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Overselling A.D.H.D.

nytimes.com

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Re: Overselling A.D.H.D.

#221

Post by panglott »

jrapdx3 wrote: post #190
panglott wrote: post #167

Earlier quoted context omitted.

> ADHD by definition is a condition that originates in childhood and persists into adulthood in about 1/2 or more of cases. Right, and all of this is a question about under what conditions it persists or fails to persist. Does ADHD medication, relative to say behavioral therapy or nontreatment/nonintervention, make it more or less likely that ADHD will persist in adulthood? This is a very important question of those…

Very important questions indeed, while there's no complete answer some data is encouraging. Imaging studies, for example, have shown children treated continuously to early adulthood show more robust brain development (white fiber tracts) vs. untreated subjects. Medication treatment is certainly not harmful in that respect and probably helpful. The role of behavioral therapies is unclear, though practitioners point to…

Thanks for the great response, btw.

Re: Overselling A.D.H.D.

#222

Post by scottmf »

forgotpwtomain wrote: post #131
scottmf wrote: post #117

Earlier quoted context omitted.

We have real data which heavily backs the case for medicating. You have emotion and conjecture. >Non-industry funded long term study (30+ years) citation needed. What do you want? You're suggesting all these studies are funded by pharma cos and the scientists are falsifying data? If you're not going to believe any of the data and stick to your own emotions on the subject there's no point discussing this. Until you ha…

> We have real data which heavily backs the case for medicating. > You have emotion and conjecture. No, I asked for you to provide a reference to a credible study, you have failed to do so. There is no need or place for ad-hominem attacks here. Who is 'we' btw? > You're suggesting all these studies are funded by pharma cos and the scientists are falsifying data? What I wrote explicitly was: >>> if the research doesn'…

Of course it has.

http://www.europeanneuropsychopharmacology.com/article/S0924...

Re: Overselling A.D.H.D.

#223

Post by falcolas »

thwarted wrote: post #211
falcolas wrote: post #178

Earlier quoted context omitted.

> this is medicating for "normality" No, it really isn't. There's nothing normal about having ADHD. It's debilitating: it makes it very hard to hold a job. It makes it nearly impossible to plan for the future. Imagine having a horn blowing in your ear at a random interval between a second and an hour, completely disrupting your train of thought, as if you just did a complete mental context switch. How big of a mental…

This description is right out of Vonnegut's Harrison Bergeron, written in the context of opposite effect of handicapping those of extreme skill/means rather than the debilitating effect of those trying to live a "normal" life. https://en.wikipedia.org/wiki/Harrison_Bergeron

Yes, it is. However the effects of the sounds on cognition as described in that short story are remarkably spot on for how ADHD affects my ability to concentrate and think.

He even got the ability to "ignore the sound" down pat - it can be done if something novel really grabs hold of your attention... and that it doesn't last.

Re: Overselling A.D.H.D.

#224

Post by saosebastiao »

dang wrote: post #212
saosebastiao wrote: post #138

I'm really glad that there is a bar for psychiatric expertise that ignoramuses like you are in no danger of passing.

That's seriously out of line. Personal attacks are not allowed on Hacker News, regardless of how wrong someone is. We ban accounts that do this, so please don't do it. Instead, please re-read the following, and post civilly and substantively, or not at all, from now on: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newswelcome.html We detached this subthread from https://news.ycombinat…

You should seriously reconsider whether sevenless was merely wrong or if he was attacking a massive group of people with completely baseless but very offensive claims, that were intended to provoke a response.

How would you respond if he claimed that Muscular Distrophy wasn't real, that doctors have made up their condition to make money, and sufferers just need to get over their awkwardness and work out more? Or if black people don't actually experience racism, that it's all in their heads, that human rights activists are just money grabbers, and they just need to work harder? Is that just being wrong? Or is that an attack on an entire group of people, intended to provoke?

I should have kept my calm. I'm sorry for acting out. But ADHD is a thoroughly researched serious executive function disorder that causes drastically higher incidences of violent crime, homelessness, joblessness, divorce, and severely diminished earnings potential compared to the average person. When you tell someone that has been a homeless and jobless college dropout, who with treatment has graduated college and gone on to support a family and hold down demanding jobs in the tech industry, that they are just imagining things, they tend to attack back.

Re: Overselling A.D.H.D.

#225

Post by PhasmaFelis »

angry-hacker wrote: post #206
PhasmaFelis wrote: post #137

Earlier quoted context omitted.

Imagine this: you're an adult professional, sitting at your desk looking at a freelance work assignment that needs to be done by tomorrow, weeping with frustration because you've been staring at it for eight solid hours, trying and trying to begin, and you can't because focusing on anything important is like trying to grip a handful of water. Because you ran out of your meds. This is what my life is like. If that doe…

Sounds more like detox. I'm regular drug addict and know the feeling.

"Detox" doesn't start before you ever take the drug, and continue long after you stop. Might as well say that diabetes is just insulin detox.

Re: Overselling A.D.H.D.

#226

Post by joshuak »

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…

This is FUD.

ADHD is well researched, and well understood by those who study it. The problem is that people think ADHD is just an issue of self discipline or attentiveness. It is not. It is a serious disorder with serious effects that are unambiguous. No doubt there are stimulant seeking people who claim to have ADHD to get stimulants, and people without ADHD representing that they have ADHD may lead to the impression that the disorder is ambiguous when it isn't. Also if someone has ADHD for long periods of time they may have co-mobidity with other disorders such as depression, etc. and this also may muddy perceptions.

ADHD is not strictly an attention issue. It's named for attention because that is an early and obvious symptom but it is much worse then that. Calling the disorder an attention deficit disorder has turned out to be very bad as it leads people to the wrong mental model of the disorder. Thinking that it's just laziness on the part of the patent or the patents parents, in the case of children. This is a tragically misguided perception, based in ignorance and the poor choice of names.

In actuality ADHD is a developmental disorder that is a more general impairment of executive function that includes regulation of emotion, working memory and the internal perception of time and other effects in addition to inattentiveness. This impairment is due to abnormal dopamine transport that can be clearly observed in MRI studies.

These studies have been repeated many times in many contexts, with various controls, and been thoroughly confirmed.

Also, you are wrong about Adderall. There is a significant difference between meth and Adderall. Stimulants are by for the best understood, most tested, longest used, and lowest risk medications in psychotherapy. Only a few stimulants show clinical improvement in the function of people with ADHD, and the improvement can be profound. Caffeine for example does not show these clinical improvements.

So basically you know jack shit about this topic, and therefore should keep quite, just like any other medical condition you know nothing about. It actually causes harm by interfering with the dissemination of reliable information in the study and treatment of a very serious disorder.

For better (read: actual) information start here:

Here: https://youtu.be/GR1IZJXc6d8

Or for a more complete talk:

Here: https://youtu.be/SCAGc-rkIfo

Re: Overselling A.D.H.D.

#227

Post by joshuak »

hellofunk wrote: post #3

I've always been skeptical of ADHD diagnoses, thinking that it was widely over-diagnosed and a problem in American culture more than anything, and not as commonplace in reality. My googling took me to this article which suggests I am wrong: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525089/

These are very old studies. It is now known that ADHD is a genetic disorder. In fact it has unusually high correlation. It is absolutely not caused by environmental factors. Though there is one virus (that I'm aware of) that may cause it.

It is not only an issue of attentiveness, but ranter all executive functions. The poor naming of the disorder, and the observability of a persons focus, causes people to over emphasize the inattentiveness symptom.

If you are interested in understanding the reality of ADHD I'd suggest watching some of the talks by Dr. Russel Barkely.

Here: https://youtu.be/GR1IZJXc6d8

For a more complete talk:

Here: https://youtu.be/SCAGc-rkIfo

Re: Overselling A.D.H.D.

#228

Post by dang »

saosebastiao wrote: post #224
dang wrote: post #212

Earlier quoted context omitted.

That's seriously out of line. Personal attacks are not allowed on Hacker News, regardless of how wrong someone is. We ban accounts that do this, so please don't do it. Instead, please re-read the following, and post civilly and substantively, or not at all, from now on: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newswelcome.html We detached this subthread from https://news.ycombinat…

You should seriously reconsider whether sevenless was merely wrong or if he was attacking a massive group of people with completely baseless but very offensive claims, that were intended to provoke a response. How would you respond if he claimed that Muscular Distrophy wasn't real, that doctors have made up their condition to make money, and sufferers just need to get over their awkwardness and work out more? Or if b…

I hear you. One way of de-escalating arguments is for people to speak from/about their concrete experiences, like you implicitly did in the last paragraph here. People who disagree strongly seem to find it easier to engage one another through that channel than by arguing in the abstract. Often, one finds that the other person's position is grounded in experiences of their own, even though they may have drawn incorrect conclusions from those experiences. That makes conversation easier.

Conversely, arguments in the abstract that are fueled by emotion coming from personal experience tend to get stuck, and nobody much enjoys them.

Re: Overselling A.D.H.D.

#229

Post by ergothus »

sevenless wrote: post #166
ergothus wrote: post #155

Earlier quoted context omitted.

I have no diagnosis of ADD/ADHD. I have recently, however, started to wonder. I'm an adult (39), and recently things that have just always been true for me are getting more rigid and interfering with my life. Things like: I need an exact amount of input: too little and I get bored/distracted, too much and I can't focus and get irritable. This has a huge impact on my ability to do work, to socialize with friends, or e…

Shorn of all pretense you're essentially wondering if you'd benefit from or enjoy taking drugs. This is quite possible. People take drugs for all kinds of reasons. What I object to is calling this a disease .

Let's take that back a step.

If we're talking about "disease" in the sense of "a condition that interferes too much with normal life absent some intervention" and not "caused by bacteria or viruses", then we already have a bunch of subjective terms in there. And I don't think you can get a reasonable definition that DOESN'T have some subjective terms.

Given that we're talking subjective terms, you're stating something like "If you have a condition that makes you suffer more than most others in certain circumstances, and this condition can be treated with pharmaceuticals, I'm fine with that, but I don't want to call that condition a 'disease'." Others might say "drugs can make your life easier, but I don't believe that you actually suffer more than others in those circumstances, you just don't handle that suffering as well". With current technology we have no means to distinguish the two.

And I almost certainly agree with your statement regarding certain circumstances. There are people that have medical conditions that make them overweight - likely including some conditions we've not identified yet. There are also people (such as myself) that just value eating over losing weight. I know of no way to know which is which for most cases, but for situations such as mine I'd not call it a condition or a disease, I'd call it overeating. All of which is to say I think I know where you are coming from.

But I lack the basis to say when other people are suffering more than I do under the same stimuli. I have no way to know if something is a disease/condition unless I've experienced it. Any more than I know if Bill Cosby raped anyone, or if the convicted murderers sentenced this year actually killed anyone.

So I extend some trust in the collective people (while at the same time thinking some large collections of people are idiots, say, politically).

Honest, non-trolling question: On what basis do you have your confidence that this is not a disease/condition?

Re: Overselling A.D.H.D.

#230

Post by kawa »

sevenless wrote: post #172
panglott wrote: post #149

Earlier quoted context omitted.

You're conflating "not medicating" with "not treating", which is exactly the sort of thing that feeds the criticism that U.S. overdiagnosis rates are being driven by the pharmaceutical industry. Behavioral therapy is also effective, and avoids some of the negative impacts of medication. There are studies that compare medicated ADHD patients to untreated ADHD patients over the course of adolescence; but people who are…

To which I'd add, the fact 'ADHD' symptoms are stereotypically behaviors of male children. I don't think it might be a total coincidence that we have a trend of drugged-up little boys for behavior deemed unacceptable, at the same time childrens' education is dominated by women.

Boys are more often diagnosed with ADHD (by a factor of 2 to 3) but that probably because boys simply have a higher base aggression level which is "added" to the ADHD symptoms which makes ADHD in boys easier noticeable than in girls. So girls are probably underdiagnosed because nobody notices their attention deficit symptoms and their hyperactivity is still not annoying enough to send them to a counselor.
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