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Overselling A.D.H.D.

nytimes.com

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Re: Overselling A.D.H.D.

#71

Post by scottmf »

forgotpwtomain wrote: post #19
rayiner wrote: 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…

>we don't have good enough science to know how potentially dangerous or helpful ADHD drugs really are.

We have nearly a century of usage which suggests these drugs are incredibly safe.

We medicate a lot of problems which are caused/worsened by society. We need a solution: Either we fundamentally restructure society, or we medicate.

Since we're not fundamentally restructuring society any time soon, medication is our best option and we have a lot of data suggesting stimulant medications in these doses are pretty damn safe—and certainly outweigh the negatives of not medicating (failing school, abusing drugs, other mental illness).

The real epidemic here is the pejorative use of the word "medication". The distrust of treatment is always based on ignorance and appeals to nature, tradition, etc.

Re: Overselling A.D.H.D.

#72

Post by crack-the-code »

While I do think that ADHD is a real condition, I don't think that the solution is to medicate children with a very serious life changing drug that alters the core aspects of a child's personality and behavior.

The true solution is to revamp our country's education system and provide a framework that can accommodate the wide variety of personalities that come into the classroom. Instead of forcing children to think one way, we should let them think the way they NATURALLY think, and flourish with their native mindset.

I strongly recommend this eye-opening video for those of you who haven't already seen it: https://www.youtube.com/watch?v=zDZFcDGpL4U

Re: Overselling A.D.H.D.

#73

Post by pyre »

chris_va wrote: post #64
pyre wrote: 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…

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 agr…

> The money for more drug research has to come from somewhere, though

The EpiPen has been on the market for awhile. Why the sudden price hike? Were they operating at a loss before?

This does not seem like a case of "we have to recover our costs" and comes across more of a case of "we are a monopoly so fuck you, give us your money."

Re: Overselling A.D.H.D.

#74

Post by soylentcola »

daeken wrote: post #32
forgotpwtomain wrote: post #19

Earlier quoted context omitted.

> 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…

> traditional response has been amphetamine-salts Not exclusively. Methylphenidate (Ritalin and friends) is generally the first-line drug in the US at least, due to milder side effects and a lower potential for abuse.

Always found this odd because at least for me, methylphenidate (and its surprise result of mixing with alcohol, ethylphenidate) made me feel more of a "buzz" or desire to take more compared to the typical amp-salts.

I actually had my doc switch me over because I don't like the idea of any more side effects or anything that might lead me to abuse than absolutely necessary.

I guess a lot is down to individual neurochemistry but I felt that mpd was almost like cocaine whereas the generic Adderall I'm on now just makes me able to focus.

Re: Overselling A.D.H.D.

#75

Post by leereeves »

daeken wrote: post #43
6502nerdface wrote: post #17

Earlier quoted context omitted.

It would be interesting to know if length of school day correlates with diagnosis rate (controlling for confounding covariates), or if, e.g., Montessori schools have fewer diagnoses than public schools (again controlling for confounding covariates like family income, etc.).

Controlling for confounding factors in a study like this would be very close to impossible. Income is one factor, but parental involvement, household stability, discipline methods (I don't have data to support this, but I have a feeling that the average discipline methods differ greatly between Montessori kids and public school kids), and many others come into play. It'd be interesting if someone could pull it off, b…

Another way to approach that might be to see (for example) if students from public school diagnosed with ADHD do better in a Montessori school.

Re: Overselling A.D.H.D.

#76

Post by panglott »

anexprogrammer wrote: post #58

As someone in my 5th decade, with lifelong ADHD (though given my age it did not exist in my youth, and was only diagnosed relatively recently), I'm wary of backing away from treatments until we actually do have real viable alternatives. It took far too long to get ADHD widely recognised, and even now it's often more likely to be received with humour than real recognition. Much more research, especially on other possi…

The thing is, diagnosis rates in the U.S. are something like 3-4 times as high as in most countries in Europe, which are themselves 3-4 times as high as a country like France, which is averse to ADHD diagnoses. The main treatment for ADHD is lifelong maintenance of powerful amphetamines, when we have no idea what the long-term consequences of that would be, nor what proportion of children would normally develop out of the ADHD spectrum with time.

Overdiagnosis at that rate means that millions of children are being given amphetamines, when they shouldn't be!

Re: Overselling A.D.H.D.

#77

Post by chris_va »

pyre wrote: post #68
dragonwriter wrote: post #44

Earlier quoted context omitted.

> 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.

I understand the point you are making, but in reality drugs will get developed based on their likely risk/reward ratio only.

If you want more diversity, unless there is a non-market force (which honestly shouldn't be needed here, there is high demand), pharma companies will just keep picking at the lowest hanging fruit.

Eventually, they'll get up to the non-stimulant variety, but developing an entirely new class of drugs is a Herculean effort with very low likelihood of payoff. To make it work, you need more data on the disease (e.g. more time), and some luck out of academia (which is where 99% of drugs come from anyway). They will also need a lot of money to do it, so anything they can produce in the meantime is essentially on that track. Thus, the wording "even more drugs".

Re: Overselling A.D.H.D.

#78

Post by carlmcqueen »

rayiner wrote: 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…

This comment made me think of Aaron Schwartz's article on schools just being instruments of corporations preparing us to be drones in eight hour jobs. [1]

I don't know where I stand on it, but I found myself realizing I believe it a little more when I read your article of preparing kids to work for 9-10 hours and keep focused.

[1] https://newrepublic.com/article/127317/school

Re: Overselling A.D.H.D.

#79

Post by scottmf »

sevenless wrote: post #69
scottmf wrote: post #53

Earlier quoted context omitted.

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 .

>It's far from clear why having the symptoms of ADHD should be considered a disease, in any objective sense.

We have children facing social rejection, failing/dropping out of school, becoming dependent on drugs, suffering from depression/anxiety and other mental illnesses, committing suicide, etc.

In a perfect world we don't have to change our lives to fit into society at all! Unfortunately, the world isn't perfect. We have an obesity epidemic because people sit in an office working all day. One treatment I'm sure you'll approve of is going to the gym. Unfortunately gyms are pretty unnatural.

Why should obesity be considered a disease in any objective sense? People are suffering because modern life is sedentary. It doesn't mean there's something wrong with them.

—We change our behaviors to make up for the personal problems that come with society. We do unnatural things like go to gyms and take medication to help our bodies (which were made for a world where we live in caves and hunt wild animals) function properly in this society, because we agree its advantages vastly outweigh its disadvantages.

Re: Overselling A.D.H.D.

#80

Post by NovaS1X »

wvenable wrote: post #30
rayiner wrote: 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…

Some children don't just have trouble with sitting at a desk at a 7-hour school day. When your imagine children with ADD/ADHD that's probably what you think because it makes sense that inattention or hyperactivity is most correlated with the times where that would be most detrimental. But most of these children have just as much trouble with a whole day of regular indoor/outdoor play too. Edit: As a parent of special…

From my sample size of one, myself, I was diagnosed with ADHD quite young, as well as tourettes and OCD to add into the mix. I had no problem focusing on school work when it was interesting.

Then again, when is school work ever interesting? I suffered from chronic boredom. It didn't end well for me though. I was rebellious and refused to listen. I'd like to think my obedience issues were worse than my hyperactivity issues.

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