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Overselling A.D.H.D.

nytimes.com

61–70 of 235 posts

Re: Overselling A.D.H.D.

#61

Earlier quoted context omitted.

I'm far from an expert on this, but I've always thought that the symptoms (inattention and/or impulsivity and hyperactivity) are only maladaptive in modern culture, where young people are expected to spend long hours sitting quietly at attention in school. Is that a disease, or a flaw in modern culture?

The article addresses this issues: One clinician quoted in the book more or less admits defeat: “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

The article briefly mentions the issue then moves on.

But is it true that "it’s too expensive to modify the kid’s environment" or simply that established powers make more money by "modifying the kid"?

Re: Overselling A.D.H.D.

#62
post #15

I challenge someone to provide evidence enough to scare me into stopping. Go ahead, save my life

Meh. So long as you don't graduate to a full blown cocaine or meth addiction, you should be fine for a long while. You'll have cardiovascular issues further down the line if you don't work out and/or smoke. I mean, all stimulants to some degree or another are bad for your heart and blood pressure. Perhaps look into that other brain pill all the kids are taking now, Modafinil. I've been meaning to try some at some poi…

This is the opposite of what I needed to hear, but exactly what I wanted

Re: Overselling A.D.H.D.

#63
Its important to note that in addition to supply-side forces increasing diagnoses, there are demand-side incentives as well.

I don't know how many parents are eager to put their kids on speed, but there are also accommodations provided by schools that they might very much want their kids to have. Like having the option to turn homework in late, or getting extra time on tests. Its worth noting that the option to turn homework in late is probably useless or worse for actual cases of ADHD, since it just moves the consequences of actions even further into the future, for people who have a deficiency in the ability to handle loose feedback systems (as opposed to tight feedback systems where consequences are immediate).

Re: Overselling A.D.H.D.

#64
post #38

I get really skeptical whenever someone uses the term "Big Pharma". 99% of the time the person using it is selling something (hey, look, a $28 book). How dare a pharmaceutical company sell a product? How dare doctors decide to prescribe medicine? While that was slightly melodramatic, here is a quote from the article: Schwarz has no doubt that A.D.H.D. is a valid clinical entity that causes real suffering and deserves…

The quote says: > a wider range of treatment options than an endless litany of stimulants Notice the "than an endless litany of stimulants" part. Saying something like: > so it all boils down to the pharma companies not creating enough drugs for ADHD? afterwards almost seems like you are intentionally misconstruing this. Is it not possible that the author wants "Big Pharma" to spend time researching alternative treat…

A couple of points:

Referring to an industry as "them" is not constructive. Comcast has a horrible reputation for internet service, does that mean we are all a part of "big tech" out to screw the little guy?

Pharma companies will develop drugs that they think they can sell. If it were possible to create a stimulant variant profitably, companies would do so like any other rational actor.

The epipen story is sad, I agree, and it would be nice if it were easier to get a generic onto the market. The money for more drug research has to come from somewhere, though, so more profitability for the industry will have a positive long term affect even if the short term is highly unfortunate for the patients.

Re: Overselling A.D.H.D.

#65
post #22

I'm generally not fond of this sort of article and this one is no exception. They present a case that drug companies like selling drugs but we knew that. What they don't do is present a good case that ADHD is actually overdiagnosed. The world in general is not very good at accepting psychological conditions. ADHD is commonly regarded as "youth", "laziness", or "lacking discipline". Watching a loved one fight to focus…

Yep. Dealt with this my entire life. Teachers, doctors, and counselors suggested I see someone regarding a possible ADD diagnosis all through school as my supposed "brilliance" (their words, not mine) came along with a seemingly unbeatable tendency to zone out in class, constantly talk to other kids when I knew I was supposed to be listening, and flat out forget to do major assignments while I just sort of daydreamed or got sidetracked the moment something else came along.

But my father didn't believe in ADD or at least thought it was overdiagnosed. By god, when he was a kid, there was a name for my behavior and it was lazy, careless, or just plain selfish. So all of those recommendations were ignored.

It took me dropping out of college, going off to work in dead-end, unrewarding and un-challenging jobs while avoiding contact with my folks out of a mixture of shame, resentment, and anger to finally motivate me to see a counselor who eventually referred me to a psychiatrist.

Got put on a mild dosage of stimulant medications, got myself about $15k in loans to enroll at another state university, finished my degree with no lower than a B in any class, and finally got myself into something of a career path. It's been weird because I always felt like I'm 10-15 years behind where I should be but then I remind myself that there is no "should" and I'm thankful that I've improved my quality of life.

Medication (and stimulant medication) isn't a panacea and there are obviously tradeoffs but I think that for a very real subset of people, the avoidance of it out of some misplaced ideas of pill-pushers or lack of "grit" is a real shame that causes some very real problems.

Re: Overselling A.D.H.D.

#66

I was diagnosed ADHD when I was 7 and the doctors put me on Ritalin. This was the early 1970s when very little was known about how to prescribe the drug to children. The doctors put me on a dose of 20mg 3X per day. It almost killed me. I remember having an overdose in 2nd grade (at least now I know that it was a Ritalin overdose). 60mgs of Ritalin is high even for an adult much less a 7yo. The teacher was required to…

This echoes the point made in the article:

> One clinician quoted in the book more or less admits defeat: “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

Re: Overselling A.D.H.D.

#67
post #9

The point about changing the kid instead of the environment is an important one. If attention deficit is defined as a kid having trouble coping with the standard 7-hour school day (more like 9-10 including homework) where he is expected to sit still and work on boring and non-essential worksheets, then the condition isn't over diagnosed at all. And if we're not willing to change that environment--and I don't think we…

> And if we're not willing to change that environment--and I don't think we are--then we should medicate the kids so at least the experience is tolerable and they can have some success with it And as a result traditional response has been amphetamine-salts for children as you say. But I completely disagree that this is something we should do . For one I think we don't have good enough science to know how potentially…

> Kids went to school for 7-hours 50 years ago as well, but ADHD diagnosis have been constantly increasing.

There was much less emphasis on doing well in school back then. Most people didn't go to college and didn't need to get the grades necessary to do so. They could have a solid middle class life without even a high school diploma. Not being "cut out for college" wasn't the end of the world.

Re: Overselling A.D.H.D.

#68
post #38

Earlier quoted context omitted.

The quote says: > a wider range of treatment options than an endless litany of stimulants Notice the "than an endless litany of stimulants" part. Saying something like: > so it all boils down to the pharma companies not creating enough drugs for ADHD? afterwards almost seems like you are intentionally misconstruing this. Is it not possible that the author wants "Big Pharma" to spend time researching alternative treat…

> Is it not possible that the author wants "Big Pharma" to spend time researching alternative treatments Or society to do that; relying on Big Pharma to spend money directly contrary to Big Pharma's interests doesn't seem like it makes a lot of sense.

Whether you consider the opinion right or wrong is beside the point that I was making (that the parent to my post seemed to be "tilting at windmills"). Saying that the author has an inconsistent position of "there are too many drugs" and "there need to be more drugs" seems like a poor reading of that sentence.

Re: Overselling A.D.H.D.

#69
post #53

Earlier quoted context omitted.

But what does "real" mean , exactly? That it's a recognizable pattern of behavior? That doesn't necessarily mean it should be treated as a disease.

Why not? People are suffering and we have safe medications which improve their lives. Not treating ADHD is far more dangerous. People with unmedicated ADHD are more likely to do poorly in school, abuse drugs/alcohol, suffer from depression etc.

I'm sure some people's school grades benefit from taking amphetamine-like drugs, but that still doesn't imply they are suffering from a disease in the first place.

It's far from clear why having the symptoms of ADHD should be considered a disease, in any objective sense. If kids are suffering because school is boring or society is restrictive, that doesn't mean there's something wrong with them.

Re: Overselling A.D.H.D.

#70

I've observed this whole drama unfold first hand. Having been born in the early 80's, I grew up on Ritalin and most of my classmates did too. I actually do have ADHD, but I'm unmedicated for well over 15 years now. This is completely by choice; every time a new doctor sees my medical history they basically ask in a rather pushy manner, "Ya want some pills for this?" I didn't grow out of ADHD, but I have had to learn…

As another who probably sits right on the border of "could use medication, but isn't interested in it after self-management for 20+ years" I really like how you mentioned practical habits that can alleviate the downsides to the symptoms. To-do lists. Taking notes. These can be learned and if they work, to make life more constructive while not really getting into the physiological side.

Honestly I enjoyed having the mind-set to be rough & tumble in the Proposal Coordinator (or Manager/Writer/etc) type role with 2-6 overlapping projects. It is/was almost a natural fit for being kind of hyper & then shutting down at the end of the day (go home to cook, beer, pets). Having multiple projects was plenty of stimulation, and breaking them each into smaller, prioritized To-Do lists with lots of human contact meshed nicely. Stressful at times, sure, Murphy's Laws are like that, but being the relentless, focused type to put all the pieces together for the whole is quite important when the scale increases (e.g. billion dollar construction projects).

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