ADHD, and
2) there is a 'tragically' high co-morbidity between bipolar disorder and ADHD
The literature, as best as I could determine, says that there are no large structural differences, and there isn't a tragically high co-morbidity. I pointed you to relevant research articles which say that. It seems that you are trying to change the topic. My tentative hypothesis is that your knowledge of ADHD helps you cope with the disease, and you don't want to evaluate the possibility that some of your knowledge may be incorrect.
Rather than point to research which confirms you point (2), you now say that there are "many subtypes, co-morbidity differs based on subtype." That's a perfectly reasonable argument, but it's a different argument than your previous one. You previously wrote "ADHD's co-morbidity with bi-polar disorder is tragically high" not "co-morbitity between some subtypes of ADHD and bi-polar disorder is tragically high."
That's okay - this is HN, not peer-reviewed literature and I don't expect you do put in all of the details when you first write something. My question is only, how do you know that what you wrote is true?
You pointed me to a video. I stopped after 23 minutes into it because it was low-information content and I didn't like the speaker's style. There are no links to the primary research, no qualifiers or evidence as to the certainty of the speaker's statements, and some terms used (like "psychopathy" at 18:03) have no basis in the DSM and are only used for general public lectures. This sounded very much like someone who has a specific model of ADHD and is looking for evidence which confirms that model, rather than for evidence which break the model.
As an example, 20:45 ("just a milder variant of the combined type") combined with the further ("it's simply a group where parents confuse oppositional behavior with ADHD"). This is odd because ADHD is not diagnosed by the parents. In addition, in his paper at http://www.ncbi.nlm.nih.gov/pubmed/22179974 he uses parental input in his own research uses parental input to design a 3-part model. How does he determine when the parents are "confused" and when they are not?
I had to stop at 23:24 because the presentation was too information-poor to be interesting. I couldn't tell which were his views and which were conclusions drawn from research, and more importantly, I couldn't tell if he understood the difficulties in that research.
For example, he says sluggish cognitive tempo is an ADHD subtype (actually, in http://www.ncbi.nlm.nih.gov/pubmed/24394633 he "conjecture[s] that SCT is probably distinct from ADHD rather than being an ADHD subtype, although there is notable overlap with the ADHD predominantly inattentive and combined presentations." That detail isn't relevant for the rest of this post, but I will point out that it's equivalent to saying that ADHD is likely overdiagnosed.)
Further, at 17:17 he says that identification of co-morbitity is a simple linear test.
This goes back to your point (2) and your modification that there are several subtypes.
Did you read the http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028268/ link I pointed out earlier? It lists 5 different ways to get false co-morbitity. Since you emphasis that "co-morbidity differs based on subtype", I refer specifically to its point (3).
> (3) Over-Splitting: Artificial Subdivision of Syndromes
> There is a long and fruitful debate between “lumpers” who favor diagnostic parsimony versus “splitters” who prefer carefully nuanced clinical description. Over-splitting would create a falsely inflated rate of comorbidity by treating multiple components of the same larger diagnostic entity as separate conditions that frequently co-occur. High rates of comorbidity thus invite questions about whether a nosological system is over-splitting.
In other words, if you add more subtypes then you would expect to see higher co-morbidity even if it were due to over-splitting, and not based on actual subtype differences.
Thus, increased co-morbitity alone can't be used to tell if a subtype exists.
But neither you nor the presenter have provided the evidence that that increased co-morbitity is anything other than a false signal. (I would also like to see evidence of the increased co-morbitity vs. subtype, but am willing to accept your word on it, because that's what I expect.)
> By doing so, psychiatry allowed a “little white lie” to take hold in the public mind, which helped sell drugs and of course made it seem that psychiatry had magic bullets for psychiatric disorders. That is an astonishing betrayal of the trust that the public puts in a medical discipline; we don’t expect to be misled in such a basic way.
Is the speaker misleading me by telling a "little white lie"? I looked at the presenter's research literature. Most deals with adult ADHD, sluggish cognitive tempo, and executive function. Based on the abstracts, I see he prefers "theoretically driven .. approaches" (http://www.ncbi.nlm.nih.gov/pubmed/18295154 ), which fits my idea that prefers to fits things to a model rather than test the validity of the model first. (Models are useful, because they allow you to make predictions. Models are terrible, because they don't fit reality. This is an old debate.)
What I don't see in his research is anything about how there are "large structural brain differences" nor how there is a 'tragically' high co-morbidity between bipolar disorder and ADHD, which are the two statements you said are true about ADHD.
Again I ask that you tell me how you came to your two conclusions, since the literature seems to disagree with you and nothing you've referenced seems to actually address those points.
Brain imaging is not ready for use as a diagnostic tool in ADHD, Shaw said."It is still too early to use neuroanatomical scans for diagnosis," he said. "We had to scan hundreds of children to identify subtle differences. They [the differences] are very real, but they are subtle. So the scan of any one child will not tell you a great deal about whether [he or she has] ADHD or not. Currently, the diagnosis of ADHD remains clinical."
Nobody is saying that ADHD is not a real condition. The article is suggesting a lot of American boys are diagnosed with ADHD when they don't in fact have it. Imagine if 30% of people undergoing chemo for cancer treatment had never even had cancer.
I'd like to see what the rates are compared to other western countries. If its 5% in Canada and 20% in the US it suggests something is wrong
Isn't that what ADHD medication tries to do. If the root cause is a chemical imbalance, then treating is as a behavioural problem is only treating the symptoms.
There is no valid support for the chemical imbalance theory of mental illness. The reasoning is circular - "if chemicals reduce the symptoms, a chemical imbalance must have been the cause"
> BL: In Anatomy of an Epidemic, you also discussed the pseudoscience behind the “chemical imbalance” theories of mental illness—theories that made it easy to sell psychiatric drugs. In the last few years, I’ve noticed establishment psychiatry figures doing some major backpedaling on these chemical imbalance theories. For example, Ronald Pies, editor-in-chief emeritus of the Psychiatric Times stated in 2011, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” ...
> RW: In a sense, Ronald Pies is right. Those psychiatrists who were “well informed” about investigations into the chemical imbalance theory of mental disorders knew it hadn’t really panned out, with such findings dating back to the late 1970s and early 1980s. But why then did we as a society come to believe that mental disorders were due to chemical imbalances, which were then fixed by the drugs? ...
RW then goes on to list a couple of likely reasons.
Instead of just talking about the dangers of a false positive, let's talk about the dangers of false negatives - of ignoring ADHD in children who do actually have it. ADHD is very treatable, but untreated, it can easily lead to other comorbidities that are much more difficult to treat (such as depression)
The most dangerous part of this is that it seems to imply ADHD is over-diagnosed in men (boys), when it's just as possible that ADHD is under-diagnosed in women (girls).
Girls diagnosed with 314.10 (Attention Deficit Disorder, predominantly hyperactive-impulsive) tend to exhibit fewer "traditional" symptoms of hyperactivity than boys with the same diagnosis. This isn't to say that the diagnosis is wrong - it's just that hyperactivity manifests in many ways - physical restlessness, "bouncing off the walls", etc. is only one.
> The interesting thing is I never asked any of these people whether ADHD is real. But their defensiveness is understandable. ADHD isn't strep throat—there's no culture, no test. To find out if you have it, or if your son has it, or if your daughter has it, you just need a human being to say so—a physician or a psychiatrist—and that makes some people skeptical
This describes the entire field of psychiatry. While there are certainly some people who are who would distrust the field, I would be very wary of throwing the baby out with the bathwater.
And of all disorders, ADHD is actually significantly easier to test for systematically than most psychological/psychiatric disorders (such as depression). The main problem is that the tests to do so are very expensive (well into the thousands of dollars), and most insurance plans won't cover it.
> Ned Hallowell once famously said that stimulants were "safer than aspirin," a statement he has since backed off of. ("That's almost a preposterous statement for anyone to say," says Saltarelli.)
So, we have a complete lowbrow dismissal of what is actually a very reasonable statement. In the end, it's impossible to compare any two drugs for safety because there are so many factors that come into play, but to the extent that one can make a pairwise comparison, this is actually a very well-supported statement.
Which article did you read? Not only was there no discussion of the cost of false negatives, there was very little treatment of the actual cost of false positives, just a nebulous assertion that its bad for kids to be on pills.
I would say the point of the article is here is a list of reasons why it might be over-diagnosed, some people on both sides of that, 50% puffed up with human interest pap about the Boy Whisperer
One of the most important questions you can ask your doctor is "what happens if we just do watchful waiting?"
Taking meds, with their potential risk, if they provide no benefit is a bad thing.
While ADHD is real and needs treatment some of the people being medicated either have other diagnoses or they have bad parents. This isn't something that should be passed onto the child ("there is something wrong with you, take these meds") when it is the family that is broken ("I need to learn some better parenting techniques; we need to set firmer boundaries").
For those who don't know Esquire, it's basically a supermarket tabloid-for-men style magazine. It's not a science mag, so for anyone to get too upset about it is, well, just not really smart. [0]
That said, the horrific FUD writing style is insulting. The comments by HN users - I can't even identify with the people here.
Now imagine that he is suffering like this because of a mistake... If you have a son in America, there is an alarming probability that this has happened or will happen to you.
Absolute bullshit. Total and utter crap. That does not happen. I have two ADHD kids and it was (a) my choice to take them to a doctor, (b) my choice of which doctor they went to, and (c) my choice as to whether there was a diagnosis of ADHD. It's farcical for me to read the opening paragraphs of this "article" and its presumption that doctors are evil and really just want to incorrectly diagnose kids. Atrocious.
"The song was written about a friend of the Loeffler brothers, who was misdiagnosed with ADHD, and developed an addiction to Ritalin. As a result, he would often do crazy and odd things, such as drive around aimlessly for hours, determined to hear a specific song on the radio."
ADHD isn't real. It didn't exist in many previous generations. Surely, the behavior of children hasn't changed much over the last few generations so how come this "disease" didn't exist previous to the current couple of generations and how come it still doesn't exist in many places on the planet? Could foreign kids somehow be better? Of course not. As the article points out, this is a ploy by pharmaceutical companies to get children hooked not only on ADHD drugs but on drugs in the future.
What do these kids do when they turn 18? I asked on pediatrician I respected what she does for the children. Does she taper them off? Does she transition them to other doctors? Does she transition them to other medicines? Nope. "That's not my problem," she said. Of course not. In a culture where doctors are not responsible, where making hundreds of dollars an hour is "not enough" to have them actually perform their duties in full, duties such as making a full investigation into their patients' cases, and spending more than 10 or 15 minutes before "diagnosing" them with a condition they do not have and putting them on drugs for essentially the rest of their lives, only in such a culture is ADHD real.
When it comes down to it, it's the responsibility of the parents to keep their kids off drugs. The body doesn't care wether you're snorting amphetamine or Adderall because Adderall is amphetamine. Parents who allow their kids to be "diagnosed" with ADHD and allow them to take drugs are encouraging their children to take drugs. They are unconscionable parents. Any child can make a mistake and start doing drugs, but now we have whole classes of drugs that are encouraged. Some drug abuse and addictions have become ingrained in life. Do you think the children will stop because they've now turned 18? Do you think they'll stop at Ritalin or Adderall when those things stop working? Addiction knows no bounds.
How many more lives will have to be ruined before people realize the psychiatric industry and the doctors pushing these drugs are only doing it for the money, money they do not need? Talk about about scummy drug dealers. Yeah, we're looking at the multi-billion dollar corporations, the "psychiatrists," the DSM writers, and the rest of the doctors who can't even be bothered to spend ten minutes with a patient before deciding on a horrific fate for them. When will people learn that the medical industry cannot be trusted, that the hippocratic oath is bullshit, and they need to be responsible for their own selves and their own children? Those parents allowing their kids to be put on this should be put in jail next to the child murderers they irresponsibly strive to be.
My parents didn't want me on ADHD meds - which is hysterical because my father very obviously has undiagnosed symptoms of ADHD too - so I didn't get any and had to rely solely on behavioral techniques and societal pressure until I picked my own damn therapist. Me at 16 in college with dinky checklists compared to me at 25 right now with the same checklists and Adderall is like night and day.
As much as I love my parents, I occasionally get angry when I think about what could have been compared to what happened because they didn't like the idea of me being on drugs (like I wasn't on other drugs). Not missed opportunities that were impossible to begin with, but a lot of reachable goals and dreams I had that I tried working my ass off towards and it just wasn't happening because I spent just as much time struggling with myself as I did working towards said goals. I'm trying to play catchup still, years later. I suspect there are some goals that I will never be able to do anything about now because there was some age/time component to it.
Speaking of other drugs, there are plenty of them - yes, maybe even "dealt" by "drug dealer" doctors that are actually terrible - that significantly improve quality of life. Drugs are not inherently bad. It's a constant balance of whether or not the tradeoffs are worth it, that's all. Like right now I'm juggling 6-7 different meds and their side effects to fix my bronchitis+asthma right now because I do not want to end up in the ER or worse, dead. Is that so terrible? Am I a drug addict for not wanting to suffer when I have a choice to not suffer? Even if you want to label me as such, what, are you a firm believer in survival of the fittest? Because if we can keep people from suffering and dying, I would do it. Screw that fittest bullshit.
I'd encourage you not to be too hard on your parents when looking back. Very difficult decision to make and it took a lot of guts to buck the system and pressure to medicate; opting instead for behavioral approaches.
Giving a growing brain a psychoactive drug is serious business.
Also, of course, you are looking back with perfect hindsight. What if you'd had a serious adverse event, psychosis, or otherwise negative outcome? No one could have known, and that was a risk your parents had to weigh. In fact, your brain now is different than then. Perhaps your parents helped you to dodge a devastating bullet by withholding psychoactive drugs at a younger age.
Similarly, ergot poisoning used to be called "witchcraft".
Anyone with half a brain should understand that Big Pharma is just trying to cover up the existence of witches. Clearly all this "medical" stuff is bullshit, especially anything that has anything to do with the mind.
Oh, and brain damage from syphilis is another interesting one. Once upon a time we still understood that some people just go crazy with age. Now doctors are trying to spread this bullshit about how a sexually transmitted virus can destroy your brain- just proof that the doctors are being paid of by the Church, I say.
Ok, so ergot poisoning is comparable to `being a child`? I conclude you think of `being a child` and it's symptoms negative but science just haven't caught up to prove that `being a child` is actually a manifestation of some serious shit going on inwards yet, I'm with you.
"Likewise, ADHD used to be called "being a child," and still is in most parts of the world."
I think it's more nuanced than that. Specifically, "being a child" in a very sedentary, physically restrictive world.
Strong, healthy, young males should not be driven in a car to sit at a desk for 8 hours and then driven home to sit in front of a TV. That describes a fair portion of first world male children and it is (obviously) a recipe for pathology.
Watch out for the downvotes bomb, this is real taboo topic these days...
But yeah, I'm with you, I'm yet to find any convincing evidence ADHD exists and I think the consequences of this unscientific+dogma approach is a damn tragedy. All the pain and suffering that it causes, the pressure and agony parents go through because, obviously, they want the best for their child, this is not quantified(I bet the money is though)
I'm curious to what will history say about this.
I was a problem child and it makes me cringe that I could have been put on this kind of shit since young, it's absurd.
People diagnosed with ADHD are three times more likely to be in a car accident. 56& of people diagnosed with adhd who are untreated have substance abuse problems.
Either ADHD is real, or psychologists have found the world's best car insurance filter.
Then there is evidence of structural brain differences,
I've seen multiple adults who grew up in previous generations where ADHD was just "being lazy" who have spent their entire life depressed, knowing that they never lived up to their potential because they quite literally could not focus.
It isn't a lack of willpower, it is a physical lack of ability. The fact that the physical lacking is in a missing neurotransmitter doesn't make it any less real.
A few years ago teachers complained that both my boys were too intense on the playground, 'diagnosed' with ADHD. Docs were eager to prescribe meds to make them conform.
There is something in our society wants to redefine normal behavior as pathology. Maybe to get you hooked and build revenue streams, maybe just to make you more pliable.
Fuck that.
Yes there are legitimate cases. But I've only experienced people who want to mis-apply the meds.
That being said, all the research I've done into it on my own shows that the ability of the system to diagnose ADHD is crap. As in huge numbers of both false positives and false negatives. The over-diagnosis is a huge problem, and it results in not only large numbers of children being prescribed stimulant medication mistakenly, but it causes parents of kids who could benefit from such medication to rightfully have second thoughts when a doctor recommends it.
In particular a lot of those who make ADHD referrals kind of have this mapping of "Problem Kid" => "Likely ADHD" when that doesn't seem to be a particularly good mapping.
There are even significant downsides to kids with ADHD taking stimulant medication, but in that case, it appears that the likely benefit does outweigh the likely harm.
Now that I'm a parent, I also wonder if the increased diagnosis of boys is partly due to the differences in the school system. I see more homework and deskwork at a younger age than when I was a kid, but combined with less of a "boys will be boys" tolerance for destructive behavior than when my dad was a kid. Of course I have no numbers on this, so it may merely be nostalgia thinking that that is the trend.
You've only experienced people who want to mis-apply the meds? What criteria for mis-apply are you using here? "Docs were eager to prescribe meds to make them conform", awkward appeal to malicious agency. It is doubtful that doctors were "Eager to make them conform".
"Something to redefine behavior as pathology... maybe to get you hooked and build revenue streams", ah yes. That's it. Never mind the much higher incident of high school drop out, repeated grades, 1/4th as likely as other kids to pass college, more likely to go to jail, and get in a car crash.
My girlfriend is a psychiatrist and we've had discussions about over medication. One thing she said to me stuck with me and may be of help to you in your current situation. She says stimulants work right away (unlike medication for depression) and she said that if the drugs do work you'll see this within a few days. If they do work then talk with a psychiatrist about long term plans and long term health affects of the medication.
The teachers are not professionals and their opinions do not constitute a diagnosis.
The only purpose for pharmaceuticals as a solution to this problem is to establish a viable industry. These drugs are not ever a solution - if they were, you could grow them in your own home. As it is, however, you have to join the right club, sign up with the right team, be a member of the right cult - to get your meds every month.
Legalized drugging of culture, is all it is. Utter, literal brainwashing.
(A real solution wouldn't require a prescription.)
