11 ms·

Doctor: ADHD, as currently defined, does not exist

106 points by onedev 13y ago

Pxtl 13y ago
I feel like this headline is terribly irresponsible. People with mental health issues suffer from a stigma associated with them, as well as denial of their suffering. Going out with both guns blazing to say their condition does not exist - not that it's a symptom of a larger problem, or that it's a gross oversimplification of a number of unrelated diseases, but instead the crude headline "doesn't exist" - that only makes the situation worse. There are many people out there who need stimulant medication to function properly in their lives for very good reasons. Yes, their attention deficit may be a symptom of a complex problem, but the fact is that it exists. Unless you have a better idea how to treat it, I don't see what this kind of article accomplishes beyond making it harder for anyone to take the condition seriously.
- colechristensen 13y ago
  It sells. Do you have an alternative? Do we regulate what the news is allowed to say? How do we prevent such poor quality journalism? News is entertainment (sadly, and mostly worthless), expecting it to be anything else these days is foolish.
- pessimizer 13y ago
  Saying that a certain medical condition doesn't exist isn't a denial of the suffering of people who suffer, it's a denial of the label that's been placed on that suffering. As long as an attack on bad science continues to be interpreted by a segment of sufferers as a personal attack, sufferers groups will never exist as anything other than tools for drug companies to subvert the scientific process.
  - Pxtl 13y ago
    Imagine reading an article on punctuated equilibrium with the headline "Darwin is Wrong". Technically true, but WTF? Or a discussion of potential side-effects of the H1N1 vaccine with the headline "Vaccines Kill People". Just because it's true doesn't mean you don't need some tact. Also, I notice you've assumed I'm a sufferer. You might want to put away the "jump to conclusions mat" and maybe just try having a little empathy?
    - pessimizer 13y ago
      >Also, I notice you've assumed I'm a sufferer. Where did you notice that? https://en.wikipedia.org/wiki/Illusion_of_transparency https://en.wikipedia.org/wiki/Illusion_of_transparency
  - darkarmani 13y ago
    > As long as an attack on bad science The bad science is this book that pretends to have evidence on its side.
- Xylakant 13y ago
  > Unless you have a better idea how to treat it Actually, if you read the article until the end, it proposes a better idea to treat it: Do not lump together all the conditions that lead to the symptoms together. Treat them as individual conditions with different causes and administer appropriate treatment - don't just hand them pills because it's simple. I sincerely doubt that stimulants are the best treatment we can give those people. They may help in the short term, but they're highly addictive and your body develops a tolerance. What are you going to do once those people are tolerant to medication? Wave your hand in the air, tell them "bad luck, you developed a tolerance, now have a nice day". Medication may be required in some cases, but it's often only the beginning of a treatment. You need to solve or at least tackle the complex problem to really help them - and assigning a simple label doesn't always help.
  - trillium 13y ago
    I've personally known someone who has taken Ritalin type meds for 20+ years and did extremely well on it. In addition, my research indicates that tolerance to ADHD meds is uncommon and typically a person can be kept on one dose for years.
    - Xylakant 13y ago
      See, I'm under long-term medication myself, for an incurable, but treatable condition. Long term medication is a last-ditch remedy and that's for a reason. It's generally speaking a PITA. Where ever you go, you need to take your medication with you. Depending on what you get, you might have to take it on schedule. Depending on what you get, the pharmacy round the corner needs to order it and the stuff needs a prescription. Most stuff has side-effects, mine is mildly liver-toxic which means that I need to go have blood tests about every 8 weeks. I need to go to the doctor every 4 weeks for the prescription. When I travel longer than 4 weeks I need to jump through several hoops to get a larger amount. It's much better than without treatment, so if a friend asks me how I'm doing with the medication, I'd say "extremely well", but mainly because without medication it's extremely bad. Yes, medication helps and it's sometimes the last remedy when nothing else helps. But I think that not labeling all conditions that lead to ADHD-like symptoms as ADHD and rather try and find a more nuanced understanding of the problem is helpful, especially in a case where a condition is often diagnosed on children where parents read stuff on the internet and run from doctor to doctor to doctor trying to get a prescription for ritalin, since they're certain that the kid matches those 5 relatively generic symptoms.
- vincetogo 13y ago
  This guy is putting on his white overcoat and trying to look like a scientist, but he doesn't actually cite any real research in favour of his claim, and instead uses anecdotal evidence ("Usually, once the original condition is found and treated, the ADHD symptoms go away" and such) rather than statistics to support his conclusion and sell his book. This isn't to say he's incorrect in his conclusion, he just isn't supporting it very well. I would hope the book has referenced stats but this article isn't very promising. He's not too far removed from a pilot claiming his story about a flying saucer must true because he was in the airforce. For the record, I've been diagnosed with ADHD and have plenty of anecdotal evidence that it's for real, but may be suffering from confirmation bias.
  - batoure 13y ago
    Yes I agree, in fact I think it is particularly concerning that these op'eds are getting picked up by more recognized news outlets. He wrote an almost identical piece for the daily mail last week. http://www.dailymail.co.uk/health/article-2577814/The-eminent-doctor-convinced-ad-hd-doesnt-exist-In-fact-says-Dr-RICHARD-SAUL-symptoms-routine-causes-drugs-harm-good.html http://www.dailymail.co.uk/health/article-2577814/The-eminen... this is clearly just self promotion
- benched 13y ago
  As a sufferer of various mental things, I feel like the suffering and problems can be real, and the diagnoses and explanations still carry a heavy bullshit component.
darkarmani 13y ago
> "It’s time to rethink our understanding of this condition, offer more thorough diagnostic work, and help people get the right treatment for attention deficit and hyperactivity." What condition? Doesn't the title say this condition doesn't exist? This article is just trying to sell his book. Besides the fact that qEEG has shown differences in activity in adults that identify with having ADHD.
- nickff 13y ago
  Article authors often have no input on the how their piece is titled, so I would not be so quick to judge the journalist.
  - bryanlarsen 13y ago
    The book has the same title.
  - darkarmani 13y ago
    That's the title of the guy's book.
- hellogoodby3 13y ago
  He isn't denying that ADHD doesn't exist but instead he is saying that it exists as a symptom of other ailments. His title is a bit inflammatory, but that doesn't disprove his argument. The article is much better than you are giving it credit for.
  - darkarmani 13y ago
    > but that doesn't disprove his argument His argument is ridiculous. ADHD is defined as symptoms and we don't have a full understanding of the underlying cause. Everyone knows that the drug treatment only treats the symptoms. If his argument is that we are only treating the symptoms then he hasn't added any knowledge. If he knows the "cure" why doesn't he make the claim: "I know how to cure ADHD?"
    - 13y ago
hyperion2010 13y ago
Terrible title. Especially since there are actually people who believe that the title is true in the literal sense. The fact that we can further subdivide something based on etiology or any other criteria doesn't mean that it does not exist.
- MBCook 13y ago
  It's amazing how many people here are skipping the qualifier in the title, taking it as "ADHD does not exist".
  - watwut 13y ago
    That is the title of both the original time.com article and the book written by its author. The qualifier "as currently defined" is only on HN.
    - MBCook 13y ago
      Oh, you're right. That's odd considering how rigorously titles on HN are changed to match the original.
bryanlarsen 13y ago
My suggested title/tldr: ADHD is a symptom, not a disease. It's an interesting article, but that title is going to derail conversation.
- darkarmani 13y ago
  But that's always been the case. They don't understand the root cause or have a definitive test for the symptoms (except recent qEEG tests).
eam 13y ago
Pretty funny. Just yesterday I was at Barnes and Noble checking out some Malcolm Gladwell books in the psychology section and right next to them was a book with the title ADHD Does Not Exist. I didn't get a chance to take a peek at it because I was too occupied reading the first couple of pages from Gladwell's Blink which was pretty captivating.
JohnBooty 13y ago
This article is so potentially harmful, even if it's more nuanced than the hyperbolic "ADHD Doesn't Exist" title would suggest. The reality is that -- whatever the underlying cause -- a lot of people struggle with attention span issues, and that these issues cause a lot of pain and unfulfilled potential. Even if ADHD medications are overprescribed Band-Aids, people benefit from them. We should try and find better diagnoses and treatments, but it makes no sense to blast people by telling them their condition "doesn't exist." If I have one complaint about the way we treat ADHD it's a lack of education for patients. The medication is only one part of the solution and in my personal experience it's nowhere near the biggest piece. Diet, environment, sleep, and exercise are just as crucial... but these are things I figured out on my own, not anything my doctors mentioned. Firstly, addiction to stimulant medication is not rare; it is common. The drugs’ addictive qualities are obvious. We only need to observe the many patients who are forced to periodically increase their dosage if they want to concentrate. This true but disingenuous at best because it omits perspective in a way that borders on maliciousness. Adderall causes only a very mild dependence according to all studies I've ever read. The FDA and my personal experiences agree. I've discontinued my Adderall on a number of occasions (by responsibly tapering it down to 0mg over several days) and it was no problem. To compare it to something most of us are familiar with: I found Adderall much easier to discontinue than caffeine, a thing I've never been able to quit. (I've never smoked, so I can't compare with nicotine) And to all those who say ADHD is a matter of "willpower..." Maybe. For some. I always told myself that too. I was born in 1976 so I went through school here in the USA right before they started diagnosing ADHD left and right and I was labeled a procrastinator instead. I never even really heard of ADHD until I was out of school. After four years in college, which were a mix of promise and opportunities torpedoed by procrastination, I worked 10, 12, 14-hour days to finish work that I was more than talented enough to finish in 5 or 6 hours. My happiness suffered, health suffered, and relationships died. Then I finally admitted that maybe it was a little more than a willpower issue. If it a matter of lacking willpower, why was I at the damn office trying to work long after everybody else had left? Whatever the hell my problem was, it wasn't work ethic. So I sought treatment... at the age of 32. And while medication was only an imperfect yet valuable part of the solution, my life has been on track again for a number of years.
- 13y ago
lolwutf 13y ago
Horse shit. There's lots of very well-vetted science supporting the problem of ADHD and attention span disorders. Ditto for the pharmaceutical interventions that are the main-line treatment for them (amphetamine is one of the most well-studied drugs in existence). Sad to see Time sinking to clickbait headlining.
com2kid 13y ago
The article is dangerously mistitled. That multiple actual mental health conditions exist that all have been labeled ADHD is well known by the research community. There are multiple causative factors that can lead to ADHD symptoms, and what have traditionally been referred to as different subtypes of ADHD respond to different types of treatment. This is hardly news! It is also where there are multiple treatment strategies for ADHD, until we get a better naming scheme in place (and make no mistake, the lack of proper names impacts both communication and how we think about the problem), we are stuck with using the catch all term ADHD. (Though some people have split into using ADHD-PI from primarily inattentive, it often doesn't respond to stimulant treatment at all.) Now I fundamentally disagree with the author's final assertion that "everyone is misdiagnosed" is pure BS. Primary evidence is that there are structural brain differences in people who have ADHD. The portion of the brain responsible for self control is dramatically smaller. Arguing that "it isn't real" when there is literally missing brain matter is disingenuous at best. Next up, people with untreated ADHD have THREE TIMES the rates of auto accidents. Now, maybe, just maybe, ADHD isn't real at all, and instead psychologists have spent their time and energy coming up with the best auto insurance risk test ever! But I doubt it.
clienthunter 13y ago
This man is peddling a book. I'm not saying that precludes his correctness but it does mean that the more analytical of us should apply a little more salt to our appraisal of his motivations than a journalist might.
- JeremyMorgan 13y ago
  Exactly what I was thinking.
deleted 13y ago
[deleted]
nerdo 13y ago
Is ADHD considered a disability? If so, looking at the timeframe (2008-2012), and the population segment (young adults), this could be the product of a backdoor welfare program, where ADHD diagnoses are the fig leaf employed.
- lilsunnybee 13y ago
  I don't think so, as far as receiving financial assistance for mental health conditions in the US. In fact except for developmental disorders and conditions involving psychoses (schizophrenia), I've heard that it is quite difficult to get any sort of assistance, regardless of how severely your life has been affected, without a good lawyer at least.
Millennium 13y ago
It might be better to say that the current definition of ADHD is grossly inadequate. The problems start from issues as basic as treating ADHD as one monolithic "thing," when in fact it is a symptom that can arise from many different diseases, some of which respond better to different medications than others, and some of which do not respond to medication at all. By treating them all as a single disease, we do almost all of their sufferers a grave disservice.
- MBCook 13y ago
  > It might be better to say that the current definition of ADHD is grossly inadequate. Isn't that why the qualifier ', as currently defined,' is in the title? EDIT: watwut pointed out to me elsewhere that the qualifier is only on HN and not in the original title.
richardlblair 13y ago
Some folks are missing the point. Both the definition of ADHD and the treatment plan for it (in North America) are broken. In France, just 0.5% of children suffer from ADHD (opposed to ~5% in North America), and with those children they find the root cause of the issue and deal with that. They tend to shy away from medication. This is, more often than not, the proper treatment option for behavioural issues. People need to realize the DSM, in its current state, is a massive cash cow for Big Pharma. When it comes to ADHD specifically, they needed a bigger market, welcome Adult ADHD. Finally, I realize a lot of people suffer from attention issues. I don't disagree that these things need to be dealt with, but a catch-all diagnosis isn't really the way to do that. I'm much more interested in finding the actual problem, and fixing that.
- trillium 13y ago
  Off the top of my head, roughly 7% of kids in the US have ADHD and roughly 4-5% of adults have ADHD. 20% of boys of a certain age have currently been diagnosed with ADHD.
  - watwut 13y ago
    If the definition of ADHD includes 20% of all boys, then I'm inclined to believe the definition takes in too many kids. If 1 in 5 kids has it, then it is normal behavior in that age range.
    - richardlblair 13y ago
      This. So much this. But, think of all the children we can get hooked on ritalin! Think of the lifetime of revenue (for big pharma)!
    - trillium 13y ago
      I don't in anyway shape or form think 20% of boys should be diagnosed with ADHD. I think something is seriously wrong with our society if this is happening.
- ebiester 13y ago
ChikkaChiChi 13y ago
Experts like this jackass and Andrew Wakefield should be held accountable for criminal misconduct when the publish crap like this. Sensationalistic 'findings' that lack a concise scientific method that have an ulterior motive are harmful to those people that expect information from experts to be presented without bias.
shittyanalogy 13y ago
A doctor? Intelligent discussion doesn't start with "one guy thinks". Authority is not a reason for scientific conclusion.
skywhopper 13y ago
The author appears to have a philosophical issue with the DSM itself, more than a useful argument. One could make the same complaint about many of the conditions defined in the DSM. The DSM faces an insurmountable challenge in attempting to taxonomize mental issues. In "reality" next to none of the syndromes and disorders there "exist", except in terms of collections of symptoms and treatments, and assumptions about what's "normal". Honestly nothing he says goes against anything anyone who's done even a cursory study of ADHD will already know. But he leaves out a lot that folks without much familiarity with ADHD won't already know, such as that many people with ADHD take medicines other than stimulants: anti-depressants, blood pressure medicines. A lot of drugs have been found to address the underlying problems, and each class works differently in different people. The fact is that, like every other aspect of brain chemistry and function, we understand very very little about ADHD. That doesn't mean that it doesn't exist or that people with the disorder should stop taking medicine that works for them. It means we need to study it more to find out how to better describe and explain all the intricate connections between behavior, diet, genetics, environment, sleep, screens, family, school, work, weather, vitamins, and drugs interplay to create what we now call ADHD.
- mrxd 13y ago
  > The author appears to have a philosophical issue with the DSM itself I find that hard to believe. He argues that some cases of ADHD are caused by bipolar disorder and depression, which have DSM definitions.
bpm140 13y ago
The author could have just as easily written "Cancer, as currently defined, does not exist" or "Arthritis, as currently defined, does not exist". In all of these cases, the the catch-all phrase is used to describe a handful of similar symptoms that stem from a wild variety of causes. This is why we won't be curing cancer any time soon. We may cure a specific type of cancer, but we're going to have to cure each type of cancer in a specific a relevant way. If the author wanted to say "ADHD is actually a catch-all term for a variety of root causes that would be better treated with specificity" I would be all over that. But, hey, page views.
a3voices 13y ago
Did ADHD exist when people were hunter-gatherers? If not, it is not a real disorder in my book.
scott_s 13y ago
Counterpoint: "ADHD and Brain Chemistry", by Steven Novella: http://theness.com/neurologicablog/index.php/adhd-and-brain-chemistry/ http://theness.com/neurologicablog/index.php/adhd-and-brain-... Also, except on the same topic from the podcast "The Skeptics Guide to the Universe": http://www.youtube.com/watch?v=-MLdvKzLl6k http://www.youtube.com/watch?v=-MLdvKzLl6k
ajcarpy2005 13y ago
In my research, ADHD seems to be basically inflammation[1] of the brain. Think: bacteria, free radicals, active immune response, underactive detox and circulation, etc. Some approaches which are most useful seem to be: Magnesium, Green Tea &/OR L-Theanine, GABA, SAMe, Milk Thistle, Fish Oil, Cholesterol, Vitamin D (Sunlight), etc. I would say there is no silver bullet. But I would say unambiguously that vitamins and minerals and occasionally herbs are low hanging fruit compared to a pharmaceutical approach. Drugs aren't used as "building blocks" in cells or biochemistry. Drugs modulate various activity in our body which can help but typically is not without some kind of side effect or not as affective as providing enough of the "raw materials" our body needs. Attention Deficit Hyperactive Disorder definitely exists although the way it's predominately treated really doesn't help solve the deeper causes of the disorder. [1] http://www.ncbi.nlm.nih.gov/pubmed/24240495 http://www.ncbi.nlm.nih.gov/pubmed/24240495
- JohnBooty 13y ago
  I don't doubt that inflammation is one of the myriad things that can cause attention issues. One thing to realize re: supplements is that, by biological design, it's really hard to get chemicals into your brain simply by digesting them. There are a lot of steps between eating something and it winding up in your brain. I mean, the very first thing that happens to ingested items is a bath in the insane mixture of acid and bacteria that is your stomach. A lot more has to happen before it even reaches your brain-blood barrier, which is a thing specifically designed by evolution to keep things out of your brain.
  - ajcarpy2005 13y ago
    The mechanisms of action that I'm referring to don't depend upon physically transporting molecules into the brain. Also, as it turns out, even inflammation in your gut or elsewhere changes the signals that the nerves send to the brain. And levels of neurotransmitters in the brain are absolutely impacted by what's going on in the rest of the body...regardless of the BBB. What specific point are you trying to make about the Blood-Brain Barrier? And stomach acid? Sorry but neither of those things somehow render the foods and chemicals we ingest meaningless! Your HCL won't somehow break down Magnesium! Even Vitamins will mostly make it through intact. I'm not a scientist but I don't get my information from Men's Health magazine either...I research reputable scientific studies and make reasonable connections.
MikeTLive 13y ago
QUOTE "For my second group of patients, who have severe attention issues, I make them undergo a full evaluation to find the source of the problem. Usually, once the original condition is found and treated, the ADHD symptoms go away." And, when the original condition is the required 14 or so traits of ADHD, which using your "over 20" treatments do not solve, do you decide this is non-ADHD with ADHD Symptoms ? asshole.
NextUserName 13y ago
Lets get half the population on ADHD Drugs, then the other half on Anti-depressants. Then we as individuals don't actually have to deal with any personal challenges, not even controlling the growing, intrusive and overreaching power of government.
NextUserName 13y ago
Modern civilization has certainly invented ADHD. It used to be that if you had ADHD, you probably weren't a banker, lawyer or politician. You certainly would not work in a cubicle and rot away all day. You also lived 15 years longer than your sedentary counterpart. You would do a more physical job. Physical work often creates the necessary stimulation that so many of these ADHD cases need. The argument that it just isn't fair that someone's mind is more suited for a desk job than someone else, so we should put them on equal footing by administering drugs the rest of their lives is a flawed and slippery slope mentality. Do we say the same the same thing for aspiring athletes who weren't born with the muscle mass to play pro football? "Lets make things fair and pump this kid full of roids so he can be an all pro linebacker"... Severe ADHD sufferers I agree should be given medication, but the majority That I personally know (some of whom I worked with before and after meds) should just have changed careers. They still have problems while on the meds and also have to deal side effects from the mind altering drug they are using. Those I know who have either pursued alternate careers, or switched are much happier overall. Imagine that, doing what traditionally, naturally was done leads to greater happiness... Wow
- JohnBooty 13y ago
  Physical work isn't necessarily easier for those with ADHD than desk jobs. In high school and college I had some physical jobs. Those jobs are often menial, and the monotony and repetition are really the opposite of what those with ADHD (especially those with ADHD and high intelligence) are "naturally" suited for. Do we say the same the same thing for aspiring athletes who weren't born with the muscle mass to play pro football? We don't "pump them full of steroids" because unlike the (admittedly imperfect) ADHD treatments we have now, muscle-building steroids have negative side effects that greatly outweigh their benefits. We do give them the best medical care possible. If an aspiring athlete breaks a leg or has plantar fasciitis, we treat those things. We don't just say, "guess you weren't meant to be an athlete." It used to be that if you had ADHD, you probably weren't a banker, lawyer or politician. Yeah, and if you had bad eyesight, you were probably steered away from those professions as well. And if you were left-handed people assumed you were under demonic influence or something. And if you were dyslexic people assumed you were stupid. I'm glad people like me are winning against people like you.
sizzle 13y ago
I remember reading an interesting hypothesis of adhd being an evolutionary trait/advantage, anyone know anything about this? I have not been able to find it.

106 points by onedev 13y ago

Pxtl 13y ago

I feel like this headline is terribly irresponsible. People with mental health issues suffer from a stigma associated with them, as well as denial of their suffering. Going out with both guns blazing to say their condition does not exist - not that it's a symptom of a larger problem, or that it's a gross oversimplification of a number of unrelated diseases, but instead the crude headline "doesn't exist" - that only makes the situation worse. There are many people out there who need stimulant medication to function properly in their lives for very good reasons. Yes, their attention deficit may be a symptom of a complex problem, but the fact is that it exists. Unless you have a better idea how to treat it, I don't see what this kind of article accomplishes beyond making it harder for anyone to take the condition seriously.

colechristensen 13y ago
It sells. Do you have an alternative? Do we regulate what the news is allowed to say? How do we prevent such poor quality journalism? News is entertainment (sadly, and mostly worthless), expecting it to be anything else these days is foolish.
pessimizer 13y ago
Saying that a certain medical condition doesn't exist isn't a denial of the suffering of people who suffer, it's a denial of the label that's been placed on that suffering. As long as an attack on bad science continues to be interpreted by a segment of sufferers as a personal attack, sufferers groups will never exist as anything other than tools for drug companies to subvert the scientific process.
- Pxtl 13y ago
  Imagine reading an article on punctuated equilibrium with the headline "Darwin is Wrong". Technically true, but WTF? Or a discussion of potential side-effects of the H1N1 vaccine with the headline "Vaccines Kill People". Just because it's true doesn't mean you don't need some tact. Also, I notice you've assumed I'm a sufferer. You might want to put away the "jump to conclusions mat" and maybe just try having a little empathy?
  - pessimizer 13y ago
    >Also, I notice you've assumed I'm a sufferer. Where did you notice that? https://en.wikipedia.org/wiki/Illusion_of_transparency https://en.wikipedia.org/wiki/Illusion_of_transparency
- darkarmani 13y ago
  > As long as an attack on bad science The bad science is this book that pretends to have evidence on its side.
Xylakant 13y ago
> Unless you have a better idea how to treat it Actually, if you read the article until the end, it proposes a better idea to treat it: Do not lump together all the conditions that lead to the symptoms together. Treat them as individual conditions with different causes and administer appropriate treatment - don't just hand them pills because it's simple. I sincerely doubt that stimulants are the best treatment we can give those people. They may help in the short term, but they're highly addictive and your body develops a tolerance. What are you going to do once those people are tolerant to medication? Wave your hand in the air, tell them "bad luck, you developed a tolerance, now have a nice day". Medication may be required in some cases, but it's often only the beginning of a treatment. You need to solve or at least tackle the complex problem to really help them - and assigning a simple label doesn't always help.
- trillium 13y ago
  I've personally known someone who has taken Ritalin type meds for 20+ years and did extremely well on it. In addition, my research indicates that tolerance to ADHD meds is uncommon and typically a person can be kept on one dose for years.
  - Xylakant 13y ago
    See, I'm under long-term medication myself, for an incurable, but treatable condition. Long term medication is a last-ditch remedy and that's for a reason. It's generally speaking a PITA. Where ever you go, you need to take your medication with you. Depending on what you get, you might have to take it on schedule. Depending on what you get, the pharmacy round the corner needs to order it and the stuff needs a prescription. Most stuff has side-effects, mine is mildly liver-toxic which means that I need to go have blood tests about every 8 weeks. I need to go to the doctor every 4 weeks for the prescription. When I travel longer than 4 weeks I need to jump through several hoops to get a larger amount. It's much better than without treatment, so if a friend asks me how I'm doing with the medication, I'd say "extremely well", but mainly because without medication it's extremely bad. Yes, medication helps and it's sometimes the last remedy when nothing else helps. But I think that not labeling all conditions that lead to ADHD-like symptoms as ADHD and rather try and find a more nuanced understanding of the problem is helpful, especially in a case where a condition is often diagnosed on children where parents read stuff on the internet and run from doctor to doctor to doctor trying to get a prescription for ritalin, since they're certain that the kid matches those 5 relatively generic symptoms.
vincetogo 13y ago
This guy is putting on his white overcoat and trying to look like a scientist, but he doesn't actually cite any real research in favour of his claim, and instead uses anecdotal evidence ("Usually, once the original condition is found and treated, the ADHD symptoms go away" and such) rather than statistics to support his conclusion and sell his book. This isn't to say he's incorrect in his conclusion, he just isn't supporting it very well. I would hope the book has referenced stats but this article isn't very promising. He's not too far removed from a pilot claiming his story about a flying saucer must true because he was in the airforce. For the record, I've been diagnosed with ADHD and have plenty of anecdotal evidence that it's for real, but may be suffering from confirmation bias.
- batoure 13y ago
  Yes I agree, in fact I think it is particularly concerning that these op'eds are getting picked up by more recognized news outlets. He wrote an almost identical piece for the daily mail last week. http://www.dailymail.co.uk/health/article-2577814/The-eminent-doctor-convinced-ad-hd-doesnt-exist-In-fact-says-Dr-RICHARD-SAUL-symptoms-routine-causes-drugs-harm-good.html http://www.dailymail.co.uk/health/article-2577814/The-eminen... this is clearly just self promotion
benched 13y ago
As a sufferer of various mental things, I feel like the suffering and problems can be real, and the diagnoses and explanations still carry a heavy bullshit component.

darkarmani 13y ago

> "It’s time to rethink our understanding of this condition, offer more thorough diagnostic work, and help people get the right treatment for attention deficit and hyperactivity." What condition? Doesn't the title say this condition doesn't exist? This article is just trying to sell his book. Besides the fact that qEEG has shown differences in activity in adults that identify with having ADHD.

nickff 13y ago
Article authors often have no input on the how their piece is titled, so I would not be so quick to judge the journalist.
- bryanlarsen 13y ago
  The book has the same title.
- darkarmani 13y ago
  That's the title of the guy's book.
hellogoodby3 13y ago
He isn't denying that ADHD doesn't exist but instead he is saying that it exists as a symptom of other ailments. His title is a bit inflammatory, but that doesn't disprove his argument. The article is much better than you are giving it credit for.
- darkarmani 13y ago
  > but that doesn't disprove his argument His argument is ridiculous. ADHD is defined as symptoms and we don't have a full understanding of the underlying cause. Everyone knows that the drug treatment only treats the symptoms. If his argument is that we are only treating the symptoms then he hasn't added any knowledge. If he knows the "cure" why doesn't he make the claim: "I know how to cure ADHD?"
  - 13y ago

hyperion2010 13y ago

Terrible title. Especially since there are actually people who believe that the title is true in the literal sense. The fact that we can further subdivide something based on etiology or any other criteria doesn't mean that it does not exist.

MBCook 13y ago
It's amazing how many people here are skipping the qualifier in the title, taking it as "ADHD does not exist".
- watwut 13y ago
  That is the title of both the original time.com article and the book written by its author. The qualifier "as currently defined" is only on HN.
  - MBCook 13y ago
    Oh, you're right. That's odd considering how rigorously titles on HN are changed to match the original.

bryanlarsen 13y ago

My suggested title/tldr: ADHD is a symptom, not a disease. It's an interesting article, but that title is going to derail conversation.

darkarmani 13y ago
But that's always been the case. They don't understand the root cause or have a definitive test for the symptoms (except recent qEEG tests).

eam 13y ago

Pretty funny. Just yesterday I was at Barnes and Noble checking out some Malcolm Gladwell books in the psychology section and right next to them was a book with the title ADHD Does Not Exist. I didn't get a chance to take a peek at it because I was too occupied reading the first couple of pages from Gladwell's Blink which was pretty captivating.

JohnBooty 13y ago

This article is so potentially harmful, even if it's more nuanced than the hyperbolic "ADHD Doesn't Exist" title would suggest. The reality is that -- whatever the underlying cause -- a lot of people struggle with attention span issues, and that these issues cause a lot of pain and unfulfilled potential. Even if ADHD medications are overprescribed Band-Aids, people benefit from them. We should try and find better diagnoses and treatments, but it makes no sense to blast people by telling them their condition "doesn't exist." If I have one complaint about the way we treat ADHD it's a lack of education for patients. The medication is only one part of the solution and in my personal experience it's nowhere near the biggest piece. Diet, environment, sleep, and exercise are just as crucial... but these are things I figured out on my own, not anything my doctors mentioned. Firstly, addiction to stimulant medication is not rare; it is common. The drugs’ addictive qualities are obvious. We only need to observe the many patients who are forced to periodically increase their dosage if they want to concentrate. This true but disingenuous at best because it omits perspective in a way that borders on maliciousness. Adderall causes only a very mild dependence according to all studies I've ever read. The FDA and my personal experiences agree. I've discontinued my Adderall on a number of occasions (by responsibly tapering it down to 0mg over several days) and it was no problem. To compare it to something most of us are familiar with: I found Adderall much easier to discontinue than caffeine, a thing I've never been able to quit. (I've never smoked, so I can't compare with nicotine) And to all those who say ADHD is a matter of "willpower..." Maybe. For some. I always told myself that too. I was born in 1976 so I went through school here in the USA right before they started diagnosing ADHD left and right and I was labeled a procrastinator instead. I never even really heard of ADHD until I was out of school. After four years in college, which were a mix of promise and opportunities torpedoed by procrastination, I worked 10, 12, 14-hour days to finish work that I was more than talented enough to finish in 5 or 6 hours. My happiness suffered, health suffered, and relationships died. Then I finally admitted that maybe it was a little more than a willpower issue. If it a matter of lacking willpower, why was I at the damn office trying to work long after everybody else had left? Whatever the hell my problem was, it wasn't work ethic. So I sought treatment... at the age of 32. And while medication was only an imperfect yet valuable part of the solution, my life has been on track again for a number of years.

13y ago

lolwutf 13y ago

Horse shit. There's lots of very well-vetted science supporting the problem of ADHD and attention span disorders. Ditto for the pharmaceutical interventions that are the main-line treatment for them (amphetamine is one of the most well-studied drugs in existence). Sad to see Time sinking to clickbait headlining.

com2kid 13y ago

The article is dangerously mistitled. That multiple actual mental health conditions exist that all have been labeled ADHD is well known by the research community. There are multiple causative factors that can lead to ADHD symptoms, and what have traditionally been referred to as different subtypes of ADHD respond to different types of treatment. This is hardly news! It is also where there are multiple treatment strategies for ADHD, until we get a better naming scheme in place (and make no mistake, the lack of proper names impacts both communication and how we think about the problem), we are stuck with using the catch all term ADHD. (Though some people have split into using ADHD-PI from primarily inattentive, it often doesn't respond to stimulant treatment at all.) Now I fundamentally disagree with the author's final assertion that "everyone is misdiagnosed" is pure BS. Primary evidence is that there are structural brain differences in people who have ADHD. The portion of the brain responsible for self control is dramatically smaller. Arguing that "it isn't real" when there is literally missing brain matter is disingenuous at best. Next up, people with untreated ADHD have THREE TIMES the rates of auto accidents. Now, maybe, just maybe, ADHD isn't real at all, and instead psychologists have spent their time and energy coming up with the best auto insurance risk test ever! But I doubt it.

clienthunter 13y ago

This man is peddling a book. I'm not saying that precludes his correctness but it does mean that the more analytical of us should apply a little more salt to our appraisal of his motivations than a journalist might.

JeremyMorgan 13y ago
Exactly what I was thinking.

deleted 13y ago

[deleted]

nerdo 13y ago

Is ADHD considered a disability? If so, looking at the timeframe (2008-2012), and the population segment (young adults), this could be the product of a backdoor welfare program, where ADHD diagnoses are the fig leaf employed.

lilsunnybee 13y ago
I don't think so, as far as receiving financial assistance for mental health conditions in the US. In fact except for developmental disorders and conditions involving psychoses (schizophrenia), I've heard that it is quite difficult to get any sort of assistance, regardless of how severely your life has been affected, without a good lawyer at least.

Millennium 13y ago

It might be better to say that the current definition of ADHD is grossly inadequate. The problems start from issues as basic as treating ADHD as one monolithic "thing," when in fact it is a symptom that can arise from many different diseases, some of which respond better to different medications than others, and some of which do not respond to medication at all. By treating them all as a single disease, we do almost all of their sufferers a grave disservice.

MBCook 13y ago
> It might be better to say that the current definition of ADHD is grossly inadequate. Isn't that why the qualifier ', as currently defined,' is in the title? EDIT: watwut pointed out to me elsewhere that the qualifier is only on HN and not in the original title.

richardlblair 13y ago

Some folks are missing the point. Both the definition of ADHD and the treatment plan for it (in North America) are broken. In France, just 0.5% of children suffer from ADHD (opposed to ~5% in North America), and with those children they find the root cause of the issue and deal with that. They tend to shy away from medication. This is, more often than not, the proper treatment option for behavioural issues. People need to realize the DSM, in its current state, is a massive cash cow for Big Pharma. When it comes to ADHD specifically, they needed a bigger market, welcome Adult ADHD. Finally, I realize a lot of people suffer from attention issues. I don't disagree that these things need to be dealt with, but a catch-all diagnosis isn't really the way to do that. I'm much more interested in finding the actual problem, and fixing that.

trillium 13y ago
Off the top of my head, roughly 7% of kids in the US have ADHD and roughly 4-5% of adults have ADHD. 20% of boys of a certain age have currently been diagnosed with ADHD.
- watwut 13y ago
  If the definition of ADHD includes 20% of all boys, then I'm inclined to believe the definition takes in too many kids. If 1 in 5 kids has it, then it is normal behavior in that age range.
  - richardlblair 13y ago
    This. So much this. But, think of all the children we can get hooked on ritalin! Think of the lifetime of revenue (for big pharma)!
  - trillium 13y ago
    I don't in anyway shape or form think 20% of boys should be diagnosed with ADHD. I think something is seriously wrong with our society if this is happening.
ebiester 13y ago

ChikkaChiChi 13y ago

Experts like this jackass and Andrew Wakefield should be held accountable for criminal misconduct when the publish crap like this. Sensationalistic 'findings' that lack a concise scientific method that have an ulterior motive are harmful to those people that expect information from experts to be presented without bias.

shittyanalogy 13y ago

A doctor? Intelligent discussion doesn't start with "one guy thinks". Authority is not a reason for scientific conclusion.

skywhopper 13y ago

The author appears to have a philosophical issue with the DSM itself, more than a useful argument. One could make the same complaint about many of the conditions defined in the DSM. The DSM faces an insurmountable challenge in attempting to taxonomize mental issues. In "reality" next to none of the syndromes and disorders there "exist", except in terms of collections of symptoms and treatments, and assumptions about what's "normal". Honestly nothing he says goes against anything anyone who's done even a cursory study of ADHD will already know. But he leaves out a lot that folks without much familiarity with ADHD won't already know, such as that many people with ADHD take medicines other than stimulants: anti-depressants, blood pressure medicines. A lot of drugs have been found to address the underlying problems, and each class works differently in different people. The fact is that, like every other aspect of brain chemistry and function, we understand very very little about ADHD. That doesn't mean that it doesn't exist or that people with the disorder should stop taking medicine that works for them. It means we need to study it more to find out how to better describe and explain all the intricate connections between behavior, diet, genetics, environment, sleep, screens, family, school, work, weather, vitamins, and drugs interplay to create what we now call ADHD.

mrxd 13y ago
> The author appears to have a philosophical issue with the DSM itself I find that hard to believe. He argues that some cases of ADHD are caused by bipolar disorder and depression, which have DSM definitions.

bpm140 13y ago

The author could have just as easily written "Cancer, as currently defined, does not exist" or "Arthritis, as currently defined, does not exist". In all of these cases, the the catch-all phrase is used to describe a handful of similar symptoms that stem from a wild variety of causes. This is why we won't be curing cancer any time soon. We may cure a specific type of cancer, but we're going to have to cure each type of cancer in a specific a relevant way. If the author wanted to say "ADHD is actually a catch-all term for a variety of root causes that would be better treated with specificity" I would be all over that. But, hey, page views.

a3voices 13y ago

Did ADHD exist when people were hunter-gatherers? If not, it is not a real disorder in my book.

scott_s 13y ago

Counterpoint: "ADHD and Brain Chemistry", by Steven Novella: http://theness.com/neurologicablog/index.php/adhd-and-brain-chemistry/ http://theness.com/neurologicablog/index.php/adhd-and-brain-... Also, except on the same topic from the podcast "The Skeptics Guide to the Universe": http://www.youtube.com/watch?v=-MLdvKzLl6k http://www.youtube.com/watch?v=-MLdvKzLl6k

ajcarpy2005 13y ago

In my research, ADHD seems to be basically inflammation[1] of the brain. Think: bacteria, free radicals, active immune response, underactive detox and circulation, etc. Some approaches which are most useful seem to be: Magnesium, Green Tea &/OR L-Theanine, GABA, SAMe, Milk Thistle, Fish Oil, Cholesterol, Vitamin D (Sunlight), etc. I would say there is no silver bullet. But I would say unambiguously that vitamins and minerals and occasionally herbs are low hanging fruit compared to a pharmaceutical approach. Drugs aren't used as "building blocks" in cells or biochemistry. Drugs modulate various activity in our body which can help but typically is not without some kind of side effect or not as affective as providing enough of the "raw materials" our body needs. Attention Deficit Hyperactive Disorder definitely exists although the way it's predominately treated really doesn't help solve the deeper causes of the disorder. [1] http://www.ncbi.nlm.nih.gov/pubmed/24240495 http://www.ncbi.nlm.nih.gov/pubmed/24240495

JohnBooty 13y ago
I don't doubt that inflammation is one of the myriad things that can cause attention issues. One thing to realize re: supplements is that, by biological design, it's really hard to get chemicals into your brain simply by digesting them. There are a lot of steps between eating something and it winding up in your brain. I mean, the very first thing that happens to ingested items is a bath in the insane mixture of acid and bacteria that is your stomach. A lot more has to happen before it even reaches your brain-blood barrier, which is a thing specifically designed by evolution to keep things out of your brain.
- ajcarpy2005 13y ago
  The mechanisms of action that I'm referring to don't depend upon physically transporting molecules into the brain. Also, as it turns out, even inflammation in your gut or elsewhere changes the signals that the nerves send to the brain. And levels of neurotransmitters in the brain are absolutely impacted by what's going on in the rest of the body...regardless of the BBB. What specific point are you trying to make about the Blood-Brain Barrier? And stomach acid? Sorry but neither of those things somehow render the foods and chemicals we ingest meaningless! Your HCL won't somehow break down Magnesium! Even Vitamins will mostly make it through intact. I'm not a scientist but I don't get my information from Men's Health magazine either...I research reputable scientific studies and make reasonable connections.

MikeTLive 13y ago

QUOTE "For my second group of patients, who have severe attention issues, I make them undergo a full evaluation to find the source of the problem. Usually, once the original condition is found and treated, the ADHD symptoms go away." And, when the original condition is the required 14 or so traits of ADHD, which using your "over 20" treatments do not solve, do you decide this is non-ADHD with ADHD Symptoms ? asshole.

NextUserName 13y ago

Lets get half the population on ADHD Drugs, then the other half on Anti-depressants. Then we as individuals don't actually have to deal with any personal challenges, not even controlling the growing, intrusive and overreaching power of government.

NextUserName 13y ago

Modern civilization has certainly invented ADHD. It used to be that if you had ADHD, you probably weren't a banker, lawyer or politician. You certainly would not work in a cubicle and rot away all day. You also lived 15 years longer than your sedentary counterpart. You would do a more physical job. Physical work often creates the necessary stimulation that so many of these ADHD cases need. The argument that it just isn't fair that someone's mind is more suited for a desk job than someone else, so we should put them on equal footing by administering drugs the rest of their lives is a flawed and slippery slope mentality. Do we say the same the same thing for aspiring athletes who weren't born with the muscle mass to play pro football? "Lets make things fair and pump this kid full of roids so he can be an all pro linebacker"... Severe ADHD sufferers I agree should be given medication, but the majority That I personally know (some of whom I worked with before and after meds) should just have changed careers. They still have problems while on the meds and also have to deal side effects from the mind altering drug they are using. Those I know who have either pursued alternate careers, or switched are much happier overall. Imagine that, doing what traditionally, naturally was done leads to greater happiness... Wow

JohnBooty 13y ago
Physical work isn't necessarily easier for those with ADHD than desk jobs. In high school and college I had some physical jobs. Those jobs are often menial, and the monotony and repetition are really the opposite of what those with ADHD (especially those with ADHD and high intelligence) are "naturally" suited for. Do we say the same the same thing for aspiring athletes who weren't born with the muscle mass to play pro football? We don't "pump them full of steroids" because unlike the (admittedly imperfect) ADHD treatments we have now, muscle-building steroids have negative side effects that greatly outweigh their benefits. We do give them the best medical care possible. If an aspiring athlete breaks a leg or has plantar fasciitis, we treat those things. We don't just say, "guess you weren't meant to be an athlete." It used to be that if you had ADHD, you probably weren't a banker, lawyer or politician. Yeah, and if you had bad eyesight, you were probably steered away from those professions as well. And if you were left-handed people assumed you were under demonic influence or something. And if you were dyslexic people assumed you were stupid. I'm glad people like me are winning against people like you.

sizzle 13y ago

I remember reading an interesting hypothesis of adhd being an evolutionary trait/advantage, anyone know anything about this? I have not been able to find it.