Doctor: ADHD, as currently defined, does not exist • Hacker News Board

Re: Doctor: ADHD, as currently defined, does not exist

#81

Post by zeidrich » Mon, Mar 17, 2014, 8:44 PM UTC

JohnBooty wrote: post #15

This article is so potentially harmful, even if it's more nuanced than the hyperbolic "ADHD Doesn't Exist" title would suggest. The reality is that -- whatever the underlying cause -- a lot of people struggle with attention span issues, and that these issues cause a lot of pain and unfulfilled potential. Even if ADHD medications are overprescribed Band-Aids, people benefit from them. We should try and find better dia…

If ADD/ADHD is a matter of willpower, then maybe that is true, but willpower is a neurological resource. Exercising willpower diminishes that resource, you can see that in studied conditions like decision fatigue.

If some people have too little of this resource to function in a normal capacity, why then should people argue against a drug that helps buoy this resource.

If doctors found a better way to treat the condition, neurogenesis or something, then fine, do that instead. But right now, we're in a position where some people, whether through genetics, traumatic stress, brain damage, or just diverse brain chemistry, don't function as well as others. We also have medication that can keep that "willpower" hanging around in your nucleus accumbens.

What bothers me is the pseudo-scientific idea of a mystical "Willpower" that just manifests itself in "good" or "strong" people, as though there's a moral component. It's like running a race with one leg, and being told "Stop using a prosthetic! Just use 2 legs! Everyone else is!"

Re: Doctor: ADHD, as currently defined, does not exist

#82

Post by exelius » Mon, Mar 17, 2014, 8:45 PM UTC

MBCook wrote: post #64

djyaz1200 wrote: post #23

Earlier quoted context omitted.

I agree the article is potentially harmful. The paradox is that people who DO NOT have ADHD easily get hooked on meds but people who DO have ADHD hate taking meds. Saying ADHD doesn't exist is cruel and shows how badly it's misunderstood. The newer drugs that have countermeasures that prevent snorting/abusing should change the debate. Older meds that can be easily abused should be taken off the market. Then let's see…

> Saying ADHD doesn't exist is cruel and shows how badly it's misunderstood. I didn't get that from the article at all. He's not saying people don't have problems, he's saying the label ADHD is doing a disservice. It's not a condition, it's a symptom. If we had a label called "breathing problems" and just lumped all lung-related stuff in there, it would be problematic too. That doesn't mean no one has lung problems,…

I won't dispute that the definition of ADHD as it exists in clinical guidelines is entirely too broad. I do think that there is a "condition" that exists in a smaller subset of the population that is described by the guidelines of ADHD, and it's not a sleep disorder or anything like that (in fact, my ADHD is far worse if I sleep too much.)

But the article is potentially harmful because it discounts this population and pretends that there's nothing there. The author says "there is no such thing as ADHD" without allowing for the possibility that there actually is, but it's far too broadly applied and needs to be tightened up.

Re: Doctor: ADHD, as currently defined, does not exist

#83

Post by JohnBooty » Mon, Mar 17, 2014, 8:46 PM UTC

siphor wrote: post #43

JohnBooty wrote: post #15

This article is so potentially harmful, even if it's more nuanced than the hyperbolic "ADHD Doesn't Exist" title would suggest. The reality is that -- whatever the underlying cause -- a lot of people struggle with attention span issues, and that these issues cause a lot of pain and unfulfilled potential. Even if ADHD medications are overprescribed Band-Aids, people benefit from them. We should try and find better dia…

To play devils advocate, I think its possible that ADHD as a title is more harmful. Letting people fall into a self-fulfilling prophecy that may or may not have occurred otherwise. You say you were more than talented enough to finish said work in 5-6 hours but couldn't. To me that sounds like you thoroughly did not enjoy it and thus got distracted and 'procrastinated'. Why did you choose to work in an office if it wa…

I don't feel that Adderall even remotely makes me "like everybody else" - I feel it has some benefits toward reducing a specific difficulty I have and that those benefits outweigh the minor downsides.

  To me that sounds like you thoroughly did not enjoy it and thus 
  got distracted and 'procrastinated'. Why did you choose to work 
  in an office if it was making you so unhappy?

I certainly don't blame you for making this assumption, since I didn't flesh out my (not terribly interesting) story. And I also agree that there are a lot of upsides that come with ADHD, though of course it's hard to tell which positive personality traits are /due/ to ADHD and which are coincidental.

However, the truth is that I actually tried starting my own business I was passionate about /before/ even considering an ADHD diagnosis!

Just like you said, I decided my inability to focus in an office environment was due to a lack of motivation. (And that was partially true, it turned out, but wasn't the whole story)

So I started my own business. Now, at the time, I didn't think about ADHD very much at all but my opinion of it was that it was a thing they over-diagnosed in kids so they could sell a bunch of pills and basically make excuses for boring teachers and ineffective parenting.

After a couple of years creating the business it was pretty clear I was hitting the limits of my ability to focus even when doing "the fun stuff" like writing code for a thing I was passionate about. And don't forget that running a business also requires a lot of deadly boring stuff too - taxes, regulations, paperwork, etc.

It was at that point I started looking at a lot of things and decided maybe exploring the ADHD thing made sense after all.

Re: Doctor: ADHD, as currently defined, does not exist

#84

Post by exelius » Mon, Mar 17, 2014, 8:48 PM UTC

ahknight wrote: post #70

visarga wrote: post #40

Earlier quoted context omitted.

I don't like that it's classified as a disorder. It's a different style of cognitive activity, with its advantages and disadvantages.

> advantages NO. NO. NO. https://www.youtube.com/watch?v=4xpEBE9VDWw

It's not a "gift" or an "advantage", but it's not necessarily a disadvantage either IF the individual learns the proper coping strategies and can structure their work/life in a way that can make the ADHD less of a liability. It takes hard work.

Re: Doctor: ADHD, as currently defined, does not exist

#85

Post by darkarmani » Mon, Mar 17, 2014, 8:51 PM UTC

pessimizer wrote: post #12

Pxtl wrote: post #2

I feel like this headline is terribly irresponsible. People with mental health issues suffer from a stigma associated with them, as well as denial of their suffering. Going out with both guns blazing to say their condition does not exist - not that it's a symptom of a larger problem, or that it's a gross oversimplification of a number of unrelated diseases, but instead the crude headline "doesn't exist" - that only m…

Saying that a certain medical condition doesn't exist isn't a denial of the suffering of people who suffer, it's a denial of the label that's been placed on that suffering. As long as an attack on bad science continues to be interpreted by a segment of sufferers as a personal attack, sufferers groups will never exist as anything other than tools for drug companies to subvert the scientific process.

> As long as an attack on bad science

The bad science is this book that pretends to have evidence on its side.

Re: Doctor: ADHD, as currently defined, does not exist

#86

Post by richardlblair » Mon, Mar 17, 2014, 8:51 PM UTC

watwut wrote: post #58

trillium wrote: post #46

Earlier quoted context omitted.

Off the top of my head, roughly 7% of kids in the US have ADHD and roughly 4-5% of adults have ADHD. 20% of boys of a certain age have currently been diagnosed with ADHD.

If the definition of ADHD includes 20% of all boys, then I'm inclined to believe the definition takes in too many kids. If 1 in 5 kids has it, then it is normal behavior in that age range.

This. So much this.

But, think of all the children we can get hooked on ritalin! Think of the lifetime of revenue (for big pharma)!

Re: Doctor: ADHD, as currently defined, does not exist

#87

Post by JohnBooty » Mon, Mar 17, 2014, 8:53 PM UTC

ajcarpy2005 wrote: post #71

In my research, ADHD seems to be basically inflammation[1] of the brain. Think: bacteria, free radicals, active immune response, underactive detox and circulation, etc. Some approaches which are most useful seem to be: Magnesium, Green Tea &/OR L-Theanine, GABA, SAMe, Milk Thistle, Fish Oil, Cholesterol, Vitamin D (Sunlight), etc. I would say there is no silver bullet. But I would say unambiguously that vitamins and…

I don't doubt that inflammation is one of the myriad things that can cause attention issues.

One thing to realize re: supplements is that, by biological design, it's really hard to get chemicals into your brain simply by digesting them.

There are a lot of steps between eating something and it winding up in your brain.

I mean, the very first thing that happens to ingested items is a bath in the insane mixture of acid and bacteria that is your stomach. A lot more has to happen before it even reaches your brain-blood barrier, which is a thing specifically designed by evolution to keep things out of your brain.

Re: Doctor: ADHD, as currently defined, does not exist

#88

Post by stan_rogers » Mon, Mar 17, 2014, 8:53 PM UTC

JimboOmega wrote: post #28

djyaz1200 wrote: post #23

Earlier quoted context omitted.

I agree the article is potentially harmful. The paradox is that people who DO NOT have ADHD easily get hooked on meds but people who DO have ADHD hate taking meds. Saying ADHD doesn't exist is cruel and shows how badly it's misunderstood. The newer drugs that have countermeasures that prevent snorting/abusing should change the debate. Older meds that can be easily abused should be taken off the market. Then let's see…

I think you're wrong there - ADHD is generally associated with a higher risk of abusing drugs than for people without the condition. (And myriad other conditions, including getting in car accidents). And as someone with ADHD I never hated taking the medication. It was, like for the OP, a great experience that let me do a lot of things I didn't think I was capable of doing. I do hate taking too much of the medication,…

There's a little hole in your argument. You've lumped "meds" in with "drugs". And sure, they fit into the broader category. But let us, for the sake of argument, say that "meds" is a term generally used for substances that effectively treat a problem/condition, while "drugs" (at least as it seems to be used here) is a much more general term.

People will self-medicate when they can, and they will use anything that reduces the symptoms they perceive as problematic even when those substances have detrimental effects elsewhere in their lives. Taking into account only correlation, there are abnormally high numbers of people with chronic depression or dysthymia among alcoholics and those addicted to other CNS depressants (like barbiturates), of people with bipolar disorder among cocaine addicts, and of schizophrenics among people who even the most pro-weed activists would say use an, um, immoderate amount of hallucinogens.

So it is unsurprising that people who have something like ADHD (for want of a better label) may find relief for the symptoms they feel in some substance that at least gives them the perception that the problem is ameliorated (whether or not it actually helps functioning). And since the problem reduction is imperfect or short-lived, there is apt to be a bit of overuse or compensation for diminishing returns (rather like the "sunk cost" phenomenon). There is nothing to suggest that medications that actually work tend to be abused among that population (accidental missing or doubling notwithstanding - I do that with my Parkinson's meds occasionally, and it ain't fun when I do).

As a long-time recovered addict, I have no trouble saying this: the biggest problems with medications that you actually need is that they only do what they're supposed to do. (Post-surgery morphine was a complete bust, and it went away before I could rely on it for anything but high-level pain.)

Re: Doctor: ADHD, as currently defined, does not exist

#89

Post by richardlblair » Mon, Mar 17, 2014, 8:56 PM UTC

conradfr wrote: post #56

richardlblair wrote: post #34

Some folks are missing the point. Both the definition of ADHD and the treatment plan for it (in North America) are broken. In France, just 0.5% of children suffer from ADHD (opposed to ~5% in North America), and with those children they find the root cause of the issue and deal with that. They tend to shy away from medication. This is, more often than not, the proper treatment option for behavioural issues. People ne…

I'm French, have ADHD and had to discover by my own at 28 years old that it was an existing condition. I guess (hope) it's better recognized nowadays but still I suspect it's underdiagnosed and also you only have access to Ritalin and Concerta as possible medication with many restrictions to fulfill a prescription. Yet it's often presented in the media as "the obey pill that Americans give to their children". As a co…

By no means am I saying that ADHD isn't a thing, shouldn't be treated, and doesn't require drugs in some cases.

I'm sorry to hear about your circumstances, and hope things are going alright for you now.

Re: Doctor: ADHD, as currently defined, does not exist

#90

Post by bad_user » Mon, Mar 17, 2014, 8:59 PM UTC

exelius wrote: post #80

spacedmountain wrote: post #53

Earlier quoted context omitted.

What are the advantages?

People with ADHD tend to be very fast thinkers -- indeed this is part of the "problem" because while we're having a conversation with someone, we've thought through every consequence of what you just said before you finish your sentence. Because of this, we tend to get to "outside the box" type solutions much more quickly than others because we can effectively execute parallel tasks in our minds and come up with an a…

Are you sure that "hyperfocus" is a symptom of ADHD?

I'm a developer, depending on how well rested I am I can go into that zone for 12 hours, sure, but I've always been like that since I was a child and if I want I can focus on subjects that don't bring me pleasure at all, it's all a matter of determination (edit: for me).

Observing children at my wife's kindergarten that allegedly have ADHD, it's quite the opposite of being able to hyperfocus. Such children can't focus for 5 minutes on a single thing. Like, if you ask them to draw something, or to play a game, or if you read them a story or whatever, there are children that once past the 5 or 10 minutes mark lose their focus completely and shift their attention to something else, being a constant struggle to win back their attention.

Or maybe these are in fact 2 different disorders? It does take motivation on my part to focus on things that I don't like. Plus I think doctors are too quick to prescribe medication to children, which is my only problem with an ADHD diagnostic - as focus is also a matter of training (i.e. the interest for hearing stories or drawing stuff doesn't develop overnight) and parents, from lack of time, prefer to succumb to giving their children drugs instead of reflecting on their interactions at home.

So you know, I've got a mixed feeling about this - on one hand I've seen children and even grown men that can't focus on anything at all, so I'm sure ADHD is real, on the other hand it's often misdiagnosed and those drugs may in fact do more harm than good in many cases.