8 ms·

As someone in my 5th decade, with lifelong ADHD (though given my age it did not exist in my youth, and was only diagnosed relatively recently), I'm wary of back

As someone in my 5th decade, with lifelong ADHD (though given my age it did not exist in my youth, and was only diagnosed relatively recently), I'm wary of backing away from treatments until we actually do have real viable alternatives. It took far too long to get ADHD widely recognised, and even now it's often more likely to be received with humour than real recognition. Much more research, especially on other possible treatments and therapies, is needed before we turn too zealously against the only treatment actually shown to work. We have a long history of over diagnosing and overdoing pretty much everything. I've only ever managed it with limited success. There's little doubt that the drugs can work. Despite some evidence of over-diagnosis and over-prescription there are many people who have had their prospects transformed as a result. I suggest the ADHD label is being significantly over applied because real awareness, even in the medical profession, is still abysmal. Doctors don't have time to look at home circumstances, or parents and other factors that might affect behaviour. Awareness coming from some TV comedy skit however is high. I don't actually care that we don't yet have full understanding of how the drugs work, or that OMG they're amphetamines. I often wonder how things may have turned out differently for me had I encountered more GP awareness and less ridicule, or even earlier self-awareness or teen diagnosis and treatment. If we are too successful "exposing big pharma" and overdiagnosis in the minds of GPs and the public, lives will be ruined once again. Let's not throw the baby out with the bathwater here rather than seek wider understanding.

panglott 10y ago
The thing is, diagnosis rates in the U.S. are something like 3-4 times as high as in most countries in Europe, which are themselves 3-4 times as high as a country like France, which is averse to ADHD diagnoses. The main treatment for ADHD is lifelong maintenance of powerful amphetamines, when we have no idea what the long-term consequences of that would be, nor what proportion of children would normally develop out of the ADHD spectrum with time. Overdiagnosis at that rate means that millions of children are being given amphetamines, when they shouldn't be!
- Broken_Hippo 10y ago
  I looked, and it seems to be about double (though figures disagree). And I wonder if this isn't simply a difference in educational systems and expectations of children. I'm in Norway, and children play quite a bit, even in school. They take frequent breaks, have outdoor recess (in nearly all weather), and have no homework. The general attitude is that kids should be kids and not have to worry about stuff. Sure, there is more pressure as the child grows up, but it isn't comparable. School days are shorter as well. Far cry from what I remember as a kid in the US or what I see now. Little in the way of recess, homework starts early. I had a few hours every night at age 11. Sit still, be quiet for hours, do all the worksheets. I'm guessing there are kids with ADHD that might not need medication, merely time to learn and develop coping mechanisms. Perhaps some children wouldn't have such a problem in the one system whereas in the other would be quite a disruption. I have nothing to back this up, just a theory.
  - Diederich 10y ago
    This is pretty important stuff, thank you for posting. Often times, 'a problem' exists largely because a person's behaviour and/or performance exists outside of the local norm. Given this, then by definition the amount and types of such problems are largely driven by the norm. As you said, I don't have anything at hand to back this up, but this seems like a very reasonable way to explain some of these big diagnosis deltas.
  - vainguard 10y ago
    I think you are right. I would really prefer to change the world, than take medication. I say this without sarcasm and a little bit of sadness.
- scottmf 10y ago
  >we have no idea what the long-term consequences of that would be Perhaps you have no idea, but we actually have a pretty good idea from 80 years of stimulant medication usage. Do you have data suggesting negative consequences of decades of stimulant usage? No? Then it's surely the best decision to ignore this FUD and continue treating people of all ages with stimulants which have been shown to be safe in such low doses. Particularly when we have evidence suggesting not medicating is dangerous, as I mentioned in my other comments.
rootbear 10y ago
I identify with a lot of what you say. I was not formally diagnosed with ADD (now properly called ADHD-PI, the non-hyperactive variant) until a few years ago, in my 50s. I did well in school but ADD has been the bane of my career. I get bored easily with uninteresting tasks and the mental effort to complete them is exhausting. If I slip, and find something more interesting to do, it can annoy my boss, to say the least. I'd like at job that fits my brain better, but at my age, opportunities are rare. I'm now taking a mild dose of an amphetamine (Vyvanse) and it does help, but I still have to maintain a lot of self awareness so I don't wander off into the weeds.
metaphorm 10y ago
I'm glad amphetamine treatment is effective for you. I hope you can recognize that your situation (an adult, in full control of your own care, with informed consent at all stages) is very very very very very different than putting 6 year olds on ritalin because they're fidgetting at their desk in class. This is really done in America.
- falcolas 10y ago
  No, it's not done that way - there are more factors than "fidgeting in class" that psychiatrists take into account when diagnosing ADHD. And frankly, if they're put on Ritalin and stop fidgeting and start paying attention, then it's probably a valid diagnosis in the first place. People without ADHD would end up fidgeting more, not less, if given amphetamines.
  - cmdrfred 10y ago
    It is done this way and it happened to me. The public school I was attending told my parents in 2nd grade put him on Ritalin or we are going to expel him.
  - metaphorm 10y ago
    these are children we're talking about. you're endorsing drugging children.
    - dragonwriter 10y ago
      Yes, so what? My son had a bladder infection, and I certainly endorsed the use of drugs to treat that. If there is a real and identifiable condition interfering with a child's quality of life for which there is concrete reason to think that a drug is an effective and remedy for which the risk of other side effects is mild compared to the expected benefit, why shouldn't responsible adults endorse drugging children in that circumstance?
      - metaphorm 10y ago
deleted 10y ago
[deleted]
engx 10y ago
Why do people on meth enjoy cleaning? There is little difference between meth and Adderall. Taking any type of stimulant even coffee helps people do menial tasks and be more optimistic while doing them. Maybe millions of people are effected by some problem of distraction and lack of focus. But to suggest there's some biochemical reason for this that's cured by amphetamines seems like pseudoscience to me. Drugs do work. If you want to take amphetamines to improve your work performance, go for it. But to suggest that it's a disease seems disingenuous. There's something like 16 million Americans who take Adderall, which has drastically increased in used (300%+ from 2008-2012). Another poll said 35% of college students had said they'd tried Adderall. The science of ADHD is ambiguous. The science of moderate uses of amphetamine or methamphetamines for improving work performance is easier to understand.
- leereeves 10y ago
  > But to suggest that it's a disease seems disingenuous. That allows (at least) two things: pressuring insurance companies to pay for treatment, and pressuring students to undergo treatment.
- sneak 10y ago
  > There is little difference between meth and Adderall. I posit that you don't yet know enough about neuropharmacology to have beneficial opinions on this topic.
  - dustinls 10y ago
    There is little difference between water and hydrogen peroxide.
- PhasmaFelis 10y ago
  Imagine this: you're an adult professional, sitting at your desk looking at a freelance work assignment that needs to be done by tomorrow, weeping with frustration because you've been staring at it for eight solid hours, trying and trying to begin, and you can't because focusing on anything important is like trying to grip a handful of water. Because you ran out of your meds. This is what my life is like. If that doesn't sound like a medical condition to you, then I don't know what you're thinking. If you think I haven't tried everything else imaginable to deal with it, you're mistaken. The only thing that works is amphetamines. There's definitely downsides, and if someone showed me a better solution I'd love to try it. But, so far, there isn't one. Maybe some people take the meds who don't really need them. That's a shame. You don't get to sacrifice my career just to keep some people from getting high.
andrei_says_ 10y ago
I am curious, are there activities that you're capable in without the need for medication? It may or may not be work-related, like snowboarding or board games etc.

panglott 10y ago

The thing is, diagnosis rates in the U.S. are something like 3-4 times as high as in most countries in Europe, which are themselves 3-4 times as high as a country like France, which is averse to ADHD diagnoses. The main treatment for ADHD is lifelong maintenance of powerful amphetamines, when we have no idea what the long-term consequences of that would be, nor what proportion of children would normally develop out of the ADHD spectrum with time. Overdiagnosis at that rate means that millions of children are being given amphetamines, when they shouldn't be!

Broken_Hippo 10y ago
I looked, and it seems to be about double (though figures disagree). And I wonder if this isn't simply a difference in educational systems and expectations of children. I'm in Norway, and children play quite a bit, even in school. They take frequent breaks, have outdoor recess (in nearly all weather), and have no homework. The general attitude is that kids should be kids and not have to worry about stuff. Sure, there is more pressure as the child grows up, but it isn't comparable. School days are shorter as well. Far cry from what I remember as a kid in the US or what I see now. Little in the way of recess, homework starts early. I had a few hours every night at age 11. Sit still, be quiet for hours, do all the worksheets. I'm guessing there are kids with ADHD that might not need medication, merely time to learn and develop coping mechanisms. Perhaps some children wouldn't have such a problem in the one system whereas in the other would be quite a disruption. I have nothing to back this up, just a theory.
- Diederich 10y ago
  This is pretty important stuff, thank you for posting. Often times, 'a problem' exists largely because a person's behaviour and/or performance exists outside of the local norm. Given this, then by definition the amount and types of such problems are largely driven by the norm. As you said, I don't have anything at hand to back this up, but this seems like a very reasonable way to explain some of these big diagnosis deltas.
- vainguard 10y ago
  I think you are right. I would really prefer to change the world, than take medication. I say this without sarcasm and a little bit of sadness.
scottmf 10y ago
>we have no idea what the long-term consequences of that would be Perhaps you have no idea, but we actually have a pretty good idea from 80 years of stimulant medication usage. Do you have data suggesting negative consequences of decades of stimulant usage? No? Then it's surely the best decision to ignore this FUD and continue treating people of all ages with stimulants which have been shown to be safe in such low doses. Particularly when we have evidence suggesting not medicating is dangerous, as I mentioned in my other comments.

rootbear 10y ago

I identify with a lot of what you say. I was not formally diagnosed with ADD (now properly called ADHD-PI, the non-hyperactive variant) until a few years ago, in my 50s. I did well in school but ADD has been the bane of my career. I get bored easily with uninteresting tasks and the mental effort to complete them is exhausting. If I slip, and find something more interesting to do, it can annoy my boss, to say the least. I'd like at job that fits my brain better, but at my age, opportunities are rare. I'm now taking a mild dose of an amphetamine (Vyvanse) and it does help, but I still have to maintain a lot of self awareness so I don't wander off into the weeds.

metaphorm 10y ago

I'm glad amphetamine treatment is effective for you. I hope you can recognize that your situation (an adult, in full control of your own care, with informed consent at all stages) is very very very very very different than putting 6 year olds on ritalin because they're fidgetting at their desk in class. This is really done in America.

falcolas 10y ago
No, it's not done that way - there are more factors than "fidgeting in class" that psychiatrists take into account when diagnosing ADHD. And frankly, if they're put on Ritalin and stop fidgeting and start paying attention, then it's probably a valid diagnosis in the first place. People without ADHD would end up fidgeting more, not less, if given amphetamines.
- cmdrfred 10y ago
  It is done this way and it happened to me. The public school I was attending told my parents in 2nd grade put him on Ritalin or we are going to expel him.
- metaphorm 10y ago
  these are children we're talking about. you're endorsing drugging children.
  - dragonwriter 10y ago
    Yes, so what? My son had a bladder infection, and I certainly endorsed the use of drugs to treat that. If there is a real and identifiable condition interfering with a child's quality of life for which there is concrete reason to think that a drug is an effective and remedy for which the risk of other side effects is mild compared to the expected benefit, why shouldn't responsible adults endorse drugging children in that circumstance?
    - metaphorm 10y ago

deleted 10y ago

[deleted]

engx 10y ago

Why do people on meth enjoy cleaning? There is little difference between meth and Adderall. Taking any type of stimulant even coffee helps people do menial tasks and be more optimistic while doing them. Maybe millions of people are effected by some problem of distraction and lack of focus. But to suggest there's some biochemical reason for this that's cured by amphetamines seems like pseudoscience to me. Drugs do work. If you want to take amphetamines to improve your work performance, go for it. But to suggest that it's a disease seems disingenuous. There's something like 16 million Americans who take Adderall, which has drastically increased in used (300%+ from 2008-2012). Another poll said 35% of college students had said they'd tried Adderall. The science of ADHD is ambiguous. The science of moderate uses of amphetamine or methamphetamines for improving work performance is easier to understand.

leereeves 10y ago
> But to suggest that it's a disease seems disingenuous. That allows (at least) two things: pressuring insurance companies to pay for treatment, and pressuring students to undergo treatment.
sneak 10y ago
> There is little difference between meth and Adderall. I posit that you don't yet know enough about neuropharmacology to have beneficial opinions on this topic.
- dustinls 10y ago
  There is little difference between water and hydrogen peroxide.
PhasmaFelis 10y ago
Imagine this: you're an adult professional, sitting at your desk looking at a freelance work assignment that needs to be done by tomorrow, weeping with frustration because you've been staring at it for eight solid hours, trying and trying to begin, and you can't because focusing on anything important is like trying to grip a handful of water. Because you ran out of your meds. This is what my life is like. If that doesn't sound like a medical condition to you, then I don't know what you're thinking. If you think I haven't tried everything else imaginable to deal with it, you're mistaken. The only thing that works is amphetamines. There's definitely downsides, and if someone showed me a better solution I'd love to try it. But, so far, there isn't one. Maybe some people take the meds who don't really need them. That's a shame. You don't get to sacrifice my career just to keep some people from getting high.

andrei_says_ 10y ago

I am curious, are there activities that you're capable in without the need for medication? It may or may not be work-related, like snowboarding or board games etc.