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Why Are ADHD Rates So Much Higher in the U.S.?

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Re: Why Are ADHD Rates So Much Higher in the U.S.?

#31

Post by tdpvb »

viraptor wrote: post #23
tdpvb wrote: post #22

It's high because overdiagnosis. - TED Talk - Recommend one of the most-watched TED Talks of all time, by Sir Ken Robinson. Gems such as, "If you sit kids down, hour after hour, doing low-grade clerical work, don't be surprised if they start to fidget." And, "Children are not, for the most part, suffering from a psychological condition. They're suffering from childhood." - Book - Also check out the book, "The Body Ke…

It's both over and under diagnosed. But you're overplaying some areas like people have no idea what they're doing. For example: > Often fidgets with or taps hands or feet or squirms in seat This is not describing typical kid behaviour, but self-stimulation. They're massively different. There's normally a follow-up discussion about the answers to that basic questionnaire. If you watched that talk, take a moment to fol…

Also, can you please reference some studies that prove ADHD is inherited?

Re: Why Are ADHD Rates So Much Higher in the U.S.?

#32

Post by viraptor »

tdpvb wrote: post #31
viraptor wrote: post #23

Earlier quoted context omitted.

It's both over and under diagnosed. But you're overplaying some areas like people have no idea what they're doing. For example: > Often fidgets with or taps hands or feet or squirms in seat This is not describing typical kid behaviour, but self-stimulation. They're massively different. There's normally a follow-up discussion about the answers to that basic questionnaire. If you watched that talk, take a moment to fol…

Also, can you please reference some studies that prove ADHD is inherited?

https://pmc.ncbi.nlm.nih.gov/articles/PMC6477889/

There's a summary from lots of studies about it.

Re: Why Are ADHD Rates So Much Higher in the U.S.?

#33

Post by viraptor »

tdpvb wrote: post #30
viraptor wrote: post #23

Earlier quoted context omitted.

It's both over and under diagnosed. But you're overplaying some areas like people have no idea what they're doing. For example: > Often fidgets with or taps hands or feet or squirms in seat This is not describing typical kid behaviour, but self-stimulation. They're massively different. There's normally a follow-up discussion about the answers to that basic questionnaire. If you watched that talk, take a moment to fol…

Dr. Barkley's counterargument is essentially "it's preposterous to suggest that ADHD isn't well defined ... because clearly it is well defined," but that's a circular argument -- and still conflates "diagnosis" with "loose pattern of symptoms". He seems to get a bit emotional and take things personally; as if merely questioning the status quo of drugging kids implies that he is a bad person. Though we can't blame ind…

> and still conflates "diagnosis" with "loose pattern of symptoms"

He doesn't, he's really precise about the naming in those cases. For now we don't have a better way to diagnose, but you can follow him review papers which do try to improve the diagnosis. If ADHD is defined in terms of symptoms, the diagnosis has to use those.

> He seems to get a bit emotional

Oh no, someone cares about their field of work being misrepresented. I'm glad it never happens in places like HN ;) You can listen to the arguments and ignore how he feels about the topic.

> Let's be explicitly clear, they're amphetamine salts; we're drugging kids with amphetamine uppers.

First, only one part of available drugs are amphetamines - there are other options. Second, they don't work for them the same as others. I've had the most relaxing naps after stimulants, which is not why others use them. I'm not sure what you're specifically against here - improving kids' lives by giving them meds that others can abuse for fun? Is this just about a moral take? Because we know that medication in ADHD lowers the chance of dying from multiple causes https://pmc.ncbi.nlm.nih.gov/articles/PMC10901868/

> How on earth did humanity survive back when cavepeople had such inadequate access to amphetamines?

Just like we do today. Some people have a bit worse experience with life than others. Is not like ADHD kills you in short term, just lowers the life expectancy.

Re: Why Are ADHD Rates So Much Higher in the U.S.?

#34

Post by tdpvb »

viraptor wrote: post #32
tdpvb wrote: post #31

Earlier quoted context omitted.

Also, can you please reference some studies that prove ADHD is inherited?

https://pmc.ncbi.nlm.nih.gov/articles/PMC6477889/ There's a summary from lots of studies about it.

These studies are correlative but not casually conclusive. As in, yes there are genes that seem correlated with people who exhibit ADHD symptoms, but that doesn't mean the counterfactual is also true: "everybody with these genes will have ADHD, no matter what".

For example, if that were true then the DSM would describe a genetic test for ADHD, not an open-ended dragnet of multiple choice, "cherrypick from these 18+ descriptions of behavior".

Re: Why Are ADHD Rates So Much Higher in the U.S.?

#35

Post by viraptor »

tdpvb wrote: post #34
viraptor wrote: post #32

Earlier quoted context omitted.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6477889/ There's a summary from lots of studies about it.

These studies are correlative but not casually conclusive. As in, yes there are genes that seem correlated with people who exhibit ADHD symptoms, but that doesn't mean the counterfactual is also true: "everybody with these genes will have ADHD, no matter what". For example, if that were true then the DSM would describe a genetic test for ADHD, not an open-ended dragnet of multiple choice, "cherrypick from these 18+ d…

> These studies are correlative

Once you have population studies from millions and include separated/not twin studies to exclude environment differences, you really need strong arguments and theory why the inheritance is not the mechanism here.

> but that doesn't mean the counterfactual is also true: "everybody with these genes will have ADHD, no matter what".

Nobody claimed that. That's not how genes work. That's not how any(?) inheritable disease works. The whole paper is about quantifying the chances. Even the most basic thing like eye colour has a random element to it.

> if that were true then the DSM would describe a genetic test for ADHD

There's no simple mapping and the candidates for complex interactions are in 200+ range the last time I've seen. There's no "you have this one gene, you have ADHD" and nobody claimed that. The work on narrowing down how exactly the candidates interact / get expressed is still ongoing, so hopefully one day we will have a genetic test.

Re: Why Are ADHD Rates So Much Higher in the U.S.?

#36

Post by andrewmcwatters »

viraptor wrote: post #29
andrewmcwatters wrote: post #28

I have a problem with the characterization of ADHD, because it just sounds like... children being children, or maladaptive adults not taking active control of their executive function. I acknowledge that the issues are real, but I suspect like many others that the issues patients have are ones that arise from societal requests and requirements. I think the attempt to formally classify attention deficit disorder is mo…

> children being children Children do not behave like the higher end of the typical diagnosis questionnaire. It may seem like that if you read it the first time, but professionals are expected to know the baseline. This claim is an unhelpful meme at this point. > or maladaptive adults not taking active control of their executive function And that's up to the follow-up chats to figure out if someone has the ability to…

Yeah, well I would know since I was diagnosed with it.

Re: Why Are ADHD Rates So Much Higher in the U.S.?

#37

Post by tdpvb »

viraptor wrote: post #35
tdpvb wrote: post #34

Earlier quoted context omitted.

These studies are correlative but not casually conclusive. As in, yes there are genes that seem correlated with people who exhibit ADHD symptoms, but that doesn't mean the counterfactual is also true: "everybody with these genes will have ADHD, no matter what". For example, if that were true then the DSM would describe a genetic test for ADHD, not an open-ended dragnet of multiple choice, "cherrypick from these 18+ d…

> These studies are correlative Once you have population studies from millions and include separated/not twin studies to exclude environment differences, you really need strong arguments and theory why the inheritance is not the mechanism here. > but that doesn't mean the counterfactual is also true: "everybody with these genes will have ADHD, no matter what". Nobody claimed that. That's not how genes work. That's no…

Right, so then "ADHD genes" are only correlated!

(You'd said, "it's [ADHD] very highly inherited" -- which sounds declaratively causal. But if you didn't mean this as a causal statement, then cool. No worries.)

Re: Why Are ADHD Rates So Much Higher in the U.S.?

#38

Post by tdpvb »

viraptor wrote: post #33
tdpvb wrote: post #30

Earlier quoted context omitted.

Dr. Barkley's counterargument is essentially "it's preposterous to suggest that ADHD isn't well defined ... because clearly it is well defined," but that's a circular argument -- and still conflates "diagnosis" with "loose pattern of symptoms". He seems to get a bit emotional and take things personally; as if merely questioning the status quo of drugging kids implies that he is a bad person. Though we can't blame ind…

> and still conflates "diagnosis" with "loose pattern of symptoms" He doesn't, he's really precise about the naming in those cases. For now we don't have a better way to diagnose, but you can follow him review papers which do try to improve the diagnosis. If ADHD is defined in terms of symptoms, the diagnosis has to use those. > He seems to get a bit emotional Oh no, someone cares about their field of work being misr…

There's definitely a moral aspect / undertone here (similar to many other topics).

I think also, disputes like this suffer from a double red herring of sorts, where folks argue past each other and confuse "whether a solution has efficacy" vs. "is there an alternate solution closer to the root cause that renders the initial problem moot".

In this case, "whether ADHD meds work" is a separate topic vs. "could most ADHD cases just be childhood anxiety, or mitigated with therapy, etc". Or diabetes: "$20B+ industry for insulin to lower blood sugar," vs. "why not just consume less sugar in the first place". Could it be that we're all be so busy trying to find solutions to a problem that itself is optional?

Re: Why Are ADHD Rates So Much Higher in the U.S.?

#39

Post by chrismeller »

Pulcinella wrote: post #2

In comparison to other places in the world (especially Asia), there is somewhat lower stigma regarding ADHD in the U.S. I would add the UK to the stigma list as well. The UK government and NHS are pretty rabidly ADHD-denialist and make it incredibly difficult to get a diagnosis.

I was surprised when I moved to Europe that at least several (many?) EU countries don’t even authorize any ADHD drugs to be prescribed. So sure, maybe the doctor knows you have it, but even if they say you have it… so what, what can they do about it?

As someone with some horrific environmental allergies, I see it as similar. The US has a ton more allergy medications available (both RX or OTC) than any of the other countries I’ve lived in or visited, so of course there are more people who have a diagnosis. In Finland they just stared at me wide-eyed and shook their heads when I asked if they had Sudafed. “Oh no, very strong…”

Re: Why Are ADHD Rates So Much Higher in the U.S.?

#40

Post by viraptor »

tdpvb wrote: post #37
viraptor wrote: post #35

Earlier quoted context omitted.

> These studies are correlative Once you have population studies from millions and include separated/not twin studies to exclude environment differences, you really need strong arguments and theory why the inheritance is not the mechanism here. > but that doesn't mean the counterfactual is also true: "everybody with these genes will have ADHD, no matter what". Nobody claimed that. That's not how genes work. That's no…

Right, so then "ADHD genes" are only correlated! (You'd said, "it's [ADHD] very highly inherited" -- which sounds declaratively causal. But if you didn't mean this as a causal statement, then cool. No worries.)

It depends if you want to be ackshualy technically correct or conversation correct. We won't confirm causality until we flip people's genes to give them ADHD or describe the whole exact interaction at whole-organism level, so practically... never.

On the other hand, for normal purposes, we know it's inheritable. You'd need to discover some whole new mechanism for how diseases could possibly transmit to prove otherwise. There's enough real world data to say this.

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