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ADHD drug treatment and risk of negative events and outcomes

bmj.com

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Re: ADHD drug treatment and risk of negative events and outcomes

#61

Post by Mordisquitos »

skeezyboy wrote: post #47
squigz wrote: post #43

Earlier quoted context omitted.

What exactly is the point you're driving at, if any? Why are you asking these questions?

[flagged]

I have a question for you. For context, in case you haven't read it, we are discussing scientific paper reporting a large population study (almost 150,000 newly-diagnosed ADHD patients, aged 6–64 years old) which compared the outcomes of those who were medicated (~57%) and those who were unmedicated (~43%). Around 88% of the medicated cohort were prescribed methylphenidate (e.g. Concerta or Ritalin).

The conclusions of the study, copy-pasted from the abstract, were:

> Drug treatment for ADHD was associated with beneficial effects in reducing the risks of suicidal behaviours, substance misuse, transport accidents, and criminality but not accidental injuries when considering first event rate. The risk reductions were more pronounced for recurrent events, with reduced rates for all five outcomes. This target trial emulation study using national register data provides evidence that is representative of patients in routine clinical settings.

My question is this: if we assume ADHD does not exist, what is going on here?

Specifically, how do you explain so-called "ADHD" patients who were medicated having a statistically significant lower risk of suicidal behaviours, substance misuse, transport accidents, criminality, and recurrent accidental injuries than those who were not medicated?

Do you think non-"ADHD" individuals (i.e. who don't fit the current diagnostic criteria for this assumed fictional disorder) would also display a reduced risk of suicidality, accidents, etc. if they were to take methylphenidate on a daily basis?

Re: ADHD drug treatment and risk of negative events and outcomes

#62

Post by Ancapistani »

notfromhere wrote: post #26
skeezyboy wrote: post #16

Earlier quoted context omitted.

[flagged]

ADHD is a neurodevelopmental disorder that's highly inheritable.

Obviously it's characterized as a disorder, but I really think that perspective should be challenged.

Like autism, the diagnostic criteria are almost exclusively framed in how other people are impacted or inconvenienced by it. Very little attention is paid to the experience of the person actually living with it.

I see it as a difference, but not necessarily a disorder. As someone with "severe" ADHD there are tons of things that I'm substantially better at than I would be if not for the condition.

I believe ADHD is "rising" because our culture has grown more homogenous in recent decades, resulting in people with ADHD attempting to adapt to environments that are designed for and run by people without ADHD.

Re: ADHD drug treatment and risk of negative events and outcomes

#63

Post by therobots927 »

haliskerbas wrote: post #50
f0daf0da wrote: post #48

Earlier quoted context omitted.

I made an account just to post this as I’ve gone through something similar. Get a formal psychiatric evaluation done out of network by a neurologist who specializes in ADHD. The exam will take a few hours and they will send you a full report and diagnosis. This paperwork will help you a LOT. I’ve used it multiple times when I’ve had difficulties getting care and was well worth the time and money.

What do I look up to find places and providers that do this especially if I don’t have a relationship established with the place already.

Personally I had success with my primary care doctor. But you could also look into online telehealth diagnosis. That was my backup plan to ensure I have access to medical treatment.

Re: ADHD drug treatment and risk of negative events and outcomes

#64

Post by 542354234235 »

skeezyboy wrote: post #57
nahikoa wrote: post #45

Earlier quoted context omitted.

Not quite? Here's the DSM-5 criteria: https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_to...

[flagged]

Additional context.

> Symptoms and/or behaviors that have persisted ≥ 6 months in ≥ 2 settings (e.g., school, home, church). Symptoms have negatively impacted academic, social, and/or occupational functioning. Inpatients aged Clearly these aren't saying "have they ever misplaced anything?" or "have they ever forgotten anything?". Sure, most people have had some of these things happen some of the time. Yeah, all kids find homework boring, but most kids are still able to do it. Most kids forget things, but aren't losing multiple coats every winter. Most people aren't experiencing these symptoms to such a degree that it significantly impacts their ability to function.

Re: ADHD drug treatment and risk of negative events and outcomes

#65

Post by squigz »

alfiedotwtf wrote: post #56
skeezyboy wrote: post #47

Earlier quoted context omitted.

[flagged]

Needing to fix ADHD is itself a cultural thing. Back 100 years ago, you didn’t need an 8 hour attention span to sit at a desk staring at a monitor while the AC dries your eyeballs until they feel like foil scratching on a blackboard

No instead you might sit at a desk writing by lamplight, having your eyes dried out by smoke, assailed by the smell of horse dung (among other things)

I really don't understand this idea that people with ADHD didn't suffer in the past or that the problems we face would magically disappear if society was just organized a bit differently. Would it alleviate a lot of the pressure? Certainly, but it wouldn't do away with the problems. It's the same with autism.

Re: ADHD drug treatment and risk of negative events and outcomes

#66

Post by [deleted] »

2c2c2c wrote: post #31

Curious if anyone has gone through the process of an adult adhd diagnosis at Kaiser SF. Through my attempts, I've been told they don't really do adult adhd diagnoses without documentation of issues as a kid. I was recommended Wellbutrin to deal with symptoms in 2017. Got onto adderall when I moved health insurance in 2021. Back to Kaiser in 2024, I was routed to the same psychiatrist who once again wouldn't budge on…

[deleted]

Re: ADHD drug treatment and risk of negative events and outcomes

#67

Post by eightysixfour »

kruffalon wrote: post #12
ravenstine wrote: post #3

Makes sense that methylphenidate helps with most of the things associated with classical ADHD symptoms but not with clumsiness that can lead to accidental injuries; or, in my case, just bruises on my shins all the time.

Why? I don't really disagree with you but I wonder how the thwarted sense of "my body in the world" is so connected to ADHD while not being connected at all to executive functioning (which in my perception is what amphetamines help with).

My hypothesis - body awareness and injury avoidance is learned and ADHD folks have a less effective reward loop. While the meds help with the reward loop, the person has decades of catching up to do for body awareness.

Re: ADHD drug treatment and risk of negative events and outcomes

#68

Post by notfromhere »

Ancapistani wrote: post #62
notfromhere wrote: post #26

Earlier quoted context omitted.

ADHD is a neurodevelopmental disorder that's highly inheritable.

Obviously it's characterized as a disorder, but I really think that perspective should be challenged. Like autism, the diagnostic criteria are almost exclusively framed in how other people are impacted or inconvenienced by it. Very little attention is paid to the experience of the person actually living with it. I see it as a difference, but not necessarily a disorder. As someone with "severe" ADHD there are tons of…

Do you have ADHD? Because as someone that has it, it's definitely very much something that heavily impacts the individual with it, and not just society.

It's hard to consistent do things, form habits, maintain attention. You have almost a lack of object permanence, a hard time remembering long-term memories, etc. There are so many problems it causes that aren't even occupational related but lead to negative outcomes outside of your personal engagement in social and economic environments.

Yes, society isn't really designed for folks with ADHD, but also the prevalence of ADHD was somewhat disguised by the fact that mental health had a social stigma and that smoking was incredibly common and people were basically microdosing stimulants every hour as such. It's not that shocking to think that the decline in smoking made adhd much more apparent.

Re: ADHD drug treatment and risk of negative events and outcomes

#69

Post by amanaplanacanal »

Ancapistani wrote: post #62
notfromhere wrote: post #26

Earlier quoted context omitted.

ADHD is a neurodevelopmental disorder that's highly inheritable.

Obviously it's characterized as a disorder, but I really think that perspective should be challenged. Like autism, the diagnostic criteria are almost exclusively framed in how other people are impacted or inconvenienced by it. Very little attention is paid to the experience of the person actually living with it. I see it as a difference, but not necessarily a disorder. As someone with "severe" ADHD there are tons of…

I think you are half right. The criteria for hyperactive type seem to match what you are saying, but the criteria for inattentive type are more about the patient.

My symptoms are all about how they are holding me back, and nothing about how they inconvenience the people around me.

Re: ADHD drug treatment and risk of negative events and outcomes

#70

Post by notfromhere »

alfiedotwtf wrote: post #56
skeezyboy wrote: post #47

Earlier quoted context omitted.

[flagged]

Needing to fix ADHD is itself a cultural thing. Back 100 years ago, you didn’t need an 8 hour attention span to sit at a desk staring at a monitor while the AC dries your eyeballs until they feel like foil scratching on a blackboard

100 years ago people smoked like chimneys and were basically self-medicating with nicotine. The classic 'coffee and a cigarette' breakfast is the most ADHD-coded thing imaginable.
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