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Overselling A.D.H.D.

nytimes.com

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Re: Overselling A.D.H.D.

#181

Post by panglott »

forgotpwtomain wrote: post #93
panglott wrote: post #91

Earlier quoted context omitted.

One thing that has definitely changed is the level of academic expectations for young kids. Working with educators, it's apparent how much expectations have changed even in the last 10-15 years. Things that children were once expected to know in 1st grade are now expectations of children in kindergarten or even pre-kindergarten. Kindergarten is the new 1st grade, in terms of reading, and that means children have to s…

> One thing that has definitely changed is the level of academic expectations for young kids. Working with educators, it's apparent how much expectations have changed even in the last 10-15 years. Really, I think this needs a reference/citation? We didn't read a classic English book until 7th or 8th grade when I was in school. In contrast to say my parents education in Russia where they read Pushkin in ~2nd grade. Ma…

Yes, the effect is very dramatic over the last 10-20 years, but I suspect it's been hard to document. It's clear in terms of some expectations: a generation ago, it was expected that children would learn the alphabet in kindergarten, but today children are expected to enter kindergarten knowing the alphabet. So many kindergarten classes spend a few weeks reviewing the alphabet before rushing into words, leaving behind some children that didn't get pre-school before the age of 5.

http://www.npr.org/sections/ed/2016/01/08/462279629/why-kind... "In 2010, prekindergarten prep was expected. One-third more teachers believed that students should know the alphabet and how to hold a pencil before beginning kindergarten. Everyone should read. In 1998, 31 percent of teachers believed their students should learn to read during the kindergarten year. That figure jumped to 80 percent by 2010."

http://blogs.edweek.org/edweek/inside-school-research/2014/0... ".The percentage of teachers who reported their students never received physical education more than tripled, from 14 percent to 45 percent"

https://www.bostonglobe.com/ideas/2015/06/13/common-core-kil... '“When we require specific skills to be learned by every child at the same time, that misses a basic idea in early childhood education,” she says, “which is that there’s a wide range to learning everything in the early years.”'

Meanwhile in Scandinavia children don't even begin formal education until they're 7.

Re: Overselling A.D.H.D.

#182

Post by openasocket »

leereeves wrote: post #12
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/

I'm far from an expert on this, but I've always thought that the symptoms (inattention and/or impulsivity and hyperactivity) are only maladaptive in modern culture, where young people are expected to spend long hours sitting quietly at attention in school. Is that a disease, or a flaw in modern culture?

I've got moderate-severe ADHD and I can tell you no amount of societal re-structuring could help me nearly as much as medication. You got the base symptoms down (though I don't have the hyperactive component) but you're missing the nature of the inattention. If something interests me, I can dive into it really deep because my attention is focused like a laser beam. But having that happen is rare and fickle, most of the time (off medication) I can't focus on anything, even things I like. It's a horrible experience, wanting to read a book about science but you can't so you just watch some TV and feel bad about yourself.

Re: Overselling A.D.H.D.

#183

Post by falcolas »

tstrimple wrote: post #176
falcolas wrote: post #118

Earlier quoted context omitted.

The two biggest factors that I can come up with would be the lack of ability to control attention, and the inability to consider the long term repercussions of actions. If you can't force yourself to keep attention on the road, you're going to crash. If you can't think about how that daily pint of ice cream will affect you beyond "it tastes good now", you're going to gain weight.

And when your eyes continuously glaze over when your wife is talking to you, it can lead to marriage difficulties.

Sorry, sweetie, what were you saying?

Heh, yeah. I've said that a few too many times. I'm just glad she understands.

Re: Overselling A.D.H.D.

#184

Post by DanBC »

metaphorm wrote: post #141
falcolas wrote: post #116

Earlier quoted context omitted.

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.

these are children we're talking about. you're endorsing drugging children.

Do you say that about chemotherapy? Or insulin for T1 diabetic children?

Re: Overselling A.D.H.D.

#185

Post by DanBC »

metaphorm wrote: post #169
dragonwriter wrote: post #148

Earlier quoted context omitted.

Yes, so what? My son had a bladder infection, and I certainly endorsed the use of drugs to treat that. If there is a real and identifiable condition interfering with a child's quality of life for which there is concrete reason to think that a drug is an effective and remedy for which the risk of other side effects is mild compared to the expected benefit, why shouldn't responsible adults endorse drugging children in…

bladder infection is an infection by a microbial disease. it's a pathogen caused by another organism that shouldn't be present in a healthy body. what exactly is ADHD? what is being treated, anyway? this is medicating for "normality", which is another way of saying our society is defining and enforcing (with mind-altering drugs) a very narrow band of acceptable personalities and behavioral responses to environmental…

People aren't treating ADHD to make children "normal".

They're treating ADHD to reduce the risk of accidental death; homicide; suicide; and drug or alcohol dependency.

Re: Overselling A.D.H.D.

#186

Post by barrkel »

whamlastxmas wrote: post #151
barrkel wrote: post #128

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.

Yeah a shill for big-amphetamine. That's like saying he's a shill for big-chicken. They're both common commodities that have a wide range of specific to generic versions. The idea that amphetamine producers gather to plan covert operations to pay people to spread propaganda on the internet is ridiculous.

I'd put the probability that the account is a shill at maybe 5%. But the account owner is definitely invested in the topic, and I'd like to know why. They're more interested in this topic than any other over nearly 2 years on this site.

Re: Overselling A.D.H.D.

#187

Post by panglott »

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.

Children's education has always been dominated by women. I think the problem is more that young children are suddenly being held to a standardized curriculum in which they are expected to learn to read in kindergarten (instead of 1st grade) while their recess time is curtailed or cut entirely. Then when the boys or the youngest quartile of 5-year-olds have trouble sitting still or focusing on desk work, it becomes pathologized.

Re: Overselling A.D.H.D.

#188

Post by jwdunne »

vainguard wrote: post #179
buttcoinslol wrote: post #173

Earlier quoted context omitted.

Imagine this: you're an adult professional, writhing in pain and occasionally vomiting, weeping in frustration while laying in bed not able to get out. Because you ran out of heroin. That is what my life was like. If that doesn't sound like a medical condition to you, then I don't know what you're thinking.

This medical condition is called withdrawal. You are right in that discontinuing ADHD medication can lead to withdrawal symptoms. But you are dead wrong in that ADHD does not disappear after withdrawal. As it would if it were a drug addiction. ADHD was there before taking medication, and it will persist long after stopping medication. (If we assume the diagnosis was correct.)

It can indeed cause withdrawal symptoms but not so bad since psychiatrists suggest "treatment holidays", where you are free to choose not to take them for a few weeks.

Other psychiatric medications are often withdrawn slowly. For example, a patient on weekend leave in hospital would be called straight back to the ward if they lose their prescribed benzodiazepines e.g smashing a bottle of solution, due to withdrawal. Especially the case if used during alcoholism detox, where the seizures could kill otherwise.

Many of the symptoms also do not go away with medication. It's not a magic bullet. It just raises the floor a little bit so things are easier to manage. Some days the medication doesn't help all that much if other things off set it.

Re: Overselling A.D.H.D.

#189

Post by vainguard »

Broken_Hippo wrote: post #101
panglott wrote: post #76

Earlier quoted context omitted.

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…

I looked, and it seems to be about double (though figures disagree). And I wonder if this isn't simply a difference in educational systems and expectations of children. I'm in Norway, and children play quite a bit, even in school. They take frequent breaks, have outdoor recess (in nearly all weather), and have no homework. The general attitude is that kids should be kids and not have to worry about stuff. Sure, there…

I think you are right.

I would really prefer to change the world, than take medication. I say this without sarcasm and a little bit of sadness.

Re: Overselling A.D.H.D.

#190

Post by jrapdx3 »

panglott wrote: post #167
jrapdx3 wrote: post #126

Earlier quoted context omitted.

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…

> 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 instances where that makes a big difference in the outcome. Admittedly it is a hard subject to study systematically given the individualized nature of behavioral treatments.

However research is hardly saying that medication is the only factor. Lately, there is a great deal of attention in the field directed to findings that childhood adversity, e.g., abuse, malnutrition, environmental impoverishment contributes greatly to conditions that resemble ADHD. The implication is clear that reducing the negative impacts of inner-city poverty, etc., would have salutary effects on reducing incidence of psychiatric disorders including ADHD.

In adults, ADHD sufferers with long-term medication treatment show better functioning than untreated peers (matched for age, sex, education, etc.) if less well than unaffected individuals.

Most such studies have used medication therapy as the marker of treatment. So far the contribution of behavioral therapies has been hard to pin down. However, clinical experience is that medication alone is inadequate for adults to improve.

The saying is "pills don't build skills". Indeed, guided behavioral practicing is an essential element of ADHD treatment, though optimized medication treatment can be very useful to enhance neurophysiological infrastructure necessary for normalizing functioning. An individually optimized combination of treatment approaches is most likely to be successful, but hard to determine a priori, thus hard to study experimentally.

I don't believe my response truly satisfies your excellent question, but I'm very glad to know there are people like you who are thinking intelligently about these problems that affect all of us directly or indirectly.

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