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ADHD is not a disease. It’s a collection of symptoms that have been arbitrarily grouped together. My son’s psychiatrist who was diagnosing my son for ADHD said

ADHD is not a disease. It’s a collection of symptoms that have been arbitrarily grouped together. My son’s psychiatrist who was diagnosing my son for ADHD said that it’s psychiatry’s dirty little secret. Back in the 60s or 70s ( I can’t remember what he said) people were starting to notice that kids were having behavioral problems, trouble focusing etc. So what they did was collect a group of symptoms, and then arbitrarily said “if the child has 6 out of 11 of these symptoms then they have ADHD.” The reason why they chose 6 was because if they chose 5 then too little number of children would get diagnosed, and if they chose 7, then too many children would get diagnosed. Having 6 would mean that 7-10% of kids would get diagnosed which “looked right” so they chose 7. It’s not a real disease like other diseases, it’s a collection of symptoms. Which is why kids get misdiagnosed all the time. Anxiety can produce ADHD-like symptoms. Other things like giftedness and boredom can also fry diagnosed as ADHD. There really are children with focus issues where medication like adderall will absolutely help. It will make kids with anxiety worse though so a misdiagnosis will ruin lives. But the origins of where ADHD came from explains why there is so many issues with ADHD disgnoses.

ashildr 7y ago
Now could you explain away major depression using the same logic?
- saaaaaam 7y ago
  You can yes - in fact, I was listening to “D for Diagnosis” on BBC Radio 4 last night. The show title was “Ever Changing Labels” and a psychiatrist made the point (3’20” into the programme) that what we call “depression” in DSM-V has 9 symptoms and if you have 5 out of those 9 symptoms you are diagnosed as having “depression”. But in reality 5 out of 9 gives a huge number - 15,000+ - variations. So there is no one form of “depression” and yet people are diagnosed with depression all the time.
  - monadgonad 7y ago
    > But I’m reality 5 out of 9 gives a huge number - 15,000+ - variations. So there is no one form of “depression” And? Do you know how many different kinds of cancer there are? We're talking about psychogical disorders that affect people's minds and personalities, of course their presentations are going to be very different. That doesn't make them not real or mean it's not useful to group them together. Diagnosis guides treatment, and most depression responds to the same treatments. You're fallaciously assuming that because there's not a single biological marker for named psychiatric conditions that they don't exist. That's not how any psychiatrist sees it.
    - saaaaaam 7y ago
      I always think that when people start a comment so aggressively it’s not really worth responding. However, that aside: I’m not “fallaciously” anything! I responded to a question that was posed “could you explain away depression with a similar argument” with a relevant piece of information. You seem to think I’m arguing depression doesn’t exist. I am not. Forgive me if that was how it appeared, but please, for everyone’s sake, try to keep things civil.
      - Rooster61 7y ago
        > Now could you explain away major depression using the same logic? > You can yes > You seem to think I’m arguing depression doesn’t exist. I am not. That is precisely what you were trying to do. And the response to your comment was in fact civil. Claiming that your argument is fallacious attacks your argument, not you, and is perfectly appropriate for civil discourse.
        saaaaaam 7y ago
        > That is precisely what you were trying to do What a load of crap. You’re projecting something here I’m afraid.
      - monadgonad 7y ago
        I'm sorry, I didn't mean to be aggressive. As someone with ADHD and a history of depression (misdiagnosed as having bipolar disorder at one point), this is an emotive topic for me.
- Keverw 7y ago
  I think a lot of stuff related to depression and ADHD is environmental too. Instead of fixing or helping just drug everyone is the plan. If you're sick of the cold winter, hate your job, etc don't think pills is the answer, should try to move somewhere warmer with a better job. Then kids not paying attention in school, maybe it's boring or they feel it's useless to them so forcing them to do what they don't want, instead of tailoring their education instead it's one size fit's all. Plus teachers recommend getting kids checked, because then you are labeled as disabled and the school gets extra funding to go into the teachers pension program. There's someone I know who was told their kid didn't have ADHD, so shopped around and went to another doctor, and then eventually went to another doctor. Kinda like the whole antibiotics resistance thing, people expect if they have a cold that the doctor will give them pills even if it isn't going to really help. Seems like doctors in general just love drugging people, instead of fixing a symptom at the root of the cause drug them and then drug them more for the side effects to cover them up. It'd be like taking your car to the mechanic for a check engine light, and instead of checking the OBD codes and stuff they just unplug the check engine light. I think a lot of psychiatry is just a form of massive insurance fraud, there's a nonprofit organization that makes documentaries called CCHR. However CCHR is founded by the church of scientology which I know many not a fan of but I think they have some good information. I really wish CCHR would disconnect it self from scientology so it could stand on it's own as I really like their message, but I feel a bit of a conflict since it's related to scientology which is an entire topic on it's own, I guess you have to pay thousands just to level up and all these other horror stories about scientology. I think drugging children is also a form child abuse, and destroying childhood creativity. Probably if they pushed this stuff when Albert Einstein, Steve Jobs or other successful startup founders were children, who knows if they'd be as successful as they ended up being. One of the pills pushed ended up making males grow large breasts too. Then there's reports another drug can cause brain damage too along with heart conditions(which usually you think it happens in older people but young people can have heart attacks too on this crap). They even want to drug 3 and 5 year olds too. If I was in power, I'd have these drug makers and so called doctors imprisoned for life. Also diet and exercise some believe also helps, add these GMOs and other chemicals in the food, artificial sweeteners can mess with dopamine receptors, etc. So I think I see the larger picture, but many just want a pill and then go back to watching TV or smoking instead of trying to improve their families healthy lifestyle. Kinda like how parents don't even try to teach their children, they just send them to school. Lazy parenting is also part of the problem. But I guess not a one solution fits all, some people say the pills and stuff helped them. I think counselors could be valuable too, maybe even help you see things from another prospective but some insurance companies won't pay for a counselor unless you also are on drugs. Some people don't even feel like anyone cares about them either, so I think having someone to listen and who seems on your side with issues is also a positive, but I know some counselors want to record your sessions so I find that kinda creepy also as feels less private so you could be less open about things.
jhayward 7y ago
It is really unfortunate that the top comment as of this time, above, is "there is no such thing as ADHD". Stop it.
- bordercases 7y ago
  It highlights common misconceptions with psychiatric methods as well as small critiques of those methods. If you're on the flipside and benefit from the drug prescriptions: good for you. I think if it were more generally acknowledged that there can be sub-clinical or contextual forms of ADHD my life would benefit.
kalium-xyz 7y ago
You diagnose a disease by the symptoms, this goes for any disease or disorder. Problem is that there are not actual diseases here but rather groupings of symptoms (as you say, its not just for ADHD though) and that its a checklist which is filled out often based solely on verbal questions answered by a child. Another interesting thing to consider is that a lot of psychological disorders are culture bound (and therefor in my humble opinion irrelevant as groupings even for psychiatric purposes).
monadgonad 7y ago
> It’s not a real disease like other diseases, it’s a collection of symptoms. Any disease with "syndrome" in its name is just a collection of symptoms. That's literally what syndrome means. Your information about ADHD is offensively wrong, and its underdiagnosis and undertreatment due to misinformation ruins far more lives than than there are people with anxiety being mistakenly prescribed stimulants.
- callesgg 7y ago
  ADHD has no known causal model. It is not a singular thing. Downs syndrome as a counter example has a known messurabe causal model. It is truth, regardless if it is offensive or not. Regardless of your interpretation.
  - wahern 7y ago
    It's not a useful truth, at least not in the way you've characterized it. The way you characterize it says more about a misunderstanding of scientific knowledge in general, but especially medical science. Age 10 is roughly when children begin to realize that their parents, and adults in general, can be as fallible and ignorant as children. It can be a shocking revelation, but eventually you move past it. But some people's response is to develop a deep cynicism about what maturity means, which can stunt their own maturity. (Notably, we all tend to feel like it's a deeply personal revelation that gives us unique insight--like we're more mature than others for having the revelation. But it's a whole different revelation to realize and appreciate that everybody goes through this phase.) It can also be a shocking revelation when you learn that in science in general, but especially in medical science, the things we don't know are unfathomably more numerous than the things we [believe we] know with certainty. But just because we don't fully comprehend a phenomenon doesn't mean we can't develop useful knowledge about the phenomenon, and to develop reliable treatments (medicine) or processes (chemistry, engineering). Were it otherwise progress would be impossible. Science is a process, not a product. Of course, just like adults who became cynical at age 10, there are professionals in all domains who harbor cynicism stemming from their educational revelations. It's not healthy. The extreme ones may say things like, "it's all a lie", but the lie is on them. When people go to a medical professional for help, they don't need to know the messy details. Some people might benefit, but others might react poorly. What they expect (knowingly or not) is to be given medical advice that already incorporates the unknowns; that already takes into account the fact that something is not well understood. The same is true for every other profession. FWIW, the term Downs Syndrome comes from before the cause was known. Today people often use the term trisomy 21, perhaps because of the cultural baggage related to the older term, but also because strictly speaking it's no longer a syndrome. There are other trisomies, like trisomy 18.
hopia 7y ago
Yeah it may be very hard to discover the actual biological mechanisms in neurological disorders particularly. But not diagnosing anything would also not resolve the problem for the patient, if there really are specific symptoms.
RankingMember 7y ago
Quibbling with the classification is missing the forest for the trees here, I think. It's a chronic condition that requires some kind of treatment to be dealt with. People have the same kind of quarrels with defining alcoholism or drug addiction as a disease, but we have limited time on this planet and we can argue about labels or we can spend that time instead trying to address the actual concerns.
- hopia 7y ago
  Agreed. I guess where it becomes a problem is when we try to find the most suitable treatment for it. I know from experience that these labels can dictate the whole treatment plan in public hospitals/clinics without much further investigation whether that label's approved standard treatment plan really is suitable for your particular case or not.
Maxion 7y ago
You're showing shocking ignorance of psychiatry and the classification of mental disorders, not to mention any of the latest research into ADHD. In the US there is a larger percentage of the population who are diagnosed than in other countries, but even there, adult ADHD is under diagnosed.
40acres 7y ago
This is wrong, studies have shown that ADHD brains are fundamentally different from non-ADHD brains in the sense that they have reduced frontal lobe (read: executive functioning, ie. cognitive inhibition, working memory, decision making) matter.
- remote_phone 7y ago
  No you are wrong. The fact that ADHD is a mostly subjective collection of behavioral traits, many people get lumped in as ADHD. So many people called ADHD would have normal brains. There are a core set of people who definitely have brains that are different and need medication etc.But the way it is currently diagnosed lumps too many people and makes it useless to call all people with ADHD the same. My son with Generalized Anxiety Disorder was diagnosed with severe ADHD. This is the problem because many things can cause the same set of behaviors so a diagnosis of ADHD is not accurate enough.
firethief 7y ago
https://slatestarcodex.com/2019/12/04/symptom-condition-cause https://slatestarcodex.com/2019/12/04/symptom-condition-caus...
bananamerica 7y ago
Medicine, as a science, is expected to fix the human body while it's running without taking it apart. Unlike other fields, modern psychiatry is still mostly clinical. Of course, it is deeply flawed, but it is our best shot nevertheless. And, unlike the one doctor that told you otherwise, there's widespread consensus in the medical community that ADHD is very much a thing. I'd rather believe in them.
dba7dba 7y ago
> Back in the 60s or 70s ( I can’t remember what he said) people were starting to notice that kids were having behavioral problems, trouble focusing etc. Unscientific personal observation, but I wonder if TV has a role in this. Didn't kids start watching a lot of TV around that time? Also, I feel kids in poor countries with no TV (not that there's much of that left now) have little to no ADHD.
- mr_woozy 7y ago
  It's like you magically didn't read the article nor read any of the discussion herein.

ashildr 7y ago

Now could you explain away major depression using the same logic?

saaaaaam 7y ago
You can yes - in fact, I was listening to “D for Diagnosis” on BBC Radio 4 last night. The show title was “Ever Changing Labels” and a psychiatrist made the point (3’20” into the programme) that what we call “depression” in DSM-V has 9 symptoms and if you have 5 out of those 9 symptoms you are diagnosed as having “depression”. But in reality 5 out of 9 gives a huge number - 15,000+ - variations. So there is no one form of “depression” and yet people are diagnosed with depression all the time.
- monadgonad 7y ago
  > But I’m reality 5 out of 9 gives a huge number - 15,000+ - variations. So there is no one form of “depression” And? Do you know how many different kinds of cancer there are? We're talking about psychogical disorders that affect people's minds and personalities, of course their presentations are going to be very different. That doesn't make them not real or mean it's not useful to group them together. Diagnosis guides treatment, and most depression responds to the same treatments. You're fallaciously assuming that because there's not a single biological marker for named psychiatric conditions that they don't exist. That's not how any psychiatrist sees it.
  - saaaaaam 7y ago
    I always think that when people start a comment so aggressively it’s not really worth responding. However, that aside: I’m not “fallaciously” anything! I responded to a question that was posed “could you explain away depression with a similar argument” with a relevant piece of information. You seem to think I’m arguing depression doesn’t exist. I am not. Forgive me if that was how it appeared, but please, for everyone’s sake, try to keep things civil.
    - Rooster61 7y ago
      > Now could you explain away major depression using the same logic? > You can yes > You seem to think I’m arguing depression doesn’t exist. I am not. That is precisely what you were trying to do. And the response to your comment was in fact civil. Claiming that your argument is fallacious attacks your argument, not you, and is perfectly appropriate for civil discourse.
      - saaaaaam 7y ago
        > That is precisely what you were trying to do What a load of crap. You’re projecting something here I’m afraid.
    - monadgonad 7y ago
      I'm sorry, I didn't mean to be aggressive. As someone with ADHD and a history of depression (misdiagnosed as having bipolar disorder at one point), this is an emotive topic for me.
Keverw 7y ago
I think a lot of stuff related to depression and ADHD is environmental too. Instead of fixing or helping just drug everyone is the plan. If you're sick of the cold winter, hate your job, etc don't think pills is the answer, should try to move somewhere warmer with a better job. Then kids not paying attention in school, maybe it's boring or they feel it's useless to them so forcing them to do what they don't want, instead of tailoring their education instead it's one size fit's all. Plus teachers recommend getting kids checked, because then you are labeled as disabled and the school gets extra funding to go into the teachers pension program. There's someone I know who was told their kid didn't have ADHD, so shopped around and went to another doctor, and then eventually went to another doctor. Kinda like the whole antibiotics resistance thing, people expect if they have a cold that the doctor will give them pills even if it isn't going to really help. Seems like doctors in general just love drugging people, instead of fixing a symptom at the root of the cause drug them and then drug them more for the side effects to cover them up. It'd be like taking your car to the mechanic for a check engine light, and instead of checking the OBD codes and stuff they just unplug the check engine light. I think a lot of psychiatry is just a form of massive insurance fraud, there's a nonprofit organization that makes documentaries called CCHR. However CCHR is founded by the church of scientology which I know many not a fan of but I think they have some good information. I really wish CCHR would disconnect it self from scientology so it could stand on it's own as I really like their message, but I feel a bit of a conflict since it's related to scientology which is an entire topic on it's own, I guess you have to pay thousands just to level up and all these other horror stories about scientology. I think drugging children is also a form child abuse, and destroying childhood creativity. Probably if they pushed this stuff when Albert Einstein, Steve Jobs or other successful startup founders were children, who knows if they'd be as successful as they ended up being. One of the pills pushed ended up making males grow large breasts too. Then there's reports another drug can cause brain damage too along with heart conditions(which usually you think it happens in older people but young people can have heart attacks too on this crap). They even want to drug 3 and 5 year olds too. If I was in power, I'd have these drug makers and so called doctors imprisoned for life. Also diet and exercise some believe also helps, add these GMOs and other chemicals in the food, artificial sweeteners can mess with dopamine receptors, etc. So I think I see the larger picture, but many just want a pill and then go back to watching TV or smoking instead of trying to improve their families healthy lifestyle. Kinda like how parents don't even try to teach their children, they just send them to school. Lazy parenting is also part of the problem. But I guess not a one solution fits all, some people say the pills and stuff helped them. I think counselors could be valuable too, maybe even help you see things from another prospective but some insurance companies won't pay for a counselor unless you also are on drugs. Some people don't even feel like anyone cares about them either, so I think having someone to listen and who seems on your side with issues is also a positive, but I know some counselors want to record your sessions so I find that kinda creepy also as feels less private so you could be less open about things.

jhayward 7y ago

It is really unfortunate that the top comment as of this time, above, is "there is no such thing as ADHD". Stop it.

bordercases 7y ago
It highlights common misconceptions with psychiatric methods as well as small critiques of those methods. If you're on the flipside and benefit from the drug prescriptions: good for you. I think if it were more generally acknowledged that there can be sub-clinical or contextual forms of ADHD my life would benefit.

kalium-xyz 7y ago

You diagnose a disease by the symptoms, this goes for any disease or disorder. Problem is that there are not actual diseases here but rather groupings of symptoms (as you say, its not just for ADHD though) and that its a checklist which is filled out often based solely on verbal questions answered by a child. Another interesting thing to consider is that a lot of psychological disorders are culture bound (and therefor in my humble opinion irrelevant as groupings even for psychiatric purposes).

monadgonad 7y ago

> It’s not a real disease like other diseases, it’s a collection of symptoms. Any disease with "syndrome" in its name is just a collection of symptoms. That's literally what syndrome means. Your information about ADHD is offensively wrong, and its underdiagnosis and undertreatment due to misinformation ruins far more lives than than there are people with anxiety being mistakenly prescribed stimulants.

callesgg 7y ago
ADHD has no known causal model. It is not a singular thing. Downs syndrome as a counter example has a known messurabe causal model. It is truth, regardless if it is offensive or not. Regardless of your interpretation.
- wahern 7y ago
  It's not a useful truth, at least not in the way you've characterized it. The way you characterize it says more about a misunderstanding of scientific knowledge in general, but especially medical science. Age 10 is roughly when children begin to realize that their parents, and adults in general, can be as fallible and ignorant as children. It can be a shocking revelation, but eventually you move past it. But some people's response is to develop a deep cynicism about what maturity means, which can stunt their own maturity. (Notably, we all tend to feel like it's a deeply personal revelation that gives us unique insight--like we're more mature than others for having the revelation. But it's a whole different revelation to realize and appreciate that everybody goes through this phase.) It can also be a shocking revelation when you learn that in science in general, but especially in medical science, the things we don't know are unfathomably more numerous than the things we [believe we] know with certainty. But just because we don't fully comprehend a phenomenon doesn't mean we can't develop useful knowledge about the phenomenon, and to develop reliable treatments (medicine) or processes (chemistry, engineering). Were it otherwise progress would be impossible. Science is a process, not a product. Of course, just like adults who became cynical at age 10, there are professionals in all domains who harbor cynicism stemming from their educational revelations. It's not healthy. The extreme ones may say things like, "it's all a lie", but the lie is on them. When people go to a medical professional for help, they don't need to know the messy details. Some people might benefit, but others might react poorly. What they expect (knowingly or not) is to be given medical advice that already incorporates the unknowns; that already takes into account the fact that something is not well understood. The same is true for every other profession. FWIW, the term Downs Syndrome comes from before the cause was known. Today people often use the term trisomy 21, perhaps because of the cultural baggage related to the older term, but also because strictly speaking it's no longer a syndrome. There are other trisomies, like trisomy 18.

hopia 7y ago

Yeah it may be very hard to discover the actual biological mechanisms in neurological disorders particularly. But not diagnosing anything would also not resolve the problem for the patient, if there really are specific symptoms.

RankingMember 7y ago

Quibbling with the classification is missing the forest for the trees here, I think. It's a chronic condition that requires some kind of treatment to be dealt with. People have the same kind of quarrels with defining alcoholism or drug addiction as a disease, but we have limited time on this planet and we can argue about labels or we can spend that time instead trying to address the actual concerns.

hopia 7y ago
Agreed. I guess where it becomes a problem is when we try to find the most suitable treatment for it. I know from experience that these labels can dictate the whole treatment plan in public hospitals/clinics without much further investigation whether that label's approved standard treatment plan really is suitable for your particular case or not.

Maxion 7y ago

You're showing shocking ignorance of psychiatry and the classification of mental disorders, not to mention any of the latest research into ADHD. In the US there is a larger percentage of the population who are diagnosed than in other countries, but even there, adult ADHD is under diagnosed.

40acres 7y ago

This is wrong, studies have shown that ADHD brains are fundamentally different from non-ADHD brains in the sense that they have reduced frontal lobe (read: executive functioning, ie. cognitive inhibition, working memory, decision making) matter.

remote_phone 7y ago
No you are wrong. The fact that ADHD is a mostly subjective collection of behavioral traits, many people get lumped in as ADHD. So many people called ADHD would have normal brains. There are a core set of people who definitely have brains that are different and need medication etc.But the way it is currently diagnosed lumps too many people and makes it useless to call all people with ADHD the same. My son with Generalized Anxiety Disorder was diagnosed with severe ADHD. This is the problem because many things can cause the same set of behaviors so a diagnosis of ADHD is not accurate enough.

firethief 7y ago

https://slatestarcodex.com/2019/12/04/symptom-condition-cause https://slatestarcodex.com/2019/12/04/symptom-condition-caus...

bananamerica 7y ago

Medicine, as a science, is expected to fix the human body while it's running without taking it apart. Unlike other fields, modern psychiatry is still mostly clinical. Of course, it is deeply flawed, but it is our best shot nevertheless. And, unlike the one doctor that told you otherwise, there's widespread consensus in the medical community that ADHD is very much a thing. I'd rather believe in them.

dba7dba 7y ago

> Back in the 60s or 70s ( I can’t remember what he said) people were starting to notice that kids were having behavioral problems, trouble focusing etc. Unscientific personal observation, but I wonder if TV has a role in this. Didn't kids start watching a lot of TV around that time? Also, I feel kids in poor countries with no TV (not that there's much of that left now) have little to no ADHD.

mr_woozy 7y ago
It's like you magically didn't read the article nor read any of the discussion herein.