ADHD researcher here, this was already known. ADHD is a neurodevelopmental disorder, the key is that developmental disorders occur over the time-course of typical development. To have a diagnosis of ADHD, there must have been symptoms before the age of 7, and furthermore, it's much more likely to occur in younger children because their executive functions are less well developed.
On the neurological level, there are different dopaminergic systems developing throughout childhood, such as the motor cortex, the prefrontal cortex, and the dopamine-based reward system. If the motor cortex develops too quickly before the PFC, which controls/regulates behavior, well you'll have hyperactivity that's unregulated. With less developed EF's comes getting out of the chair, losing things, daydreaming, hyperactivity, and all of the diagnosable symptoms of ADHD. Naturally, those who are 6-9 months younger (which might be a 10% age difference in kindergarten) are going to be in very different developmental stages. Requiring younger children to sit still and pay attention may be a much more challenging task since their brains are actually less developed. Thus, they more easily get pushed over the diagnosis line compared to their older classmates.
There is another wrinkle here beyond age, which is gender: boys are around 2.5-3X as likely to be diagnosed because they are more hyperactive naturally, i.e. their neurological systems develop at different rates than girls. This sort of behavior in the classroom is much more disruptive than what girls exhibit. Girls tend to be diagnosed with primarily inattentive subtype, since their motor cortex is not usually as over-active, but they still may suffer underdevelopment of the EF that helps them to focus. A girl daydreaming is much less disruptive than a boy standing on his chair, rolling on the floor, or wandering the classroom (all of which happened multiple times in my own classroom).
It sounds a lot like what you are saying is that the diagnostic criteria for ADHD do not appropriately account for normal differences between children of different ages and sexes, and therefore systematically overdiagnose younger children and boys (or underdiagnose older children and girls, or some combination.)
But, while that may be true (it certainly sounds true), I think there is another factor at work explaining the specific result here:
If you need a diagnosis by age 7, and school is the first structured environment where symptoms are likely to be noticed, a child born in August will have essentially twice as long to manifest symptoms to qualify for the diagnosis.
If you take any condition, the number of people who will demonstrate symptoms over a two year period of observation will be greater than over a one year period, all other things being equal.
It seems to me that this study proves something I have long suspected: whatever the neurological reality of this disorder in people who actually have it, the diagnosis is often in effect something like "Teacher Inconvenience Syndrome". And the practical upshot is that rather than build an educational system suitable to children, we are willing to drug them for the convenience of the current system.
I was diagnosed ADD in 6th grade, took medication and it greatly helped me, so a bit biased
I was told the disorder is not just about not being able to concentrate or sit down. It’s more about lacking executive control that helps you to focus, stay sitting down, or keeping your mouth shut. Makes you more prone to all sorts of behavior that loses you friends and makes life generally miserable.
During my diagnosis a lot of discussion happened around non-focus things, and possible alternative solutions (including CBT through a school program, which was pretty good now that I think of it)
This was 15-odd years ago. I think that popular culture goes along the axis you say, but the reality is professionals are trying hard at the diagnosis phase I think? But meanwhile this comment means I get the “lol so you can’t concentrate? Not a real illness” BS that plagued people with clinical depression forever if I ever discuss this with certain people.
That being said, the school system is uniquely challenging to all children who have executive control difficulties. Almost nobody’s adult life is as complicated as “trying to fill the demands of 10 different teachers in a week + also grow as a human”.
But at least for me, discussion during diagnosis went beyond just school, because it does affect all parts of life in nasty ways.
It doesn't help at all that the common medications are mild, situational nootropics with grossly inflated PR. Usually you say something like "I got a prescription for X and, instead of overdosing and dying, stopped having episodes" and people immediately realize that you're not making things up. Unless the prescription that fixed your brain was Adderall, in which case they just accuse you of being addicted to speed and try to lecture you about drugs.
I've started saying that I have a neurological issue that interferes with memory and concentration. Having been diagnosed at age 27 also helps. People react much better when they're not being blind, bigoted asshats.
You can show symptoms and not be diagnosed. For example, "at his parent's request, had his hearing tested 4 times before age 8 despite there not being any difficulties" could be evidence that inattention was evident, even though it was mis-diagnosed at the time. They may have been labeled "lazy" or "space-cadet" without being offered any practical support: especially among women who grew up in the 80s, it's pretty common to have not been diagnosed despite having a clear history of symptoms.
> They may have been labeled "lazy" or "space-cadet" without being offered any practical support
Yep. For the longest time I just thought that I was lazy and disorganized and that all the "brains" everyone said I had were useless because I just made stupid mistakes continually. Everyone knew I had issues, including myself, but because everyone just thought I was forgetful and lazy the only help I got was well-meaning advice from friends and self-help books.
The really fun part: other people have stated in this thread that therapy, absent pharmaceutical assistance, has effectively no value for ADD. I believe it. All of the advice I got and tried, over a decade and a half of real effort, had about as much of an effect as spitting into a hurricane. People's personal organisational tricks are woefully insufficient for ADD, just like with every other real mental health problem in existence.
The parent for example had a gap of 20 years. It just seems strange to be relying on 20 year old notes, rather than what you see before you.
I don't know anything about the subject, and not saying anyone is wrong or anything.
It just seems very strange to me, how many parents didn't bother taking their children to the Dr X number of years ago either because of money, or just because ADHD wasn't a thing, so the parents thought the child was just naughty? Unless you start relying on the 20 year old recollections of random family members, which doesn't seem better in any way better than diagnosing them based on the here and now, which is ultimately what is important. I would far rather we treat people that have ADHD now, rather than had it 20 years ago.
I wasn't diagnosed until half way through college. I got mostly As until sixth grade, then a gradual decline began. I graduated high school with a 2.something GPA. I think the decline was gradual enough that I guess it didn't set off any alarm bells in the guidance office.
Also I was much more the inattentive type than the hyperactive type.
During my diagnosis I was able to bring a bunch of report cards from my entire school career. That was useful. I empathize with parents who face the dilemma of having a child evaluated, without so much data to go on but with the pressure of not wanting to wait too long in case there is an issue.
The form of hyperactivity I had was mostly fine to the teachers during my first years of school, but my inattentiveness made me unable to complete writing tasks and this was clear from my first year at school. Medication helped a great deal with this and more importantly it showed me what I could be capable of and I think it helped me develop coping strategies.
I wasn't long on the medication, even in the 1980s there was a backlash against the overprescription and side effects of Ritalin so my mother took me off it. Later during my school years my hyperactivity was a problem, in a different school where the teachers were more strict. I received beatings for things like not sitting still on my chair and for messy handwriting. Medication could probably have helped here and also with my academic performance, though the school and the teachers really should have been more accommodating and understanding around what are rather trivial behavioural differences in the greater scheme of things.
It makes me wonder what role overstimulation at home plays in diagnosis when kids are dropped into an environment where they must abide by certain structure. I am not qualified to comment on the disorder itself but part of me thinks kids are exposed to vastly different environments today than they were for example 20 years ago. At home you have all sorts of things - devices and increasingly complex games & toys that stimulate the mind, and when you're put into a school environment, you're supposed to all of a sudden conform into that "sit still and learn" mold? To what degree is this accounted for in the diagnosis? I grew up in a totally different time where stimulation was somewhat consistent from home to school, but I can't even imagine what kids are dealing with these days when they are exposed to high tech devices, games that interact on a whole new level than they have before, liberal parenting to controlled environments - that must count for something?
5-6 years old don't really play those increasingly complex games. They play games on simple level. When I was young, ADHD was blamed on tv.
There is big difference between ADHD and bored neurotypical child. It is not just walking instead of sitting, it is jumping on the table running around hitting kids so wild that other kids are scared - and kid is unable to control it. The same kid can be in control and all good and then suddenly loop to out of control mode in second.
There are behavioral issues related to games in my observation, but those are temporal and milder. Mostly that kid act like a jerk right after playing or during playing. Also there is ... not so great culture around gaming streams that makes kids think that being jerk is cool. It however does not cause ADHD like behavior (nor violence it seems to be).
In the disability rights movement, disability is defined basically as having a trait that the social and built environment discriminates against: a disability is something the society is doing to you, not a flaw in yourself.
> this was already known. ADHD is a neurodevelopmental disorder
You're sounding like: "being a certain age is a disorder".
> Requiring younger children to sit still and pay attention may be a much more challenging task since their brains are actually less developed. Thus, they more easily get pushed over the diagnosis line compared to their older classmates.
Teachers who can't control kids (and to be honest, school requirements have been getting broader) will want to give them a pill as it's easier.
Reminds to be seen what is the effect of such medicines on kids under development.
> Reminds to be seen what is the effect of such medicines on kids under development
I mean adderall (amphetamine) is pretty well studied. Yea they have some adverse effects (stunted growth, not good if you have a pre-existing heart condition, etc.) but as with literally every medicine, the decision to take them or not take them requires you to balance the adverse effects (which can be monitored) with the adverse effects of the illness. It frustrates me so much to see people just flippantly ignore the actual underlying problem that the pill is supposed to be treating as though it's "healthier" to not take the pill. Depressed people can kill themselves or if they don't their lives are pretty crappy. ADHD can cause all sorts of real problems. If you think pills are just an "easy way out" then that's really insulting to people who actually benefit from using them and really don't want to have to deal with judgement from other people who clearly have no idea what it means to suffer from a serious mental illness (ADHD can be debilitating). If you do happen to suffer from a serious mental illness and do not take pills, that's great (maybe?) for you, but that doesn't mean that's the "right" way. In fact I had two parents with mental illnesses that took that route and it was really not fun growing up with that, though it was a great lesson in how not to deal with mental illness.
For many the “actual underlying problem” is that forcing small children to sit and focus on unmotivated externally assigned busywork while being passively monitored by a stressed out and outnumbered authority figure is a cruel waste of time. Many of the same kids would be just fine if their day consisted primarily of free play, especially outdoors.
" Many of the same kids would be just fine if their day consisted primarily of free play, especially outdoors."
Not if they have ADHD. Then they often can't focus on things they want to focus on for their own reasons.
A lot of things that people with ADHD would like to do include boring parts if you want to get good at them. Practicing scales three hours a day, or whatever.
> Then they often can't focus on things they want to focus on for their own reasons.
Ding ding ding, winner. You know what sucks? Not being physically capable of paying enough attention to a piece of paperwork to be sure you've read all the instructions right and spelled everything perfectly and copied over every number with no transcription errors. Even when you desperately want to be able to focus that hard on anything in your life. Now take that and apply it to programming, watching TV, finishing video games so you get the whole story, remembering your SO's favorite things... Yeah.
Hmm. I'm a little skeptical when medical phenomenon are ascribed to social factors, but I don't really know either way.
I wonder if anyone has studied whether ADHD rates are influenced at all by type of schooling. I'd love to know whether KIPP (which is very heavy on "sit and focus") or Montessori (which isn't) have particularly different rates of ADHD diagnosis for their students.
Could go either way. Maybe focus is a skill that can be learned, and by drilling it you would reduce rates of ADHD? Maybe focusing is annoying, and if kids have to do it too often, they'll stop wanting to learn or focus on anything? Or maybe it's mostly biological or chemical, and the rates would be roughly the same?
I don't strongly share your intuitions, but I'd absolutely support someone giving a shot at testing the impact of schooling type on ADHD rates, validating you if your intuitions are right, or just adding more information if you aren't.
Some ADHDers will do worse in Montessori because it requires more executive function that regular school. Look up "hyperfocusing". The student might do one thing that interests them and nothing else. That will be a huge problem in Montessori, which expects the child to by themselves go from activity to activity. Some ADHDers will do better in more structured environments.
"Requiring every building to have a ramp instead of stairs wastes everyone's time and money. Many of the people that need them could get along in crutches long enough to use the occasional building."
People like you are why I went undiagnosed until I was 27. Everyone around me thought that I just needed to focus harder and take better notes and get some exercise. Hell, I thought those things too, which meant I was dealing with burnout and depression on top of everything else. It ruined grad school and it's going to take me decades to catch up with my life goals. You should find a way to contribute that doesn't involve sweeping generalities that make it impossible for people with real problems to realize that they have them.
> You should find a way to contribute that doesn't involve sweeping generalities that make it impossible for people with real problems to realize that they have them.
You think that me arguing for more free play for 4–8 year olds makes it impossible for adults with ADHD to realize they “have real problems”?
You think it would have made your life significantly better if teachers had started medicating you at age 6 and forced you to spend more time memorizing spelling lists or whatever?
I’m not talking about people in grad school here. Or even high school.
For whatever it is worth: I am 32, and have undiagnosed ADHD, probably more extreme than yours.
More free play is not exclusive with school. More free play does not solve ADHD. ADHD kid I know have hours of free play every day and he still have trouble to behave in school - while other kids don't have such problem. He has good days and bad days and that is not correlated to type of work. And when he has bad day, the other kids in class essentially sit bored waiting, because all teachers attention necessary goes toward that one out of control kid (he is too disruptive to be just ignore when he has that). When he has good day, he is fine boy trying to please those around. He is trying to not have bad day I think, he seems unable to.
Also, while there are some shitty schools with "forcing small children to sit and focus on unmotivated externally assigned busywork while being passively monitored by a stressed out and outnumbered authority figure", ADHD happen in non shitty ones.
When kids universally hate the school and there are problems with everyone then it is one thing. When there are few kids who behave differently then other kids, then we maybe should accept that there is something different about them. Because that is the thing - many many kids like to go to school at that age. Or are indifferent to school. Or don't like it, but don't have problem to sit while class is going on. And some kids have problem to control their behavior regardless of whether they like the school, teacher and other kids.
> Also, while there are some shitty schools with "forcing small children to sit and focus on unmotivated externally assigned busywork while being passively monitored by a stressed out and outnumbered authority figure", ADHD happen in non shitty ones.
Op wasn't describing shitty schools. He was just describing schools.
> For whatever it is worth: I am 32, and have undiagnosed ADHD, probably more extreme than yours.
If you think that it's significantly affecting your quality of life and none of your existing coping strategies are helping - which is the actual definition of "severity", by the way, not anything about how much you think your brain sucks - you should talk to a competent doctor and/or counselor or therapist. Medical professionals have access to far better ways to address real neurological problems than you can get hold of, ranging from referrals to specialists that work 8-hour days helping people test coping strategies to medication that will directly address the underlying cause to simply being able to approach the problem with a calibrated idea of what "normal" is and deal with it with a brain that isn't affected by the problem. They can probably help you keep your job or your marriage or whatever else it is that's continuously at risk of being derailed and collapsing around you.
Yes, I know that it's hard to do. It's hard to remember to make phone calls while businesses are open. It's hard to remember when you have appointments. I know that paperwork is terrifying. It sucks. It gets better if you do it and get help. Get a good friend to sit down and help you do it. Seriously, not having gone to the doctor in years because you couldn't pull together the functional executive capacity to deal with analysis paralysis when you search for "primary care providers $mycity" is unhealthy in a ton of ways. Just call one at random. At worst you'll pick a terrible doctor and have to try again. Get friends to help. They're not crippled like you are.
(Though, if I'm going to be honest, I will say that someone self-diagnosing severe ADHD in a thread about overdiagnosis of ADHD is hilariously ironic. Nothing says that the office lifestyle is any better for adults than it is for children, after all. Go read Dilbert or watch The Office or something, we're just as bad at handling it in cubicles as we are at our assigned seats in history class! Get some fresh air, go hiking on the weekends, get your macros right and lose 20 pounds. /s)
> You think it would have made your life significantly better if teachers had started medicating you at age 6 and forced you to spend more time memorizing spelling lists or whatever?
I did perfectly well on spelling tests and homework and projects during school. In fact, I barely needed to "study" anything at all. Maintained a high A all the way through to the end of my undergraduate. It just turned out that the month-long and semester-long projects sharply limited the scope of the careless mistakes I'd make that would, on real-life-sized projects, cascade into crippling architectural issues. So I just figured I needed to work harder (because "smart people don't work hard") and take better notes and pay more attention to the big picture. And I burned out catastrophically. Those problems all went away overnight when I finally managed to talk to a doctor about it. It was magical. I have so far not been able to identify any side effects rising above the noise floor.
So, based on the side effects and benefits of medication so far, yes, I actually really would have liked to have had it earlier. At least ten years earlier. I'd have spent exactly as much time studying - i.e. none - gotten back the 10% of my grade that I usually spent misreading the fucking question, been able to handle personal projects big enough that I'd have been able to get real practice with project management and software architecture, and gotten papers out of the research projects I was involved with during my undergraduate. I'd have been able to go to the doctor reliably and avoid the stress and wasted time I spent dealing with carelessly fucked-up paperwork. And that all would have compounded on itself to improve my life exactly the way the failures compounded the way it actually happened. If I'd had this shit ten years ago I'd probably have my fucking PhD right now and be working on getting tenure, which is what people were expecting when I was in second grade.
> It just turned out that the month-long and semester-long projects sharply limited the scope of the careless mistakes I'd make that would, on real-life-sized projects, cascade into crippling architectural issues.
Beyond any difficulties with controlling attention, I think this has a lot to do with lack of practice with large (and “real”) projects, ramping up in scope and scale slowly over the course of years. This is a big problem with the school curriculum/pedagogy, IMO.
Many people I know working in creative jobs (computer programming and otherwise) have various problems with large-scale project management, long-term problem solving strategies, etc., plenty of which have nothing to do with ADHD.
I don't think that's what OP was saying at all, though. I took his comment as saying that we often expect too much structure from kids at too young of an age, then diagnose the worst of them. For example, at age 7 I was still bursting with pent-up energy and often didn't want to sit still, especially if I was bored. My first grade teacher once taped me to my chair to try to get me to sit still during reading time (I was reading at a higher level, and "See Spot Run" bored me to tears). She and my kindergarten teacher probably could have pushed for an ADHD diagnosis, but they didn't because I think they realized that we often shove kids too young and expect them to adapt to a fairly rigid structure too quickly.
Now, I'm not saying that nobody has ADHD and that it's not a horrible problem for those who do. Sometimes, I really do wonder if I might have it, though I tend to think against it. But for those who truly do have ADHD, I understand that medicine is needed, and that the sooner we give it, the better off those students can learn. I just feel that OP was saying we test for it way too young, and expect way too much out of kids when testing for it.
> Many of the same kids would be just fine if their day consisted primarily of free play, especially outdoors.
There needs to be a balance between free play and structured learning, where the youngest students spend more time in free play than older students. The primary function of school is learning, and learning is often very structured time. Children need to be able to handle that type of environment.
I think the issue that GP is having is that we often expect this of them too young. We expect them to come in and be quiet and sit in focus at an age when they're bursting with pent-up energy, and then diagnose the worst of them as ADHD and give them a pill. Yes, we need to teach them to handle that type of environment, as that's (sadly) how the rest of their lives will be...But I think we need to do it a lot more gradually, or even a bit later, than we currently do.
If their day consisted of outdoor free play, they wouldn't actually be learning - which is half the problem. They need to learn, and about every 5-10 years, the amount they need to know in order to function (in other words, how much the teacher needs to teach and test for) seems to be doubling. Then again, I wonder how different our world would be if I could just send the kids outside who didn't want to be in my classroom, let them have their "free play" time, and then be able to spend my focus & energy on a smaller and more focused group who know that there's an option - and make a deliberate choice to stay.
> If their day consisted of outdoor free play, they wouldn't actually be learning
Are you serious? You think that young children don’t learn from free play? What in the world is your definition of “learning”?
> how much the teacher needs to [..] test for
Oh I see. You mean “learning” as judged exclusively by standardized multiple-choice tests.
Well fine, it’s not exactly surprising that if we force children to spend 5+ hours per day sitting in rows in desks working independently filling out busywork worksheets or watching teachers solve similar trivial exercises on a whiteboard, they will be better at doing the same thing for arbitrary test points than someone who hasn’t spent any time practicing that, even if both kids think the test is a pointless waste of time.... but that doesn’t really indicate anything at all about children’s abilities more generally.
If we instead measured the kids’ balance, strength, running speed, hand-eye coordination, intuitive understanding of physics, ability to improvise mechanical devices from found objects, knowledge of local plants and animals, emotional self-understanding and self-control, negotiation and bargaining skills, social organization/leadership, .... we would find that the professional worksheet-fillers are years behind their playing peers.
Some of the most capable (even at book-smarts) people I ever met were absolutely horrid throughout school, but then did amazing things after. Others never went to school at all and still did amazing things. Others I know aced every test right up through college, and then had no idea what to do afterward, because they had never really been forced to think for themselves.
Getting children to be as successful as possible at multiple-choice tests at age 8 is not a good top priority for the education system.
Your comments here presume that there is an "actual underlying problem". But this study proves that isn't always the case.
I also think you're ignoring the extent to which a neurological difference has been medicalized here. Depression is truly debilitating in any context. Here ADHD is sometimes being diagnosed due to a poor fit between an artificial environment and and children who would have been seen as "normal" had they been born a week later. Is there actually a problem with those kids? Or is the problem with an industrial-age education system that expects kids to demonstrate obedience all day and drugs the ones who don't? That's far from the only way to educate children; maybe the problem is not the child's brain, but that we expect all children to fit a very specific mold.
Personally, I'm a September baby so was relatively young compared to my grade peers.
I got mostly A's in K-6. Once in 4th grade another student pitched a tiny fit about how I always got A's on spelling quizzes.
After that my grades started to decline. I was having trouble with the increasing demands of the work. Graduated high school with a 2.25 GPA or something like that.
In college I was diagnosed with ADD.
The industrial-age education system wasn't a problem for me, until it became a problem for me.
But it really isn't the problem, because ADD can prevent people from being able to focus on things they want to do of their own free will in their own time. Industrial-age education isn't an issue there.
So, being unable to maintain focus especially on the boring bits, they end up sucking at whatever it is, which gets depressing.
Just to be clear, I believe some people have disorders that affect attention. I also believe there's a larger group of people who are just cognitively different. They are fine in some circumstances, not in others.
As an example, I'll note that common characteristics of people with ADHD include hyperfocus [1] and higher creativity [2]. They are also more easily bored. Is this different? Yes. Is it bad? Certainly in the context of the standard educational experience. Do stimulants help? Sure, but they also help everybody cope with boring things. Almost every office in the world has a coffeepot. We have built a system that most people need stimulant drugs to function well. That some people need more or different ones than others to fit the system's needs is unsurprising. I'm just suspicious that the disease model fits it particularly well.
As an analogy, consider who can reach which cabinets. We just accept that there's a pretty wide normal variation in human height; some people can reach higher shelves than others. We also recognize that kids grow taller. If we started declaring kids below the median height had "Height Deficiency Disorder" and started giving them growth hormones because they couldn't reach the top shelves, that would be pretty sinister. Especially when that happened to the ones who were just younger in their grade, and therefore naturally shorter. Especially when it's possible to build cabinets differently, to provide assistive devices, and to help short kids learn how to deal.
So yes, we definitely don't want kids to fail. But I would like us to treat medication as a last resort, and to start being more accepting of neurodiversity.
The spread in executive functioning and other attributes between ADHD sufferer and non- is WAY wider than the spread between tallest and shortest person.
I would be interested to see your data for that. But even so, so what?
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There are plenty of human characteristics that have wider variation. Nobody's diagnosing people with European Skin Syndrome despite the way white people can't handle reasonable amounts of sun and are highly prone to cancer.
Also, it's an analogy, and not meant to be taken literally. It's just meant to give people a feel for what unnecessary medicalization might be like.
Amphetamine, opiods, and steroids are catch-all drugs. They can cover up the symptoms of pretty much anything.
People are right to be skeptical when the message is: "we don't understand the problem well enough o cure it, but take these pills and it will get you through one day at a time."
That doesn't mean it's wrong. But skepticism is warranted and inaction is a good default.
This sounds like "kids who can't read the white board should just sit closer or look harder". Yeah, some kids can't read the white board because they are sitting way far back or haven't figured out their letters yet, but some kids need glasses. The reason professionals make diagnoses instead of HN commenters is because they can tell the difference between "needs more phonics" and "can't see".
I was as sceptical of ADHD as most of the commenters here and have been resisting sending my son for an assessment for about a year because I guess what the diagnosis will be. However the more I've been looking into it and observing him, the more I'm coming to the conclusion that it seems to be something physical that he can't control. Just this evening we were in a restaurant and he was standing in his chair, climbing up a pole. etc... When he eventually knocked something over and I sternly reminded him to sit down, he started hitting himself on the head, apparently rueful that he's disappointed me again. It seems to be something he can't control and his repeated failures to do so seem to be affecting his self-esteem.
What would you recommend as the best interventions to explore? I would prefer something behavioural but am opening up to considering medication if the will make him feel better about himself and facilitate smoother interactions with his peers.
I was diagnosed with ADHD in my 50's. Without meds I have to spend an enormous amount of energy managing my cognitive state. Imagine you had to spend 60% of your time creatively managing yourself into a mental state where you can do something meaningful with the remaining 40%. And I've been practicing meditation for 30 years, I'm very active, I've adapted my lifestyle around my needs.
All that work doesn't even come close to the benefit I get from Vyvanse. I get effortless self control, and all that time back.
I figured out I had ADHD by observing my (very intelligent) daughter in kindergarten--she was the obvious behavioural outlier. All the other kids were mostly attending to the teacher, my daughter was attending to everything else. We didn't medicate her until Grade 4, when she started to think she was dumb. Meds changed everything for her, allowed her to develop a better self-concept (and winning the academic prize that year). She's off meds right now, struggling a bit, but a least she knows she's not dumb. That's huge.
Here's my thinking: stimulants are relatively safe. They aren't particularly addictive. Yes, they suck, there are tradeoffs. But if they don't work out, you can stop. You can stop whenever you want.
But once a kid has internalized "I'm dumb" or "I'm a loser" it is very hard to undo. That can stay with them for life.
I was diagnosed with ADHD in my 50's. Without meds I have to spend an enormous amount of energy managing my cognitive state.
I appreciate if you don't want to answer, but I've been diagnosed in my mid 30s (it came out of the blue, I was not seeking the diagnosis) and wonder what you mean by "managing your cognitive state"? I have so far not sought medication but wonder if I should do so.
I do software and system architecture, and I'm generally responsible for creating original content. In order to make any progress on deliverables, I have to be calm, have my memory loaded up with all the necessary context, and have just the right level of stimulation--too little and I fall asleep, too much and I'm wrapped around the axle.
I'm much better in the mornings, so I wake up early, 4 or 5AM, and I spend some time reading interesting technology stuff. Then I start casual reading on the task, not really trying to work on it, but just loading my brain. I set up my visual workspace (I have 3 monitors because visual context assists my shitty memory.) After an hour or two I reach a point where I can really focus and make great progress. I guess it's a way of getting into flow.
But a morning meeting that isn't directly relevant will wipe most of that prep away, and then I have to start again. So I avoid early meetings like the plague, unless it's purely an exercise in optics and I can ignore it completely and continue working.
When I'm medicated, it's way easier. I can direct my attention and it is resistant to distraction. My short-term memory doesn't keep reloading on every stimulus. I can get into flow in a reasonable amount of time throughout the day.
I'm off medication last few years, but plan to go back on in the next year. I love the cognitive benefits, but I have a couple of the rare side effects.
Thanks for replying! That's all very interesting to hear. I am much like your explanation but just considered that to be "normal". Maybe I should explore the medication options I've been signposted to after all.. I once experimented with modafinil and it had similar effects to what you mention.
Her decision. She's been reading stuff on the Internet that says ADHD might be fake and over medicated. :-) Her main real issue is the appetite suppression, which she hates.
Her mom and I can see the difference on/off, it isn't subtle. We aren't pushing. I'm committed to her success, but meds are just one tool. I expect she'll go back on them at some point, once she's exhausted her youthful political correctness.
Not OP, but I strongly suggest getting a full neuropsychological evaluation to diagnose your child. This could ADHD, it could be some other disorder, or it could be nothing at all, and a standardized professional evaluation is the best way to tell. They will also be able to suggest the best path forward for treatment. I can speak from experience, because when I was having trouble in elementary school my parents had be evaluated, which was how I was diagnosed with ADHD. I received behavioral therapy and medication and it really improved my functioning and my quality of life.
I was diagnosed with ADHD (inattentive) when I was a senior in college. My oldest son was diagnosed a year ago, when he was in first grade.
I began to suspect my son might have it when he was frustrated at learning to read—especially when he reported that distractions in the classroom (such as a new pencil sharpener) were making it difficult for him to focus. At home, I noticed that he was much more effective—and self-confident—when he did his reading in our basement den, away from his younger siblings and other distractions.
We took him to a prominent local child psychologist, who spent a few hours with us—first with me, going over my observations, his history, family, etc.; then with him alone. A few weeks later, we received a ~10-page report with his assessment, which included results from a battery of tests he had done with my son, concluding with a diagnosis of ADHD. Based on this, our pediatrician had us try a couple of different stimulants, and we've landed on Vyvanse as the best combination of convenience and efficacy. The difference has been staggering—not only with his progress at school, but most importantly, his self-confidence has risen remarkably.
I haven't read it, but the title of one ADHD book—"You Mean I'm Not Lazy, Stupid or Crazy?!"—has stuck with me. Growing up with undiagnosed ADHD, I often felt that I was simply inadequate, or not trying hard enough. Of course, personal responsibility still plays a role, but I now understand more what's going on.
Medication has markedly improved my life as well. But I think being diagnosed in early adulthood meant that I still had to deal with years of bad habits, self-esteem issues, perception by family and friends, transcripts filled with bad-to-mediocre grades...
Both my son and I present the inattentive side of ADHD more than the hyperactive side, but I suspect the results would be similar.
Getting my son's diagnosis started with his pediatrician, who recommended the child psychologist. I'd suggest starting there.
BTW, the reason I think my son was diagnosed earlier is due to the curriculum: it's simply more challenging at an early age than what I remember. I was able to coast on intelligence alone until I was a teenager, when I finally had schoolwork that required sustained concentration. My son was being asked to read books in first grade that I probably didn't read until second grade—and there wasn't nearly the systematic focus on it. My suspicion is that the increased diagnoses of ADHD is due in large part to this—it's always been prevalent, but has been less of a burden in the past (career options, too—so many ADHD-compatible jobs are getting automated away).
If it's ADHD, behavioral therapy isn't super effective, unfortunately (at least according to research I've seen). Medication could help and you... should see results pretty quickly (after a nasty adjustment period though. It changes how your brain works and feels extremely weird)
My understanding is that if you actually don't have ADHD, the medication isn't effective, so if it's helpful there's a strong signal there.
A proper analysis by a psychiatrist would be helpful (and you should share your doubts). But I think if you look at things beyond the "attention" and "hyperactivity" aspects . For example, saying things without thinking, lots of remorse for actions after the fact (showing proper judgement but lack of control), etc. Medical professionals are the best for this, but there's a lot of reading out there that you can check out.
To expand on this: for about two-three weeks after starting to take a Ritalin variant (this was in working life, I didn't have meds in HS + college for reasons) I was pretty on edge, getting pretty mad at stuff and even just pre-emptively cancelling meetings with some friends because I felt I would start yelling at the next person who talked to me.
I've heard this happen to other people too, and it's frustrating, but luckily it also comes with the feeling of clarity that was always missing, and fortunately people around me are supportive. No lasting damage, just "oh yeah I was a bit on edge then"
> If it's ADHD, behavioral therapy isn't super effective, unfortunately (at least according to research I've seen).
I'm surprised by that impression as my understanding was that it was "generally accepted" that a combination of therapy and medication was more effective in treating ADHD than either alone.
Sorry, the comment was more that behavioral therapy _alone_ is very ineffective according to a lot of research out there. Granted, the funders of such research are... well...
If you have to chose one or the other, medication will be much more powerful, but the combo is the best. But trying to fight ADHD with just CBT is a massive uphill battle once described to me as "asking someone who needs glasses to see to train their way to better vision"
Does your child have enough outlets to burn off his excess energy? It seems to me that kids really evolved to be outside running around with friends and siblings extensively.
I would bet if he was getting his heart rate up for 3-5 hrs a day he would be way way calmer the rest of the time.
It seems to me that the real problem is that we have constructed a world that is fundamentally at odds with our biology and then when people cannot function within it, we diagnose them as having a disorder.
It's a bit more than that though. I definitely got plenty of exercise as a child, but my ADHD still manifested in me getting hurt a lot more than my peers, because I either didn't have the impulse control to not do something obviously dumb, or because I would get distracted while playing a game and then get hit in the face with a soccer ball or something as a result. I had a poor summer camp counselor actually start crying to my parents because she felt she was doing her job terribly because I got injured so often. My parents knew that was just how I operated though.
Getting the excess energy out definitely helps with feeling overly-energetic, but it doesn't fix many of the core issues that ADHD causes.
> It seems to me that the real problem is that we have constructed a world that is fundamentally at odds with our biology and then when people cannot function within it, we diagnose them as having a disorder.
I don't know if you meant it this way, but this certainly sounds like you are implying that people with ADHD (or some portion of them) don't really have anything wrong with them, they just need to exercise or something. As someone who has lived with ADHD for their whole life, I find this attitude really offensive. I have a medical disorder, there's a chemical imbalance in my brain that has been diagnosed by doctors. I can't just walk it off.
It's not a case of the modern world being at odds with how we were evolved, I would be struggling in the ancient world too. Without my medication I have real trouble remembering things, making plans, and following directions. Moreover, if the modern world is so at odds with our biology, why does the overwhelming majority of the population have no problem functioning in it while I do? And I don't mean to come off as hostile here, but I find it insulting to be told by someone who presumably has no problem functioning in the modern world that my inability to function in it isn't really a problem.
I actually have ADHD-PI (primarily inattentive), and have struggled my whole life with it. It did not manifest as being hyperactive, just being extraordinarily bad at focusing on anything i don't find highly stimulating and being really damned forgetful. Adderall was a godsend for me as a child and I would have never gotten through school without it. I had to discontinue use of it in High school because it started to have very bad side effects for me as I got older.
I am no way trying to imply that ADHD is not real. I know it is real. But I am skeptical that every single kid diagnosed with it really would still have hyperactivity problems if they were running around and riding bikes for hours every day. If the kid still can't focus in school even with improvements to diet and more exercise, then yeah the kid probably really has ADHD and may need stimulants.
Even though I struggle with it, I don't think it's really a 'disorder' except insofar as it can interfere with one's ability to function in modern society.
It seems to me to be just a different way of thinking, one that is unfortunately much more suited to activities like hunting than it is to remembering to pay my parking tickets on time.
The majority of the population has lots of problems functioning all the time.
Its not that there isn't a problem, its that you are not the problem. The majority of the population manages to cope in various ways, you don't know how bad it is because everyone is hiding this coping away, as the modern world suggests they do so as not to be a burden.
Are you offended because you actually have tried working yourself to exhaustion and still were hyperactive?
I don’t believe that’s what the OP is saying. I understood his comment to mean that ADHD can be considered more of a “bad fit” for the person’s environment than an objectively diagnosable disease. Perhaps by changing the environment, ADHD’s symptoms may be mitigated. Maybe it’s not a 6-year-old’s fault that he/she cannot sit still and quiet in a room for 8 hours with maybe a 30 minute break for recess? Maybe it’s our expectations that are at fault.
You can really see developmental differences at 5-7. My son is 6, his kindergarten last year had kids between 4-6 on the first day of school and they vary substantially. Their lives vary a lot as well... how do you expect a 6 year old in early day, school and aftercare from 7-5 to behave?
I’m sorry, but your individual anecdotal experience does not refute his hypothesis in any way. It is reasonable to hypothesize that the increase in ADHD may be due to environmental factors (diet / exercise / etc). Those factors may affect certain subgroups more than others. Your perceived offense is not helpful to the discussion because you cannot speak for all people with ADHD and it should not shut down any line of inquiry that could help people in the future. I completely understand that you are not considering yourself as part of that group, but please let other people try and find alternative ways to address the problem without trying to shut down the conversation by proclaiming how insulted and offended you are.
I don't know, "being able to put dishes in the dish washer", one of the tasks I personally particularly struggle with, doesn't seem like it's an unreasonable social construction.
> When he eventually knocked something over and I sternly reminded him to sit down, he started hitting himself on the head, apparently rueful that he's disappointed me again.
I'll admit that this was upsetting to read--your son is literally beating himself up over this. And I would guess his inner monologue is probably at least as equally unkind.
There's a lot to unpack from your comment to which I'd like to respond but given how long it's taken me to even sit down to write this, I will limit myself to urging you to read "Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood" by Edward M. Hallowell & John J. Ratey (https://www.goodreads.com/book/show/108593.Driven_to_Distrac...).
One of the reasons why I recommend this book is that it is very focused (you may wish to excuse the pun) on establishing a correct diagnosis before moving onto possible therapeutic approaches. This includes a chapter on issues that are misdiagnosed as ADHD/ADD when the cause may be something else and another chapter on misdiagnosed issues which may actually be ADHD/ADD.
The book also addresses a wide range of other aspects related to ADHD/ADD which often aren't mentioned:
* Mood swings
* Difficulty communicating "serially"
* Acceptance of diagnosis
* Heightened sensitivity to criticism
* Parental guilt over existence or non-diagnosis
* Mourning over lost opportunities/time
* Impact on relationships with family, partners, friends & authorities
It also includes case studies of individuals, families & partners and how they have been impacted.
FWIW a common refrain from adults with ADHD/ADD is that frequently the biggest/longest-lasting damage that un-diagnosed ADHD/ADD has on an individual is the anxiety, depression & self-hatred that comes from not being able to do the "right thing" and not understanding why. Something exacerbated when others around them are all too quick to reinforce the message that it's because they're lazy, lack willpower, or, are just not trying hard enough.
On the other hand, unlike many other mental heath disorders, even just having a diagnosis can actually be helpful because it provides some answers to "why am I like this" and a new lens through which to view oneself & interactions with the world--and hopefully also leading to new ways to cope & progress.
Personally, I feel it's also worth contemplating why you (and others) were/are skeptical about the existence/reality of ADHD/ADD.
My observation is that a contributing factor to skepticism is that ADHD/ADD intersects with an almost perfect storm of societal/cultural fears, including:
* Fear of children being negatively affected by misguided/incorrect parental actions.
* Fear of the impact of "unnatural" medication.
* Fear of medication that can be misused by those not affected by the disorder (and lack of understanding on how the medications work for individuals with the disorder).
* Fear of misdiagnosis due to the "invisible" nature of the disorder.
* Fear of not applying discipline & boundaries in childhood negatively impacting the child's future
* Fear of enabling bad character traits such as "lack of willpower" & "laziness" by accepting an "excuse" for behavior rather than demanding more effort. (And other effects of a "puritanical" belief that the solution to every problem is to "work harder".)
* Fear of someone else gaining advantages/shirking responsibility through deception.
It's also worth noting that--like in relation to many medical issues but exacerbated by ADHD/ADD even triggering skepticism in the medical community itself--the response/assistance you & he will receive regarding an assessment will unfortunately be highly dependent on the individual medical practitioner.
I'm just a stranger on the internet but for the sake of your son please strongly consider at least reading the book I suggested and preferably seek an assessment from a medical professional with experience in such disorders.
Oh, also, you don't mention how old he is but perhaps when a similar restaurant situation happens again (or even now) you could listen to his answers to some gentle questions from you about what he thinks just happened and why it happened. It might give you some insight into his experience of the situation/existence.
Additionally, I do think it's important to acknowledge issues like this aren't easy for child or parent, so I consider it positive that you shared your situation & asked for recommendations.
Thanks for taking the time to read and consider my suggestions.
Thank you for taking the time to write your comment.
That book looks exactly like what I am looking for. I will definitely look for it.
With regards to my scepticism, I think you captured a lot of it in your examples. I guess i am afraid of people taking the lazy approach of labelling and medicating anyone who doesn't fit into the system rather than questioning the legitimacy of the system in the first place.
My son only recently turned 6 and I also believed that with enough outside and physical play perhaps he would be better able to regulate his behaviour the rest of the time. However he goes to a very progressive school with no desks and all enquiry based learning through play yet he still struggles more than the others with self-regulation.
As I said I'm coming round to a diagnosis possibly being appropriate as I learn more about the condition. He will go for a full neurological and developmental assessment in the next month or two. I want to be informed enough by then to interrogate the results to ensure he receives treatment that is situated appropriate. Another commenter mentioned that the efficacy of stimulants is a strong signal in itself so that's something I want to keep in mind should we get to that point.
Thank you to all the thoughtful comments, much appreciated!
I have ADHD and I use to do this when I was younger.
I was diagnosed with ADHD when I was in 1st Grade. I was having a hard time learning to read, just moved to a new school, and was supposed to go into 2nd, but was held back because of my reading level. Once I was medicated I improved so much, I went from hating school to actually wanting to go and spend time with my friends. It also helped me to stay in control, it brought me down to a normal level.
It's really interesting that you used the story of him knocking something over. I can think of many times I have knocked something over or touched something and broke it. I remember when I smack myself or just break down. I did this when I was younger and yeah it's a feeling that will be hard for him to control. I felt like an idiot and that I ruined everything when it happened. Just build him up and let him know it is okay!
It's hard to make a recommendation but going to a neurologist and also seeing a therapist have been huge. That helped with the medication and diagnostic.
What has helped with everything is exercising and eating clean. There was an article posted recently that showed children's test scored improved by 10% (not positive on the 10 but it was enough) when they did cardio before tests. I know and feel totally different when I have exercised. It's hard to tell a child that they need to run or do some form of exercise, but getting them out and running around with them will do so much. Also not eating food with food coloring or sugar will be so helpful as well. It's simple but it is super key.
TL;DR: Go see a neurologist/Therapist. You don't need to medicate, and it's not the only solution, but it has helped me. Read as much as you can on ADHD. Exercise. (Scooters are hot right now)
My comment may be lost on you, as I feel we are looking at life very differently, but I'll try, and perhaps you can think about it. I would be interested if others have experiences that are similar to mine.
Let me give some background first...
I grew up like most kids, going to school, but also perhaps unusually for the time (20-30 years ago), spent nearly all my free time playing in the fields and woods and riding bikes with my small group of friends. Honestly, it was the highpoint of my life so far.
From about age 6, I was obsessed with "living in the wild" and survival skills. I read books about it, and taught myself skills such as plant identification and friction fire-lighting. I did exceptionally well at school, mostly through natural ability, but also a fear of getting told off, which meant I always did as I was told. It turns out that if you are naturally intelligent and stick to the task, you do well. Who knew?
By about about 13, I began losing focus. At first I still did well, but in the end, I left school with a mixture of As and Bs. It was made clear to me that for someone of my calibre, this should be regarded as a failure.
Looking back, knowing what I now know about mental health, it was clear to me that going to secondary school had been emotionally devastating for me -- I was overwhelmed by the pettiness and the bullying -- and was increasingly depressed as time went on. On reflection, the tone of pettiness and bullying was actually set by the teachers, and in fact, the school system itself.
Skipping forward, I became an arborist (tree-surgeon) when I was 20. Even as a previously active person, I discovered a depth of "animality" that was unknown to me. I became profoundly tuned to my strength and power. It was liberating. All this time, I found it difficult to socialise, as I found other people so boring, not because of who they were, but because of what they did, or rather, didn't do. Once everyone got to age 16, they took up drinking, which is just an elaborate form of spending your time sitting down, which I found intolerable. When they weren't drinking, they would maybe go to the cinema, or drive around in their cars, all activities a million miles away from my outdoor interests.
It wasn't until I was 27 years old and suffered a knee injury, that I learned how to be comfortable sitting down. I didn't really like it, but I got used to it. Since then, I have spent plenty of time sitting down, the internet has taken over all our lives, and I have developed chronic sleep problems. I've never felt worse. I never did go and live off the land; it turns out the UK isn't really set up for that kind of thing.
So that's my experience of life. I don't know what yours is. It's probably quite different. From my perspective, I have zero difficulty understanding where children are coming from. Think about it. You're born an unknowing blob, unable to even focus you're eyes on things, but you're growing, and have many built-in urges. As you learn, naturally, to walk, you begin to explore and learn about the world. In the first years (and in fact, you're whole life) your outlook on the world just keeps getting bigger. You need adults to watch your back, but you want to get out there on your own too. How? Walking, running, climbing, engaging those animal instincts that I found so intoxicating in my twenties after years of education.
But then you reach an age (5) where your world starts to get smaller; you're sent to school by people who you thought cared for you and a stranger makes you do things that you don't want to do. A year later, things change and a different stranger bosses you around. This pattern repeats every year. If you ask mum or dad why you're doing this, it's said that it's for your own good.
Maybe the early years aren't so bad, but for my own part, even as as kid with no formal training in exercise physiology, as I got older, I had a visceral sense that I wasn't getting enough exercise, and would strenuously devote all my free time after doing homework to being outside, even in the dark winter nights. I was lucky, as I had friends who would do the same, but still, it was boring at times.
Restaurants are designed for adults, with refined sensibilities in cuisine and conversation. These sensibilities are usually lacking in children who just want to eat and get back to playing.
Your son was hitting himself over the head. Sure, why not? After all "[you] sternly reminded him to sit down, [leaving him] apparently rueful that he's disappointed [you] again". I don't know you, so won't judge your parenting, but you might want to judge yourself, by noting how many times a day you sternly remind him of things. If it's frequent, then what's in it for him? It's one thing to be corrected now and again, but if every day is one correction after another, then what does he have to look forward to? Clearly not family time at the restaurant. You might be surprised just how upset this all makes him. If people are upset and feel they have no control, then they tend to act erratically and "uncontrollably".
There is debate in the other comments about whether ADHD is over-diagnosed and people "just need more exercise". Your kid hasn't even been assessed, let alone diagnosed, so while other people in the thread may be talking about ADHD, we are not. We are talking about your perception of your child's behaviour. Hopefully, I may have given you a different perception.
This study straddles the time when the DSM-5 was published and came into general use, and in any case it didn't follow kids past age 6-8 depending on birth year, so that part of the change in criteria probably isn't relevant to the results.
I'd also love to know how children were diagnosed. My 10 year old was diagnosed with ADHD, but that was the result of a fairly comprehensive two day evaluation by a neuropsychologist. In that case, she was able to provide evidence and reasoning that went well beyond the "can't sit still in class" or "needs constant reminders" notes we'd get from frustrated teachers. Ironically, it was that diagnosis and subsequent lack of support from his school that led us to pull him from private school and put him in public school.
Since you're a researcher in the field, what would you suggest a teacher (specifically an after-school "enrichment" teacher - who cannot give grades and/or homework) do to maintain better classroom control? I'll be honest, I'm getting to a point where if there's a boy in my class, he gets one class session to prove whether he's one of the loony kind or will actually focus - and then almost completely ignore him and his behavior if the former. It's not good for the kids, it's not really a productive thing on my part, but it's been the only thing that works.
Occupational therapists can be particularly helpful in working out accommodations like bouncing balls for seating, balance boards, fidget devices, etc, that can provide extra stimulation that allows kids with ADHD to focus.
I went through OT for eye-hand coordination for several years. I wish I had the means to provide that level of accommodation or to successfully convince my schools to do so.
>> To have a diagnosis of ADHD, there must have been symptoms before the age of 7...
As every five year old is likely displaying symptoms of ADHD, that is going to lead to a lot of false positives which seems to be the issue that most concerns people.
This is pure speculation, but is it possible that we're less strict nowadays in child-rearing behavior (none of that children are meant to be seen, not heard nonsense.) So perhaps the children don't develop the same degree of control over their behavior because their parents aren't forcing them to behave themselves to the same degree?
I remember when I was a kid, we had to learn to be quiet when my dad was home. Making too much noise would inevitably lead to escalating admonitions from my father to be quiet.
People voted this down, but it's plausible. The brain is like a muscle in some ways, you work it out and it gets stronger. So I think it's entirely possible that if you work out your pre-frontal cortex by having to control your behavior all the time because your parents are strict - you develop stronger self control. Sample size of 1, but it seems true enough in my case.
Can this have anything to do with the increasing use of cell phones and tablets by small children?
At a relative's house about a week before Thanksgiving, having McDonalds at the table, the children were actively busily engaged with noisy tablet games and videos at the table. Definitely not something that would be allowed at my house.
Hostile gotcha comments, which this reads like to me, are not ok on HN. Please don't post like this.
When a user contributes an informative comment in his or her field of expertise, the last thing we need is other users showing up to disincentivize them from ever doing that again.
It may not be the case here, but Laboratory Schools are pretty common in early childhood development programs. Basically normal elementary classrooms located on college campuses for researchers to observe.
>A laboratory school or demonstration school is an elementary or secondary school operated in association with a university, college, or other teacher education institution and used for the training of future teachers, educational experimentation, educational research, and professional development....Some lab schools are only for preschool or kindergarten children, some are preschool through fifth or sixth grade, and some continue through high school...Laboratory school classrooms may be observed by university professors to assess the student-teacher, but it is desired that the observation be done without the students or student-teachers aware of the observation, thereby avoiding creating a distraction or disruption of classroom activities.
it is quite possible that some differences in neurodevelopment between boys and girls can be accounted for by differences in how others interact with them as boys and girls, e.g. what they are punished or not punished for doing, how much self control or aggression they are expected or permitted to express, and so on. those are hypotheses, of course, but the brain is plastic, and environmental inputs really do matter.
I read that the researchers knew this was already known, but wanted to publish this because they considered their results to be quite pure of any other factors
The message is dangerous here. We're telling young people (very young people) "you are not in control of yourself." The message should be, "you need to learn how to control yourself." The fact that this is a modern malady, and mostly occurs in the medication happy United States (where healthcare is a for profit industry), indicates it's a matter of making money and not improving the lives our our youngsters.
> The message should be, "you need to learn how to control yourself."
For someone with ADHD/ADD some combination of therapy, diagnosis & medication may enable them to learn how to manage their interactions with the world better (or "control themselves", if you prefer).
In most cases medication isn't a "magic pill" that fixes everything but it may bring a person to a place where they are able to effectively use the same self-management/organizational techniques used by people who do not have ADHD/ADD.
You're probably going to have a Bad Time if you try to run a marathon with a broken leg--regardless of how much self-control one has.
I am really surprised at all the skepticism about ADHD in this thread.
1) Attention (or executive functioning in general) is normally distributed, just like a lot of other human traits. If you don't doubt that intelligence is normally distributed (and that some people are smarter than other), what makes you think that there is no variability in executive functioning / attention?
Executive functioning also improves as brain develops, and that's why problems of younger kids are probably more noticeable.
2) Re: diagnosing using checklists and interviewing. That's literally how every other psychiatric disorder is diagnosed. Depression? Checklists and interviewing. Anxiety? Checklists and interviewing. Schizophrenia? Also checklists and interviewing.
Studies show that there are measurable differences between ADHD brains and normal brains. People complain that these are not used for diagnosis. The reason these scans are not used for diagnosis is because the resolution of common brain scan methods is not high enough, and these differences are seen on the population level.
Skepticism is common. I believe this is because the idea of ADHD as someone who can't sit still or is disruptive in group classroom settings has been popularized and accepted as the defining characteristic of the disease.
What people do not understand is what you called out in #1. ADHD is primarily an executive function disorder, and people do not understand what this means or the impacts it has on someone's life. Though this does materialize as impulse control and risk taking, it also represents an inability to plan, execute routine behavior, make decisions and have perspective to retroactively modify behavior.
If we popularized the idea of ADHD as the adult who always leaves at the time they're supposed to be somewhere, has had their utilities shut off because they forgot to pay their bill, poor credit, constantly loses items, always seems to be making last minute decisions (or is painfully indecisive), has poor dental hygiene because they consistently forget to brush their teeth or go to the dentist and so on, people might be better able to relate to what happens in the day to day life of ADHD. Low self-esteem, anxiety and depression are co-morbid with ADHD at staggering rates. Imagine being someone expending immense amounts of energy and thought just to do the "normal" expected things of individual life, and failing consistently to actually do them. Additionally, you're producing consistent disappointment in those around you ("Why can't you just show up on time just this once!?") compounding the sense of worthlessness.
I believe if people viewed ADHD through this more nuanced lens, they might focus less on the "drugging children" aspect of ADHD and far more on the human reality and toll of the disease.
Spot on. I wish ADHD had a less cute sounding name, maybe then people would take it more seriously. And it is also a misnomer: it is often about being unable to regulate attention (rather than simply having a lack of it), which leads to mysterious variations in productivity, especially with tasks that are not novel, interesting or challenging.
IQ arguably follows a normal distribution because such tests are constructed to do so. This leads to the criticism that useful measures of intelligence are excluded because they have a threshold effect which can't be sensibly normalized ( https://en.wikipedia.org/wiki/Intelligence_quotient#Systemat... ).
Disorders typically refer to such threshold effects, where rather than expected variance, there is a distinct anomalous population. ADHD is such a case where there is a threshold, which appears to be most commonly caused by a genetic factor affecting the dopamine transmission system. Although that's not to say the distribution function isn't continuous, and a person's membership in a statistical population isn't arbitrary.
I suspect the rather poor diagnosis situation is going to naturally produce a lot of skepticism. Anyone is going to start questioning things if they see kids with a diagnosis who seem basically normal. And, unfortunately, that does seem to be happening quite often.
If they are being successfully medicated they'll seem normal.
And even if unmedicated, they may seem entirely normal, because you're not watching them read the same page of a book 20 times, or doing other things where the condition causes a problem.
Not everyone with ADHD is like an energetic child who's had too much cake.
> How do I, personally, define normal? Who gives a shit?
If you care enough to leave a comment on HN, please also explain _why_ you think it is poor. Because right now your comments add no substance to the discussion.
We are in a discussion about an article providing strong evidence that diagnosis is poorly done. Do a little research yourself, and you'll find it's hardly the only evidence. Feel free to peruse a good New York Times write up from a while back: https://www.nytimes.com/2013/04/01/health/more-diagnoses-of-...
Maybe the ADHD brain is the normal brain and there is something abnormal about domesticated human brains, the ones that conform to the needs of modern corporations and the schooling system that supports them. Maybe the ADHD brain is a better hunter gatherer / forager brain.
There is a 'hunter vs farmer hypothesis'. It is certainly a cute idea. But even if it is true, the society isn't going back to back to persistence hunting.
There is some real human suffering right now (simply by definition from DSM - if there is no impairment, it is not ADHD).
"I guess I picked the wrong time to be a human being".
I have ADHD and hunting and fishing are some of the most engaging things I can think of. Spearfishing can keep me focused for an entire day. I also love working on my equipment and researching hunts. This is all boring to everyone I know. I guess the key thing is that ADHD isn't an inability to engage or focus at all - there's a degree of selection involved.
For what it's worth, I never hop out to examine rocks. Some people with ADHD might suffer from impulsive distracted behavior like that, but certainly not all.
Humans run slowly, but human bodies can dissipate heat very efficiently through sweating, and this makes humans good long-distance runners. AFAIK, humans can outrun most other animal species.
So if I understand it correctly, the hunting method involves scaring your prey, running for a while(yay hyperactivity), using your big brain to figure out where the prey went and running again for a while. Rinse and repeat for many hours, until the prey literally dies from exhaustion.
I imagine persistence hunting as a series of puzzles while you literally can see your reward - no delayed gratification involved.
With regards to positive selective pressure, there's also the even simpler explanation that ADHD correlates with a greater number of sexual partners, early parenthood, etc.
Although genetic success doesn't necessarily mean success for people's well-being.
2 - Okay all psychiatric disorders use checklist and interviewing, but that may reflective of a problem with modern psychology.
It's very hard to say with any objectivity how much happiness, calmness, or attention is proper when your life situation may be bad, stressful, or boring.
So even if there is a biological condition that stems from brain differences, what is the R^2 between professional diagnoses of ADHD and actual biological cases of it?
> 2 - Okay all psychiatric disorders use checklist and interviewing, but that may reflective of a problem with modern psychology.
And this problem being what exactly?
> It's very hard to say with any objectivity how much happiness, calmness, or attention is proper when your life situation may be bad, stressful, or boring.
And your solution is what exactly? Do nothing?
The reality is that it's not easy, but certainly not as hard as you make it to be. Most psychiatric diagnoses (including ADHD) have decent inter-rater reliability. They are certainly going to produce some amount of false positives and false negatives. But the moment humanity invent magic test for depression/anxiety/ADHD/etc, psychiatry is switching to it.
> So even if there is a biological condition that stems from brain differences, what is the R^2 between professional diagnoses of ADHD and actual biological cases of it?
Like I mentioned, brain scans are not really used for diagnosing (yet), because they are not sensitive enough to be used for diagnosis. How would you compute R^2 in this situation?
The point is just establishing condition X exists doesn't establish that most people diagnosed with X actually have X (and those who don't, don't).
The burden of proof on the psychiatric community is greater than to prove a condition exists in a biological sense. It is:
1. Prove condition exists. Identify if it is a specific illness or just an extreme on a range
2. Prove that they have a reliable and accurate way to diagnose it and that most physicians in the field agree on their diagnoses (i.e. interviewer intereliability > 90%). In so doing, prove this diagnoses is independent of self-image (e.g. a kid who's told they are distracting all the time may answer that they "can't focus" on a questionnaire because that's what adults tell them).
3. Prove that whatever solutions they are offering are statistically effective at helping the condition described in 2. Administer a post-test on each person receiving treatment to verify that they are indeed helped by whatever drug they are purchasing.
--
The community doesn't meet this standard. And therefore we are right to be skeptical of it, it's half-assed with peoples mental health. I'm more rigorous with my software than they are with mental health.
To answer your question - You'd do a research study on "Brain ADDness" based on size of brain structures. Then you'd give a traditional ADD test to these people. And you'd look at the correlation.
My birthday is in November, and the cutoff when I started school was October 31st. I was always the oldest kid in my grade, all the way through highschool. Back when I went to school, ADHD didn't exist as an identified condition. If it had, I may have been diagnosed.
Everything was way too easy for me, and I acted out a bit, perhaps out of boredom, or simply because I had way too much free time. I've always been "book smart", even among people my age, and it was particularly true when I was six months older than the median student in my class and nearly a full year older than some.
I'm highly skeptical of ADHD as an actual condition. Some kids clearly have learning and behavioral problems, but I've got plenty friends and family whose kids were diagnosed as ADHD and they are now medicating them into submission. I think most of them are more like me; they're not being stimulated enough at school, or stimulated properly. These kids need better schooling and better parenting. They don't need to be drugged up.
Anecdotal evidence isn't enough. There is actual neurological evidence that those with ADHD have mismatching development of their motor cortex and their PFC which controls the executive functioning of the brain. Most meta analyses of the diagnoses in recent years do not support your skepticism, in fact, some researchers believe the condition is properly or even UNDER diagnosed.
Let me unpack what you're saying here. Note that I have not surveyed the literature, but I am slightly skeptical of ADHD as a diagnosis, having seen "early detection/intervention" results amongst the children of my peers that seem patently ridiculous.
> There is actual neurological evidence that those with ADHD have mismatching development of their motor cortex and their PFC which controls the executive functioning of the brain
That is to say that the set of people diagnosed with ADHD correlates to the set of people who have mismatching development. But the tests for ADHD (especially in early childhood) do not undergo any sort of PET or fMRI scans for mismatched development; they typically have a set of questions that they ask with a threshold for the number of "wrong" answers. I suspect (without evidence) that as the testing moves earlier in age, there is more "success" with early intervention simply because the condition is transient.
In situation where intervention is recommended, I think overreactions are common and doing large-scale studies to determine how effective the questionnaires are at rooting out both positive and negative findings of "mismatched development" through directly measurable means like fMRIs or PET scans, which are contraindicated in non-acute cases for children of the ages in question, so we have to have longer-term survey studies before we can begin to evaluate effectiveness.
The age-related results referenced in the article (thought I haven't read the study) seem to indicate that at least some of the ad hoc testing is just measuring normal childhood development milestones rather than serving as a useful indicator of ADHD.
Early intervention may in fact be able to mitigate the symptoms, support earlier development of compensating skills and possibly make future treatment unnecessary. That should be considered a success, not cast doubt on the original diagnosis.
It's not a transient condition, like an infection, it develops over time as the brain matures. To call it transient implies that it's fleeting/ephemeral, and having met people diagnosed in their 60's crying because they finally understand why the struggled in life, I saw first-hand that it is not transient.
So, developmental means that it's not present at age 1, but by age 7, it must have become present. Otherwise, we're looking at anxiety or depression or something else. Even those diagnosed with ADHD as adults, one of the stipulations is that they MUST have had symptoms before age 7, though admittedly the DSM versions have changed regarding this point (side note: this is part of the reason the diagnosis is seen as trendy/over-done recently, because subsequent DSM versions have changed it up quite a bit, from what was called minimal brain dysfunction in the 50's to ADD to ADHD these days).
Anyway, the gold standard diagnosis in children is about functional deficits in multiple settings. It's the following: can you remember the items you need every day, can you focus on school, do you lose things, are you disruptive in class, can you keep your seat, are you hyperactive w.r.t. your motor activity? If you have enough deficits, you are diagnosed. These deficits are observed in school, at home, and in as many settings/by as many people as is practical. It's not about expensive scans, which would be impractical and costly. It's all about functional deficits, problems in life. I merely bring up the neurology because it's important for skeptics to understand there is a real, scientifically proven difference in the brains of those with ADHD.
I agree. I'm not completely dismissive of the diagnosis. Just highly skeptical of its application. The sad state of modern medicine is that these diagnoses come not from extensive detailed study of every individual by a specialist, but from a few brief Q&A sessions where behavior is compared to a checklist. It's certainly not hard science at the individual level.
The hard science went into developing the DSM-5, which is used for diagnosis. We don't need to conduct a study every single time a phychiatrist is presented with a kid who might have ADHD. Yes, the DSM is a checklist but it's a checklist for pretty much every single mental disorder that exists, by definition.
To say that it's been criticized doesn't mean anything, because there are skeptics who criticize ADHD diagnoses with zero understanding of the literature. If you actually read the experts on the subject, for instance my advisor Dr. Weyandt who wrote a very in-depth book overviewing the literature on ADHD, you'll see that over-diagnosis is not a commonly held view amongst actual experts. But, like climate change skepticism, many people think they can make a claim about over-diagnosis with zero expertise.
The previous poster expressed skepticism of the DSM-5 as a diagnostic tool.
You responded the DSM 5 was developed with hard science, and that it is sufficient for diagnosis.
I'm saying criticisms of the DSM-5's diagnostic strength is valid and not a fringe position. Part of the reason it is updated periodically is to improve upon its capabilities as a diagnostic tool.
The belief the DSM has weaknesses is not equivalent to climate change denial.
> In one of them, I was informed that America is medicalizing normal childhood mischief and loading anyone who gets worse than a B+ up with Ritalin or amphetamines as part of the pathologization of everyday life.
> In another, I was informed that ADHD is shamefully underdiagnosed and most of the children who need stimulants most are going without them and failing school unnecessarily, so we need better screening programs and more efforts to seek out potential sufferers of the condition.
> So I asked one of my attendings, Dr. L, which one it was. Are we overdosing ADHD? Or underdiagnosing it?
I'm in a similar situation. I was a gifted student in school, so I breezed through school without actually ever having to put in any effort. It didn't matter that I couldn't focus on anything because I didn't need to.
Then I started in the workplace and I really struggled. Sitting in meetings was a special kind of torture, but even at my desk I was struggling to actually stay on track.
Anyway, I'm on dexamphetamine now, which is good because it actually means I can get some work done. It's bad though because I feel like a fucking zombie. I actually like being scattered, it feels like a big part of my personality. I hate the concept of having to take drugs so that I can fit in and be a "productive" member of society.
Part of me wants to try the experience you've had. I also breezed through school and am tortured by office mundanity, and I waited until 29 to finally get on medication for ADHD. It helped a lot, but it's definitely not a solution. I'm more focused than I was, but I'm still very scattered.
It's a bit like buzz lightyear saying he's flying when really he's "falling with style". Adderall takes me from falling like a ragdoll to falling with style. Better than nothing, but I still don't feel like I have the mental properties that "normal" people seem to.
Off the meds, I have the apparently typical ADHD mentality of "totally gone 90% of the time, uninterruptible superhuman flow state 10% of the time". Have you found that this dynamic changes or is evened out fully by the meds? I've found that it's tamed slightly but not nearly in full, and not sure if that's as good as it gets or if I should be trying to make more adjustments.
I'm someone with ADHD and I've had it diagnosed and medicated since I was around 10.
Medication is only half the battle. It takes the edge off, but it's not a cure-all.
For me, therapy was by far the most impactful thing in my life. I learned how to externalize things so my forgetfulness or distractions don't cause them to be forgotten, I learned how adhering to a strict schedule can be extremely beneficial for me, and I learned that the "superhuman" state you talk about isn't actually a good thing to be in (it's more of a "manic" state when I really looked at it. I feel superhuman at the time, but when I go back and look at what I actually accomplished, it's often I got sucked down a rabbit hole that wasn't actually on task), and that I could almost "trick" myself into getting into a good amount of focus (not hyperfocus, and not constantly-distracted) with a combination of all of it.
It's taken years, and the medication is still a very integral part of it, but it's only part. And every year I feel like I get better at managing it.
I had the same experience growing up; never had to pay attention in class but always got good grades. I took meds (Ritalin) when I was 7 but stopped because it made me feel like I was trapped in a cage.
Now I use caffeine to control my symptoms, which only works because I'm extremely sensitive to stimulants.
I breezed through until 6th grade or junior high, then my grades began a slow decline. I was diagnosed half way through college. I've been on stimulants since.
Like you I was schooled at a time when ADHD wasn't something teachers were trained to look for, which meant I wasn't diagnosed until I was well into adulthood. Once I actually got treatment it turned my entire life around. I mourn for the years that I lost. I'm certain that there are times when it is over-diagnosed but ADHD is absolutely a real thing. No amount of stimulation, schooling, or parenting can fix a person who has it.
It is an actual condition, I was diagnosed in my early 20s. While I don't think young children should be drugged up immediately, diet and exercise can definitely help. It's sad to say, but it's shockingly easy to recognize a misdiagnosis and someone that has the condition.
But drugs can be useful at a certain point. They shouldn't be the go-to right away though. But it is outright ignorant to doubt the condition exists.
I'm a bit surprised I haven't seen any comments (admittedly, I got too distracted to read them) about the decline of children's free play and the increase in adult-guided activities in America over the past 50 years.
I was diagnosed with ADHD when I was 15 and have intermittently suffered through it over the years. I took meds for a while, but I felt like an amped-up zombie and stopped some time during college.
Kids have not always gone to school for full 7 hour days starting at age four or five, where they have been subject to strict rules that emphasize obedience to adults and "sitting still." In fact, some research indicates that children at a young age learn best how to regulate themselves through play with other kids, including through games (that they themselves create) and role-playing. Kids figure out how to regulate themselves from each other, not from adults. (This could explain why increases in ADHD, bullying and teen suicide seem to be happening at the same time.)
I look back and think that at least in my case, this might explain a bit of my issues. In my case, I think there are probably underlying causes that are only now, years later, being looked at, including pretty serious trouble sleeping and some hormone problems. But I also think that I lacked the child-oriented play that kids really need, and was wound up in adult-guided activities where I didn't learn to govern myself.
I'm not anti-schooling, but I do think that the schools have gotten too high-stakes at earlier ages, and we should probably limit younger kids to shorter school days and allow them to engage in relatively hands-off free play with each other. (Of course, this is much easier said than done - teachers unions and the lawyers' guild are quite powerful, and we moms and dads love the free babysitting we get at the public expense.)
It's interesting because one thing about ADHD, and Autism Spectrum disorders too, is that diagnosis is very dependent on people having a base point to compare against. That's why for most of these disorders, you're more likely to be diagnosed if you're 2nd born and 1st born doesn't have it. The parents are familiar with how the first child developed and can see the discrepancy sooner.
Meanwhile, in cases like my family, where me, my sister, my Dad, some cousins, and probably my mom's siblings too all fit the criteria for ADHD (we're a family of troublemakers) - my parents couldn't tell anything was off. When my cousins got a diagnosis through school, my parents were skeptical of the whole thing. But the treatment they got for it early on helped a ton and those cousins turned out better adjusted in many ways than my sister and I who didn't get diagnosed til adulthood.
It's funny though because now I have a step-niece (no biological relation) and my mom keeps commenting on how crazy well behaved she is, because she doesn't run around every time they go to a restaurant or talk incessantly or constantly run into things... So from her perspective, children without ADHD-behaviors are the abnormal ones. Go figure.
I don't dispute that ADHD is an observance of a real phenomenon, but maybe the prevalence of the diagnosis is a result of society overoptimizing human productivity? Having ADHD, especially now that ADD is ADHD-PI, seems very normal these days, but it we treat it more like an affliction than a common behavior the modern world needs more compassion towards.
If I have a child and they seem to have ADHD, I would pull them out of the public school system so as they don't have their time wasted and their esteem destroyed. If the system doesn't become more understanding, then it's up to me. At least then my child can be brought up to learn good coping mechanisms they'd be lucky to otherwise learn before it's too late.
Speaking as someone who was diagnosed with ADHD-PI as an adult I can assure you that it is an affliction and there is nothing normal about the behavior. It's not just that someone is prone to daydream and with a more compassionate environment you could leave them as they are. Some (if not most) will need to be treated just to be functional at all in any environment.
I don't doubt that some people have forced drugs on their kids to try to get them to some next level in productivity but in the case of someone who needs those medications it's really more about getting somewhere close to the same level everyone else operates on even if only for a few hours of the day.
If you do end up with a child who appears to have ADHD the best thing you can do is get checked and if they are diagnosed start experimenting with treatments to see what the kid needs. The longer you wait the harder everything becomes.
I researched ADHD and was a teacher to boot. You wouldn't think it's about human productivity when you have ADHD children standing on their chairs, shouting, wandering the classroom during examinations. It's a serious neurological disability and it's not just down to societal pressures for productivity.
Some sad facts: Those with ADHD are much more likely to be friendless, to have fights with parents, to abuse alcohol, nicotine, marijuana, and cocaine, and to develop mental health problems like depression, anxiety, and conduct disorder. The brain of those with ADHD is not "normally" developed and that leads to a lot of issues.
I think you missed the point. Kids have been kids forever. Kids with ADHD have presumably also been around forever, and seemingly they make up perhaps as much as 1 in 10 kids. Is it ADHD causing these kids to "act out" or the unreasonable expectations of our modern, industrialized and highly regimented school system that's part of the problem? The school system as it exists suits some (perhaps a slim majority of kids, by some measure), at least to the extent that it creates a population of obedient students, but does it suit everybody? And is the solution to ADHD to simply smash the kids who are unable to be cogs in the machine as it exists today into the shape of cogs that do or is it to change the machine so that kids of all types can learn and succeed?
You point to the "worst" examples of problem children with ADHD but you miss the fact that the majority are nothing like that, you also miss the fact that their issues are hugely exacerbated by a system that does not work for them, does not care about them, and a society that does not prepare them with the coping skills necessary to deal with their issues.
What makes you think those kids did fine before? Rather than that those were the kids who ended up dropping out, unemployed, in poverty, in the poor house, turning to crime or dying in duals? It's not like things were great for almost anyone back when average life expectancy was 36.
I wonder why is it that we didn't have any kids who were standing on their chairs, shouting and wandering the classrooms during examination when I was attending primary school in the 80's. I have never heard of such a case and we had a decent sized school of about 150 children of the same age. Multiply that by 8 grades and that is 1200 children and surely these symptoms must have manifested in at least some of the children if ADHD existed back then also.
Another sad fact: medicating such kids is often a problematic solution. ADHD drugs make one lethargic and just feel "off" (according to my sister, who was on them for a long time).
What we need are more vocational schools to give the "hyperactive" among us a realistic, career-oriented outlet.
There's so much negativity in this thread towards ADHD meds. I want to chime in with my own experience, when I was in elementary school, there were suspicions that I had AD(H)D, and I got tested, but apparently "I was the quietest and most compliant kid they had ever had". Didn't get a diagnosis.
~15 years later, and I have serious trouble with executive function, I am insanely easily distracted, I have trouble with emotional regulation, I was physically incapable of focusing on something that I did not enjoy for more than 10 minutes, ever. I have no idea how I got through college, heck, I almost didn't. In addition to all this, I was hyper, impulsive, and completely incapable of ever taking a second off, I couldn't relax, at all.
At some point, I saw ADHD somewhere, and I decided to take a more serious second look at it, "what actually is this thing?", and it resonated with me to the core. So after that, I pretty quickly got myself a diagnosis, and not much later I got a ritalin prescription.
I have barely any significant side-effects, I'm calmer, I can focus, I can talk to people without losing my train of thought during the conversation, I can relax better, I can take time to prepare my days and weeks; clean my room, make and follow todo-lists, continue work on a single project for more than a week, I could finally read books without going like "oh huh?!" to every single sound around me 10x a minute, etcetcetcetcetcetc...
My life is pretty terrible still for all kinds of reasons, but no, ritalin doesn't make me feel lethargic -- especially not if I take a slightly lower dose than I'm prescribed -- nobody forced this onto me, I'm not doing this for "compliance" or whatever, I'm not abusing this to be more productive or whatever weird Silicon Valley stereotypes there are about ADHD meds.
Ritalin helps me maintain a relatively stable foundation for my disturbingly disorganized life. It's not magic, and there are real downsides to it, but it really, really helps me very, very effectively.
Have you ever considered whether you suffer from depression and/or anxiety? I was in a similar place after my ADHD diagnosis. Ritalin helped my career greatly, but I was still unsatisfied with life in many ways. After I started taking an antidepressant (Remeron), things got really good for me. I took control of my life and fixed a lot of problems. I find my work and my social relationships more fulfilling. It also fixed my insomnia.
I don’t know the nature of your problems of course, but I found the antidepressant didn’t just make me feel better about things - it also made me better at actually solving my problems.
It fixed my social anxiety and made me better at talking to people, which helped with all sorts of human-related problems. People enjoy my company in social situations, and I enjoy my family’s company (I didn’t really connect with many of them before). I used to think I couldn’t relate to people because I was autistic - maybe I’m on the spectrum, but now that I’m not scared of talking to people and am less of a bummer, I can be friends with all sorts of people.
Also made me less afraid to deal with a bunch of other things I needed to change. It makes things that seemed too hard to bother fixing, suddenly doable. Problems that I used to think of as “facts of life” have been solved.
Of course if you’re dying from a terminal illness or something it’s not going to fix that. And, different antidepressants work for different people, and it’s possible that none will work for you. But there are combinations like Remeron + Effexor (aka “California Rocket Fuel”) that are much more effective if the first attempt fails.
Fair. I didn’t mean to imply that medication is never beneficial. I just think it’s over-prescribed (but this is anecdotal so if anyone really wants to take me to task on it, I forfeit in advance).
How do you get "often problematic" from one person's experience? People have different reactions to drugs, and "ADHD drugs" isn't even one particular drug or kind of drug, although stimulants are the most widely used kind of drug for treating ADHD.
Who said I’m just going off one person’s experience? That’s just the experience I mentioned above. But there have been numerous articles on this topic over the years IIRC.
I see how it could have come off like that. I didn’t mean to make the point based solely on her experience, and I was perhaps a little too strident. But her experience is visceral for me and helps to drive the point home.
I got "diagnosed" with ADHD and tried taking the medicine for two weeks and it was terrible. What's the point of doing better in school if you feel terrible, lose your appetite, and have problems sleeping?
If you reacted poorly to the medication, it could have been that your diagnosis was off, or that you didn’t benefit from the type the doctor prescribed.
I’m not positive about adolescent applications but my ADD is treated well by Adderall/Vyvanse vs. Ritalin, as the active ingredients in Ritalin made me feel hyperactive and on the others I feel “normal.”
After stopping your course of medication did the original symptoms which lead to the diagnosis go away?
A good psychiatrist works with you to find medication that addresses your challenges with a minimum of side effects: the nice thing about most ADHD meds is that they work relatively quickly and don't have the terrible withdrawal symptoms some psychiatric meds do, so you don't have to wait six weeks to see if its working. And whether or not you are interested in medication, there are strategies and adaptations that can make it easier: support from a professional therapist can be super-helpful, with or without meds.
Tell me, how do stimulants make someone more compliant? Why is it that when someone comes to the hospital in an agitated state, they aren’t given adderall? Why isn’t ritalin given before surgery? Why are people with schizophrenia given antipsychotics instead of vyvanse? This type of attitude is as ridiculous as it is cynical.
People act as if the idea of a Ritalin zombie is the goal for ADHD medication. It’s not. I’m not going to deny that stimulants do make some people lethargic, but that’s the exception, not the rule.
Do you want to know what it’s like to take medication for ADHD? For the first time in my life I can make choices. I can choose to clean up my desk without something deep inside me rising up to stop me. I can sit down and read a book and not feel the tensions building up inside me until it feels like a rubber band about to snap. I can wait at a restaurant without feeling the need for stimulation itch over me. My mind no longer jumps from idea to idea until I get lost in my own head. I can speak without stumbling over words because my mind is three sentences ahead. I can read a paragraph and actually remember what I just read.
The notion that I’m just some lobotomized zombie shuffling to the strings of my corporate masters is frankly insulting to everyone that struggles to live a normal life with ADHD.
In addition to making me a better worker, my ADHD meds also make me a better father, allow me to follow through on hobby projects, and other non-"cog" pursuits. I also started and ran my own business for a while. And my current workplace is about as un-factory-like as they come.
I actually enjoy the meds. Not in every situation and not all the time but the effects are definitely not unpleasant. I don't get the "zombie" thing.
Talking about Concerta/Ritalin. I actually asked to be taken off Vyvanse (more similar to Adderall) because it was a little bit too pleasant and disconcertingly similar to recreational substances.
Is there any way to get in touch with you? I work in accessibility and would love to connect with an ADHD researcher to discuss some specific questions. My contact info is in my profile, if you can reach out!
> much more likely to be friendless, to have fights with parents, to abuse alcohol, nicotine, marijuana, and cocaine, and to develop mental health problems like depression, anxiety, and conduct disorder.
All of these are also side-effects of over use of amphetamines...
> All of these are also side-effects of over use of amphetamines...
Surely you are not the first person with this idea? Could it be that other people thought this too and compared unmedicated and medicated ADHD populations?
ADHD is heavily underdiagnosed in the adult population, hence it is not hard to find adults who have ADHD and who never took stimulants. IIRC, The studies show that kids medicated with stimulants actually have lower rates of substance abuse.
Anecdata, but this was my experience. I have a November birthday, and the school district in Massachusetts gave my parents the option of having me start a year younger than everyone or wait a year. My parents opted to send me to school a year earlier. I performed poorly, and at one point was labeled with ADHD. On the standardized tests they gave in 6th grade I scored at the 12th grade level, so I don't think my problems were cognitive as much as behavioral. Also, in high school having some peers who have been held back a grade being 15 years old while one is just turning 13 can lead to some rather unpleasant physical bullying. I often wonder how those early experiences may have limited my life.
I was so tempted to send that article to my mom, but I didn't know how she would take it.
This is a striking statistic: "...children born in August in those states are 30 percent more likely to receive an ADHD diagnosis, compared with their slightly older peers enrolled in the same grade."
I think it would make more sense to have an evidence-based determination for what grade a child should start in, rather than some arbitrary cut-off date like we have now.
The problem is that children with ADHD are acting somewhat how healthy - but much younger - children naturally act.
There seems to be another component though. Adults with ADHD can be quite "mature" in most respects, while still having trouble related to the disorder.
Hyperactivity and lack of impulse control are only part of the disorder, and not necessarily that pronounced.
> Here in Spain, everyone born in the same year goes to the same class, is it different in USA?
So Spain has a cut date of 1 Jan while the USA is 1 Sept. The overall effect is exactly the same: When a school term begins, some of the students will be nearly 1 year older than some of the others.
As per the article itself, many states implement the "1st of September cut date". A kid born in September has to wait an entire year to start school compared to one born on 08/31.
How is it a "paradox"? It makes total sense that kids older and bigger will dominate most sports. It will re-enforce their self esteem and confidence and help them get even better. I don't dispute the phenomenon, I've never heard it called a "paradox".
Well, I made a mistake by saying that "NHL players most likely to be born in December" when in fact they most likely to be born in January. December is the horrible month to be born for a future NHL star (https://www.quanthockey.com/nhl/birth-month-totals/nhl-playe...). So it is not that obvious, isn't it? :)
It's yet another piece of evidence that ADHD is a developmental disorder, it develops over time, and those who are younger have brains which are underdeveloped. Their ability to tamp down disruptive behaviors and use executive functioning to effectively manage planning is reduced compared to other children. So, in younger children, those who are borderline ADHD will appear to be more solidly ADHD, and those with moderate or severe ADHD will seem to have worse symptoms, as we're putting them in a classroom and comparing them with children whose brains have a higher EF capacity. It's also worthwhile to note that the gold standard diagnosis of ADHD involves observation of childrens' behavior in the classroom, where they will be compared to older, more neuro-developed classmates.
In my area, it is very common for parents of boys that will be "young" when starting kindergarten to hold them back a year. They call it redshirting (a reference to US college athletics).
Our local school district prohibits the practice, but really can only enforce it at the kindergarten level. So many parents continue to enroll their boys in private preschool for two additional years and then enroll them in first grade when the school district can't say no. It is very rare for girls because of the assumption that emotional and behavioral development is far ahead of boys at that age.
The September 1st cutoff for Kindergarten is treated as a distinct milestone when it really should be treated as part of a developmental window. As far as California is concerned, if you have a kid born on September 1st, they get 2 years of Kindergarten (TK + K). If their sibling happens to be born on August 31st, they get 1 year of Kindergarten (K only). And that 1 day distinction could be the difference between a childhood of grade appropriate behavior (older, more mature) or being labeled as ADHD (younger, less mature) with many years of drug treatment to look forward to.
My best mate in college started using Adderall when he was about 11 and abused it through college. He's growing up to be a high functioning lunatic. My best analogy of him would be a Bender from Futurama, but with a few STEM degrees.
There has always been ADHD around. When my normative group were kids, we climbed trees, played Indian and cowboys and had a lot of outdoor fun. There were some kid or two who was more risky or over the edge, but hey, we had fun.
Today, looking back, I would consider some of my childhood friends to have ADHD or some kind of other diagnose.
Yesterday, these ADHD-kids, was not a great deal. There were also a lot of local jobs and other opportunities as well that didn’t demanded a high education.
Now kids don’t play outdoor and it’s easier to single out the ones with ADHD. Further more people have moved to the cities and there is a greater pressure to study. Today it’s hard to find a decent job for a supporter of a family without a good education.
Hence, without a diagnose, these kids would not stand a chance. They need all the help, support and understanding they could get.
Even in the old days when there were good jobs for people without high school educations, I'm sure the jails were full of people with ADHD. As they probably are today.
My kid was born in September and I remember my wife doing a little research around that "for fun" (yeah, that's how she has fun) a while ago, how kids far and/or close to the cut off do.
She found a few studies mentioning that older kids (like born between September and February or something) were doing way better in terms of the academics as well. Which in a way makes sense, but maybe indicates that either children start school too young or that programs are too agressive.
I do suspect that there is an emphasis on pushing little children harder academically now than there was in the past. They were still doing half-day kindergarten when I was five, and the majority of the curriculum was "don't bite the other kids and play nicely." The height of first-grade was basic phonics, single digit addition and subtraction, and coloring between the lines.
On that note, my little brother repeated a year for academic reasons, but it also had benefits on sports. He's older than nearly anyone else in his grade (12th), and he's just about the best swimmer in the state.
I only see positive benefits from his repeating a grade.
This. My older kids have birthdays later in the academic year but have ended up in groups for more advanced students.
Mind, nursery was a complete wash when it came to academics -- learning to count to 3 when you can already count to 20 is rather futile. Public schools just can't tailor to individual students.
Socially though, nursery was well timed for them IMO.
That's a good point yeah. But I think when I said that younger kids didn't do as well it meant both in terms of ranking (they were in the lowest percentiles) which indicates that they don't do as well as their peer, but also in terms of future opportunities to attend college or university.
They don't really talk about the harm that could be done by "overtreating". Between treatment options being quite safe and there being a continuum of maturity/impulse control I would guess it is relatively low. Especially compared to the consequences of ADHD not being treated (lower academic success, lower social abilities, more violence, maybe even addictions later on).
Probably not, because the benefits and side effects of appropriate ADHD drug treatments are completely reversible and the scientific evidence for treatment being positive is extremely strong.
Everyone benefits from taking stimulants. That’s why we drink coffee. The efficacy of ADHD medication is not limited to people with ADHD. Should we all take them?
The long-term effects of taking stimulants from childhood onward are not well understood, let alone completely reversible. We’re performing uncontrolled experiments- but that’s nothing new.
Not sure creating a situation where people are incentivized to get a diagnoses giving them access to performance enhancing drugs is a great idea, though.
The line between disease/disorder and "unsatisfactory performance" is drawn somewhat arbitrarily. But in general, those patients with an ADHD diagnosis have much more to gain from "stimulants" than those who do not have this diagnosis.
The potential for abuse of a drug should not limit its appropriate use, though this happens all the time. Also, the safety of ADHD medication is quite well understood, and even the long-term effects seem to be less than the disadvantages of the disorder itself. There may still be a lot of room for exact quantification, but at the moment it looks like ADHD medication is a "good deal" in general.
It is surprising to me that people are so dubious of ADHD when for people with the disorder who metabolize caffein normally diagnosis is remarkably simple: give a six year old a cup of coffee. If they settle down or go take a nap, they quite likely have ADHD. Give a neurotypical kid a cup of coffee and then live with the results because no way are the parents going to thank you for helpfully demonstrating how normal their child is.
One part out of many that interested me in the discussion:
"data from insurance claims do not allow us to determine when a child starts school. Parents may delay school entry for children born in August, which would mean that those children start school at 6 years of age rather than 5 years of age. Because we did not directly observe children’s ages when they entered school, we cannot know how often this occurred"
There are other confounds, but suffice to say that this is not a very well controlled cohort study. It is however interesting for guiding further research.
"Trust me, no matter how unsuitable a candidate you are, no matter how bad a liar you are, somewhere there is a psychiatrist who will give you Adderall. And by “somewhere”, I mean it will take you three tries, tops."
PSA: If you have ADHD symptoms, the first thing you should do is see if getting enough sleep makes them go away. I'm not saying all ADHD is sleep related, but bad sleep spawns ADHD in otherwise non ADHD people.
I'm currently reading "Why We Sleep" [1], which argues (among many other things) that over 50% of children diagnosed with ADHD are actually suffering from a lack of sleep.
Get rid of a single long summer break and the entire concept of a “school year”. Divide the year into quarters. Students can start in summer, spring, winter, or fall.
> Students can start in summer, spring, winter, or fall
That's much harder to do than it sounds because now you have 4 groups 3 months apart in the curriculum. The only way to really do it would be to segregate the kids from the different start times into separate classes otherwise it'd be pretty impossible to teach. There will also be a slight variation in class size depending on the quarter it's for. as August and September are over represented as birthdays.
I do think year round schools probably make more sense overall so there's not such a huge gap where kids forget so much.
My local elementary school has 3 classrooms per grade. If we broke the year into quarters and made each student attend 3 out of 4 quarters, what you'd end up with is more efficient use of school facilities making up for a slightly higher teacher cost. Probably.
I think before we do rolling quarters moving to a year round schedule would do more to improve student performance than the more granular age groupings. Could also just group the kids into however many classrooms are in each school to do both.
FiveThirtyEight ran an article on ADHD prescriptions [1]. It's getting pretty silly. If people don't know ADHD was not recognized as a disorder until 1968. And the popularity of drugging people for it didn't really take off until the 90s when a pharmaceutical industry astroturfing group called CHADD (Children and Adults with Attention Deficit) started marketing ritalin hard. Since then the use of using various pharmaceutical stimulants has become extremely widespread - jumping up by multiple orders of magnitude.
I'm unsure what the latest numbers are but they offer the data to 2013. And just between 2008 and 2013 adult usage of ADHD medication doubled. It was at 2.8% and has likely continued to rapidly increase. That's completed dwarfed by what we're now doing to kids and particularly boys. In 2013 we were up to 9.8% of all boys 12-18 years taking ADHD drugs. And those numbers again were, and presumably still are, rapidly increasing.
I have this likely decreasingly controversial view that history is not going to look back so kindly on psychology and our decision to start pretending we can create a pill for everything. I mean what could possibly go wrong getting 10%+ of boys setup with stimulants, and increasingly often other sorts of psychotropics as well, from their earliest and most critical developmental years?
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Of course I'm sure people will now respond with how these drugs saved their life and without them they'd be homeless, in prison, etc. To these people I have a simple logical question. Let's assume this is true that you would indeed be homeless, in prison, etc without these drugs. We now see these drugs numbers are absolutely skyrocketing to the point that sizable chunks of our entire population are on them. So if we go back in time, why don't we see skyrocketing prison/homelessness/etc as a consequence of people not being able to have these drugs? Given the exponential increase in prescribing rates you don't need to go back far. We should be able to see huge and causably linked differences just over the last decade or two.
The realities are a lot more mundane than your last paragraph tries to paint them. I was 29 when I finally got treatment (therapy + low dose of adderall). I had been making 100k for years. It's perfectly possible to have an okay life with ADHD.
But stuff falls through the cracks. You forget to brush your teeth. To pay your bills. There was a year when I was making over 150k and every single quarter, as often as was possible, my water got shut off to my house. I had to shower at the gym and call the company with my tail between my legs and pay over the phone and it was turned on 2 days later. I had the money. I had the desire to pay the water bill. I just... couldn't. It was stupid. I felt like a caveman, scared that a coworker in my open office would overhear this frantic call and wonder WTF was wrong in my life that I couldn't pay my water bill.
I turned down promotions onto the manager track because it felt ethically dubious to manage people when I couldn't even manage myself. Do you want a person who can't remember to pay their water bill to be pulling the strings of your career lader? I stayed on the IC Principal track to try and localize the logistical fallout of my inabilities.
It's a little better now. It's not the difference between homelessness and elon musk. It's the difference between a guy who pays his bills on time, has a clean dishwasher, and goes to the dentist, versus a guy who is constantly browbeaten by everyday life as the shit that most people think of as routine and invisible derails you over and over in tragicomic ways.
I'm not sure what statistic would capture that. On paper, barring a decrease in collections notices and faster email response time, I appear to be exactly the same person.
But my life is better now. There are still cracks in the sidewalk – my life is still pretty scattered, but you're not as likely to lose a leg when you trip on one.
This is my experience being diagnosed with ADHD at 29 as well. Things seemed fine from the outside. Well paying, stable work. However, I had an incredibly difficult ability to do anything that needed intrinsic motivation, and my self-image began suffering as a result. I was constantly finding motivation from external factors and/or fear of rejection/failure and/or adrenaline to accomplish anything.
The first time I took a central nervous system stimulant (Modafinil as a nootropic) I could suddenly book my dentist appointments, and book a doctor's appointment to talk about mental health, and book holidays I'd been putting off. And read several chapters of a book in one sitting. And make my bed and remember to brush my teeth. And check in with friends I hadn't heard from in a while. Normal life stuff. Is this what neurotypical people can do!? I wish my frontal lobes had more activation and bloodflow by themselves.
My GP didn't understand how I could think I had a problem since I could maintain a 9-5. My family compared me to my less "obedient" ADHD older brother and never had me tested. I am pretty sure my mother has it but is in denial.
Dr. Russell Barkley has some great videos explaining how ADHD is an intention disorder, and how knowing and doing are separate parts of the brain.
Thanks for sharing! There's a lot of misinformation about ADHD out there. I'm glad that there are treatments that help right away (unlike most psychiatric conditions).
Amen. I'm on medication but even with it I used to forget to pay bills frequently despite having the money. I'm better now, mostly because I have a loving and supportive fiancee who helps me organize my life.
I can't speak for others, but my family history is full of people who ran from the law, got knocked up too young (or knocked someone else up at a young age), got involved in the use and/or selling of drugs, and faced difficulties because of impulsive behaviors that were probably related to undiagnosed to ADHD.
None of my generation, many of who have been treated for ADHD since childhood have had problems with the law or been/got anyone teen pregnant so far. I don't think they do hard drugs either. Progress!
My 10 year old was diagnosed (via a thorough neuropsych evaluation, not by annoyed teachers) and my wife and I have been very leery of medication. It's not that we doubt the efficacy, but we do have concerns about its effects on growing brains and, most importantly, want our guy to be able to manage things himself.
Step one has been to help him become more self aware of what's going on. We use lots of checklists and consistent routines to ease the load on his executive functioning. We also work to break bigger projects into lots of small chunks. Working on a thing for 2 hours is hard, but working on a thing for 15 minutes is pretty easy. We'll also set a timer during homework and have mandatory "run around and do something" breaks after 30 minutes of homework. At school, he'll even ask to take a test in a separate area of the room, or ask to go walk up and down the stairs a few times when he's getting restless.
In our case, things are working w/out drugs. He's learning school materials, and the positive feelings he's getting from not being in trouble more at school and getting his homework done have made a nice feedback loop for continuing to stay with the program. That said, I'm sure there are cases where progress is impossible and medication is the only option to get results.
"why don't we see skyrocketing prison/homelessness/etc as a consequence of people not being able to have these drugs"
Look at crime numbers in the past. You may notice that crime has been dropping for decades.
As for people without criminal tendencies, there used to be good jobs for people without a high school diploma, that would enable a person to raise a family in a good town in a nice house with one income.
And of course a lot of people with untreated ADHD probably died young from reckless behavior.
If it’s a physiologically based condition we should be able to observe it in other population groups. I’ve heard that the French don’t medicate their hyperactive children; they send them to cooking school. Some articles have explored how paranoid schizophrenia has been handled among American native tribes (shamans, medicine men, etc) and how it manifests differently among cultures (in Africa historically people seem to get laughing voices while in the US and a lot of the West threatening voices).
For similar reasons, I suspect most of the correlations of ADHD with substance abuse and poor social relationships have more to do with how we treat our peers in the US.
Then there’s the hunter-gatherer theory for how ADHD may have actually been advantageous but I have little insight into how well that’s accepted.
The french do medicate children who are diagnosed with ADHD, but they don't depend on medication to the extent that the US does. Ideally, where medication is needed it is used along with therapy including cognitive behavioral therapy and teaching other life skills and coping mechanisms. In the US where our healthcare is prohibitively expensive and we're all overworked and have far less time to spend on ourselves many kids and adults with ADHD get the pills but very little other help. France also has a different means of diagnosing the condition which leaves some people with ADHD unable to get diagnosed and for others diagnosis is long and difficult. There is a even support group for french families dealing with problems getting a diagnosis.
I can see how ADHD could have been somewhat advantageous in the past but even in a world where you don't have to clock in to work at a specific time 5 days a week or pay your bills each month being able to choose when and to what extent your attention is focused would always be beneficial. I'm sure people with ADHD have always suffered even if their illness was at times a benefit for the group.
I went to a Steiner school for kindergarden and the focus is completely on play and hands on outdoor activities. I have fond memories of messing around with hand drills in the playground!
Adults who can perform knowledge work and have sufficient impulse control.
I believe that sitting children down for a couple of years, compulsory, is a strong factor in what we call civilization and the overall decrease in violence. You can think of it a bit like Zen's "just sitting" meditation practice, if you want.
My kids' daycare has adopted it. It seems perfect for my daughter who seems self-driven, but maybe too open-ended for my son (who we pushed ahead..so far - mid-november bday with 10/31 cutoff).
I can't say that nobody gets some benefit from the drugs, but having grown up with some friends on them in elementary/middle school I can safely say it's a serious thing to be on, and it's not to be taken lightly.
Why don't you quote him? I'll go ahead and summarize it for others: Jordan Peterson, among other things, thinks that we are using drugs to alter the brain structure of little children because they can't sit still for 6 hours a day. He thinks it's harmful and we over-diagnose ADHD in children who act naturally.
On the neurological level, there are different dopaminergic systems developing throughout childhood, such as the motor cortex, the prefrontal cortex, and the dopamine-based reward system. If the motor cortex develops too quickly before the PFC, which controls/regulates behavior, well you'll have hyperactivity that's unregulated. With less developed EF's comes getting out of the chair, losing things, daydreaming, hyperactivity, and all of the diagnosable symptoms of ADHD. Naturally, those who are 6-9 months younger (which might be a 10% age difference in kindergarten) are going to be in very different developmental stages. Requiring younger children to sit still and pay attention may be a much more challenging task since their brains are actually less developed. Thus, they more easily get pushed over the diagnosis line compared to their older classmates.
There is another wrinkle here beyond age, which is gender: boys are around 2.5-3X as likely to be diagnosed because they are more hyperactive naturally, i.e. their neurological systems develop at different rates than girls. This sort of behavior in the classroom is much more disruptive than what girls exhibit. Girls tend to be diagnosed with primarily inattentive subtype, since their motor cortex is not usually as over-active, but they still may suffer underdevelopment of the EF that helps them to focus. A girl daydreaming is much less disruptive than a boy standing on his chair, rolling on the floor, or wandering the classroom (all of which happened multiple times in my own classroom).