Overselling A.D.H.D. • Hacker News Board

Re: Overselling A.D.H.D.

#121

Post by cmdrfred » Tue, Aug 23, 2016, 5:50 PM UTC

falcolas wrote: post #116

metaphorm wrote: post #106

Earlier quoted context omitted.

I'm glad amphetamine treatment is effective for you. I hope you can recognize that your situation (an adult, in full control of your own care, with informed consent at all stages) is very very very very very different than putting 6 year olds on ritalin because they're fidgetting at their desk in class. This is really done in America.

No, it's not done that way - there are more factors than "fidgeting in class" that psychiatrists take into account when diagnosing ADHD. And frankly, if they're put on Ritalin and stop fidgeting and start paying attention, then it's probably a valid diagnosis in the first place. People without ADHD would end up fidgeting more, not less, if given amphetamines.

It is done this way and it happened to me. The public school I was attending told my parents in 2nd grade put him on Ritalin or we are going to expel him.

Re: Overselling A.D.H.D.

#122

Post by falcolas » Tue, Aug 23, 2016, 5:51 PM UTC

sevenless wrote: post #50

jordanlev wrote: post #48

Earlier quoted context omitted.

This is a book review, not an article per se. I'd assume the book goes into much more detail. Also, from the review: > Schwarz has no doubt that A.D.H.D. is a valid clinical entity that causes real suffering and deserves real treatment, as he makes clear in the first two sentences of the book: “Attention deficit hyperactivity is real. Don’t let anyone tell you otherwise.” But he believes that those who are disabled b…

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.

So don't call it a disease. Call it a Snuffleupagus. Just don't stop treating patients affected by this particular Snuffleupagus because it doesn't meet your definition of a "disease".

Re: Overselling A.D.H.D.

#123

Post by smelterdemon » Tue, Aug 23, 2016, 5:52 PM UTC

sevenless wrote: post #114

smelterdemon wrote: post #102

Earlier quoted context omitted.

You can make that argument for most if not all mental disorders (cf. Erving Goffman). The fact is that persons with ADHD face significant difficulties functioning in modern society and suffer as a result, which is our best criteria for treating a mental issue as a disease.

Like I said elsewhere - does that mean that being ugly/unattractive is a disease? Or having an awkward personality, or having a low IQ? Or for that matter, being a member of any discriminated-against minority? It seems unjust and coercive to tell people they have a disease and should be medicated simply because society demands it.

Those certainly could result in some mental disorder. An awkward personality and to some degree low IQ could be symptomatic of a mental disorder as well. It's definatly possible to make a convincing case that all mental illness is a manufactured construct [1]. But I don't think you can reasonably say ADHD is not a disease and still believe, say, depression or anxiety disorders are diseases.

[1]https://en.wikipedia.org/wiki/The_Myth_of_Mental_Illness

Re: Overselling A.D.H.D.

#124

Post by sevenless » Tue, Aug 23, 2016, 5:52 PM UTC

falcolas wrote: post #122

sevenless wrote: post #50

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.

So don't call it a disease. Call it a Snuffleupagus. Just don't stop treating patients affected by this particular Snuffleupagus because it doesn't meet your definition of a "disease".

We aren't morally obliged to treat people for things that aren't diseases.

Re: Overselling A.D.H.D.

#125

Post by anexprogrammer » Tue, Aug 23, 2016, 5:53 PM UTC

panglott wrote: post #76

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 o…

We don't yet know how many of those are being overdiagnosed - we don't yet know the limits of the spectrum. There's a lot of opinion on both sides, which is never helpful.

I can say that I wish I had had 30 more years on amphetamines, the difference has been marked. For the first time in my life the engine wasn't misfiring. If it were certain to take a decade or more of my remaining life, I'd continue fully aware. I still drift, but I think that's more because I have the habits. For me it'll still be a lifelong process to try and correct the bad habits and thought patterns reinforced throughout the first half of my life. Others will be less clear beneficiaries of treatment or better served in other ways.

I think diagnosing and treating toddlers and 7 year olds is appalling - better to try and manage it, or look into causative factors like poor home environment and such. A more Scandinavian approach to school may help more (The UK would benefit from this too). A good proportion will grow out of it. That comes back to wider real awareness though especially with first contact - teachers and GPs etc.

Re: Overselling A.D.H.D.

#126

Post by jrapdx3 » Tue, Aug 23, 2016, 5:54 PM UTC

panglott wrote: post #76

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 o…

Some of these questions have been studied. When the same criteria are used, prevalence is comparable in Germany, Brazil and other locations. The recognition of the condition is affected by cultural factors but that's true for many conditions.

ADHD by definition is a condition that originates in childhood and persists into adulthood in about 1/2 or more of cases. In adults ADHD is indeed a chronic condition that often responds to amphetamine or methylphenidate treatment. At therapeutic doses, long-term treatment with such agents is generally well-tolerated, but careful monitoring is necessary to assure medication use remains effective and tolerable.

Interestingly, amphetamine has been used for this purpose for nearly 80 years, and methylphenidate for >50 years. Despite the several decades these agents have been employed, nothing more effective has yet been developed.

As I pointed out in my other comment, among adults anyway, the issue is that ADHD is vastly undertreated to the severe detriment of individuals, their families, communities and nation as a whole.

Re: Overselling A.D.H.D.

#127

Post by leereeves » Tue, Aug 23, 2016, 5:55 PM UTC

engx wrote: post #120

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…

Why do people on meth enjoy cleaning? There is little difference between meth and Adderall. Taking any type of stimulant even coffee helps people do menial tasks and be more optimistic while doing them. Maybe millions of people are effected by some problem of distraction and lack of focus. But to suggest there's some biochemical reason for this that's cured by amphetamines seems like pseudoscience to me. Drugs do wor…

> But to suggest that it's a disease seems disingenuous.

That allows (at least) two things: pressuring insurance companies to pay for treatment, and pressuring students to undergo treatment.

Re: Overselling A.D.H.D.

#128

Post by barrkel » Tue, Aug 23, 2016, 5:56 PM UTC

You're amazingly invested in this topic for an account with so few historical comments. I counted 11 comments on this topic out of 20 comments total.

I'm not saying you're a shill, but it's suspicious.

Re: Overselling A.D.H.D.

#129

Post by dang » Tue, Aug 23, 2016, 5:56 PM UTC

scottmf wrote: post #112

>Psychiatrists are not that much different from witch doctors I wish you had said this several comments ago. We have nothing to discuss here.

I agree that that was an inflammatory statement that went over the top, but please keep internet tropes of rudeness off HN. They send bad signals into the community.

We detached this comment from https://news.ycombinator.com/item?id=12345614 and marked it off-topic.

Re: Overselling A.D.H.D.

#130

Post by ryandvm » Tue, Aug 23, 2016, 5:59 PM UTC

jrapdx3 wrote: post #86

Since I've had the responsibility of managing the treatment of at least a thousand adults and adolescents with ADHD, it's a subject I've studied quite a bit. And as the medical literature attests ADHD is probably among the most researched of all medical conditions and its reality is unquestioned based on the scientific literature. When people say "I don't believe in ADHD" I point out it's not like believing in Santa…

When people say "I don't believe in ADHD", they're not saying that the symptoms don't exist, they're just rejecting the premise that a large percentage of the population is disabled by it.

As someone diagnosed with ADHD and who occasionally takes Adderall for it, I certainly empathize with this viewpoint. I love the way my brain works both on and off medication. I feel like my ADHD gives me a creative swiftness that evades most people. However, there are indeed times when I need to buckle down and focus one aspect of something for an extended amount of time and that's where the Adderall comes in.

Like introversion or any other number of tendencies, I think of ADHD as a dimension of personality rather than a disability. Do I consider myself disabled by it? No. But I can certainly appreciate that our academic system disadvantages those with the condition to the point that it appears to be a disability.

And yes, I am aware that some people have ADHD to such an extent that they are functionally disabled by it. I just don't think it's everyone that is diagnosed.