4 ms·

Ritalin's been used to treat ADHD for about 70 years. Also, we know that ADHD results in reduced life expectancy, so ADHD medication just has to improve that nu

Ritalin's been used to treat ADHD for about 70 years. Also, we know that ADHD results in reduced life expectancy, so ADHD medication just has to improve that number for it to be pretty good. If your life expectancy due to taking ADHD meds improves by a couple years because you're less likely to crash your car or overdose on recreational drugs then ADHD meds are a far preferable option to not taking them.

zepto 5y ago
> If your life expectancy due to taking ADHD meds improves by a couple years because you're less likely to crash your car or overdose on recreational drugs Do we know that accidents are the causes of excess mortality for people with unmedicated ADHD, or are they deaths of despair because of a lack of accommodation? Edit: Looks like there is evidence supporting the idea that it’s accidents. I would still be cautious about assuming this is true given how weak almost all social science and medical research is.
- BirdieNZ 5y ago
  There are actually a lot of causes. Barkley (2018)[1] says: > The reduced ELE linked to ADHD was found to be a function of the first order variables of less education, less annual income, greater consumption of alcohol and tobacco, diminished sleep, and poorer overall health status relative to the control group. Moreover, ELE was also shown to be a function of the second order traits of deficient behavioral inhi- bition in daily life and, much less so, of low verbal IQ, greater interpersonal hostility, and deficient nonverbal fluency. and: > For instance, besides ADHD-C itself, this study showed that behavioral disinhibition (as assessed by EF ratings in daily life), verbal IQ, the comorbid psychopathology of hostility, and the EF of nonverbal fluency (and its associa- tion with nonverbal working memory) all uniquely contrib- uted, in descending order, to variation in life expectancy. The largest percentage, however, by far was contributed by behavioral disinhibition. Nigg (2013)[2] says: > ADHD is clearly associated with worse physical health outcomes across multiple domains. These include unhealthy behaviors and outcomes like smoking, illicit substance use disorders, accidental injuries, obesity, and even suicide attempts and completed suicides. ---- Basically, having ADHD means you have less self-control, engage in riskier behaviour (including riskier eating habits, substance abuse, driving, sex. It also means you struggle in life, resulting in suicidality, aggressiveness and anti-social behaviour. You sleep worse. You're more likely to smoke because nicotine is a stimulant which has a medicating effect on ADHD symptoms. [1]: Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors, Barkley 2018 [2]: Attention-deficit/hyperactivity disorder and adverse health outcomes, Nigg 2013 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322430/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322430/)
  - zepto 5y ago
    > It also means you struggle in life, resulting in suicidality, aggressiveness and anti-social behaviour. This is the stuff that seems like it could be dealt with by society being more accommodating rather than drugs.
    - BirdieNZ 5y ago
      How is society being more accommodating going to help with me wanting to be able to live my life like a normal adult rather than struggling with simple things? It isn't society's expectations that make life most difficult for me, it's my own.
      - zepto 5y ago
        Where did you get your idea of how a normal adult lives their life, if not from society?
        BirdieNZ 5y ago
        I did get it from society, of course. I wouldn't equate changing society's accommodations with changing how easy the normal adult finds life, though. Changing accommodations has no impact on how easy my non-ADHD friends find their lives compared to me. Society can accommodate my difficulty in doing chores but that doesn't change that most of my friends don't find it difficult to take out the rubbish if they want to.
        zepto 5y ago
        > Society can accommodate my difficulty in doing chores How do you define “chores”? It’s seems very true that people with ADHD find it hard to get through a to-do list in a linear fashion. If that is what it means to do chores, then maybe there is a way to prevent rubbish accumulating that doesn’t require that of you. > that doesn't change that most of my friends don't find it difficult to take out the rubbish if they want to. Do you want to take out the rubbish? Or do you start out wanting to and then want to do something else?
rsanek 5y ago
>Also, we know that ADHD results in reduced life expectancy, so ADHD medication just has to improve that number for it to be pretty good. I'm hesitant to agree with this statement outright -- on the population level, I do think it makes sense to pursue interventions that increase life expectancy. But on the individual level we must ask, are we comparing apples-to-apples years of life? For example, I would pick 10 years of life with vitality over 12 years with mobility issues.
- BirdieNZ 5y ago
  That's a fair statement. For ADHD medication specifically, for most people diagnosed with ADHD I would expect to see both improved life quality AND life expectancy. Of course, specific individuals may experience worsened life quality on medication, in which case they will have to weigh up whether they want potentially longer life with lower life quality. Given the kinds of mortality causes from ADHD, I would think the calculus looks more like "ADHD meds make me feel yuck but maybe that's worth it to not get fired regularly, because my family needs me to support them financially and being fired regularly makes me depressed and suicidal".

zepto 5y ago

> If your life expectancy due to taking ADHD meds improves by a couple years because you're less likely to crash your car or overdose on recreational drugs Do we know that accidents are the causes of excess mortality for people with unmedicated ADHD, or are they deaths of despair because of a lack of accommodation? Edit: Looks like there is evidence supporting the idea that it’s accidents. I would still be cautious about assuming this is true given how weak almost all social science and medical research is.

BirdieNZ 5y ago
There are actually a lot of causes. Barkley (2018)[1] says: > The reduced ELE linked to ADHD was found to be a function of the first order variables of less education, less annual income, greater consumption of alcohol and tobacco, diminished sleep, and poorer overall health status relative to the control group. Moreover, ELE was also shown to be a function of the second order traits of deficient behavioral inhi- bition in daily life and, much less so, of low verbal IQ, greater interpersonal hostility, and deficient nonverbal fluency. and: > For instance, besides ADHD-C itself, this study showed that behavioral disinhibition (as assessed by EF ratings in daily life), verbal IQ, the comorbid psychopathology of hostility, and the EF of nonverbal fluency (and its associa- tion with nonverbal working memory) all uniquely contrib- uted, in descending order, to variation in life expectancy. The largest percentage, however, by far was contributed by behavioral disinhibition. Nigg (2013)[2] says: > ADHD is clearly associated with worse physical health outcomes across multiple domains. These include unhealthy behaviors and outcomes like smoking, illicit substance use disorders, accidental injuries, obesity, and even suicide attempts and completed suicides. ---- Basically, having ADHD means you have less self-control, engage in riskier behaviour (including riskier eating habits, substance abuse, driving, sex. It also means you struggle in life, resulting in suicidality, aggressiveness and anti-social behaviour. You sleep worse. You're more likely to smoke because nicotine is a stimulant which has a medicating effect on ADHD symptoms. [1]: Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors, Barkley 2018 [2]: Attention-deficit/hyperactivity disorder and adverse health outcomes, Nigg 2013 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322430/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322430/)
- zepto 5y ago
  > It also means you struggle in life, resulting in suicidality, aggressiveness and anti-social behaviour. This is the stuff that seems like it could be dealt with by society being more accommodating rather than drugs.
  - BirdieNZ 5y ago
    How is society being more accommodating going to help with me wanting to be able to live my life like a normal adult rather than struggling with simple things? It isn't society's expectations that make life most difficult for me, it's my own.
    - zepto 5y ago
      Where did you get your idea of how a normal adult lives their life, if not from society?
      - BirdieNZ 5y ago
        I did get it from society, of course. I wouldn't equate changing society's accommodations with changing how easy the normal adult finds life, though. Changing accommodations has no impact on how easy my non-ADHD friends find their lives compared to me. Society can accommodate my difficulty in doing chores but that doesn't change that most of my friends don't find it difficult to take out the rubbish if they want to.
        zepto 5y ago
        > Society can accommodate my difficulty in doing chores How do you define “chores”? It’s seems very true that people with ADHD find it hard to get through a to-do list in a linear fashion. If that is what it means to do chores, then maybe there is a way to prevent rubbish accumulating that doesn’t require that of you. > that doesn't change that most of my friends don't find it difficult to take out the rubbish if they want to. Do you want to take out the rubbish? Or do you start out wanting to and then want to do something else?

rsanek 5y ago

>Also, we know that ADHD results in reduced life expectancy, so ADHD medication just has to improve that number for it to be pretty good. I'm hesitant to agree with this statement outright -- on the population level, I do think it makes sense to pursue interventions that increase life expectancy. But on the individual level we must ask, are we comparing apples-to-apples years of life? For example, I would pick 10 years of life with vitality over 12 years with mobility issues.

BirdieNZ 5y ago
That's a fair statement. For ADHD medication specifically, for most people diagnosed with ADHD I would expect to see both improved life quality AND life expectancy. Of course, specific individuals may experience worsened life quality on medication, in which case they will have to weigh up whether they want potentially longer life with lower life quality. Given the kinds of mortality causes from ADHD, I would think the calculus looks more like "ADHD meds make me feel yuck but maybe that's worth it to not get fired regularly, because my family needs me to support them financially and being fired regularly makes me depressed and suicidal".