This study focused specifically on methylphenidate, one of many medications prescribed for ADHD. The title should be adjusted accordingly, as the current title is ambiguous and potentially misleading.
I was actually going to point that out. IMO from what I've seen of parents are that people who bring their children at a young-ish age to a therapist have a different issue. Especially "being to hyper" or "being unable to focus" have a different issue.
Children are supposed to be outside moving 8-12 hours a day, have you seen puppies? They need something similar. Instead many parents give their children tablets, plop them in front of the TV and do something else. Kick them into the back yard or go throw a ball with them.
Every child I know diagnosed with ADHD had parents who didn't want to deal with them. Bringing them to the gym, to the park, playing in the backyard; it's a lot of work. Kids who have trouble focusing are likely tired and overstimulated. Reduce the number of toys, remove TV / tablets, and send them outside. It'll probably solve itself.
As an experiment, look at the people you know on medication (or ask), look at the troubled children, etc. I guarantee you'll see the same trend: single parent home, started medication at an early age, regular therapist appointments, etc. They're unhappy and need depressants, ADHD medication, etc.
It's not always the case, but it's a trend. People who are diagnosed with ADHD at a younger age likely have parents who just don't want / know how to deal with issues. Mental health "experts" treat the symptoms via medication, but the underlying issue(s) just continue to fester.
What we really need is a strong emphasis on family development, courses built around it and support groups. Parents naturally do this, but I think it's been severely broken down the past 50-60 years and is getting exponentially worse. As such we see more: single parent homes, abundance of medication, reduction in religion and adult social clubs, etc.
I have ADHD, and increasing eustress by working out or doing fun physical things like sports to the point of being tired is one thing that is better than anything I've been prescribed. It's not fall asleep tired, it's more akin to being physically spent. When there is no more need to fidget and do things, I focus like a laser and am less prone to impulse.
Great it works for you. You probably have the hyperactive type of ADHD. For me and my daughter with inattentive/non-hyperactive ADD, doing physical things, while fun, just make us tired and want to sleep. Not a good idea if you need to focus and get work done.
I take daily medication and it has been literally life saving as I was able to turn things around and keep my marriage from falling apart, not to mention my happiness from being able to accomplish much, much more. I'm holding off medication for my daughter only because it lessens appetite and she is very skinny already. Once she's grown to her full height we'll get her meds she can use too.
I feel for you, I hope you guys settle on something that works with as little sides as possible. It's a spectrum with a lot of means to address a moving target, so some trial and error unfortunately comes with it. Luckily I was able to work with my doc to find things that work for the things that eustress cannot solve. Just curious, what do you take?
I don’t see how you are getting that from OP’s comment. OP seems to be claiming that ADHD is often over diagnosed and/or treated improperly. A viewpoint shared by people I know in the field.
Bringing them to the gym, to the park, playing in the backyard; it's a lot of work.
I agree with your point but as I’m wrapping up raising my own children I’m coming to the conclusion that I made it a lot harder in myself. Driving them to a million activities, even driving them to playgrounds several times per week, Home Depot kids workshops and so much more.
Sometimes I think a better thing would’ve been to simply say, “Go play outside.”
I formed this opinion from knowing many and seeing the way they are being / were raised. There's quite a bit of evidence to support this btw (outside of my observations).
> Approximately 10% of the sample was classified as having ADHD. We found depression, anxiety, healthcare coverage, and male sex of child to have increased odds of being diagnosed with ADHD. One of the salient features of this study was observing a significant association between ADHD and variables such as TV usage, participation in sports, two-parent family structure, and family members’ smoking status. Obesity was not found to be significantly associated with ADHD, contrary to some previous studies.
> Youth with ADD/ADHD engaged in screen time with an average of 149.1 min/weekday and 59% had a TV in their bedroom. Adjusting for child and family characteristics, having a TV in the bedroom was associated with 25 minute higher daily screen time (95% CI: 12.8–37.4 min/day). A bedroom TV was associated with 32% higher odds of engaging in screen time for over 2 h/day (OR = 1.3; 95% CI: 1.0–1.7).
> A shorter sleep duration and less time spent in cognitively stimulating activities were associated with an increased risk of developing ADHD symptoms and behavior problems.
There's plenty more, but the gist is pretty clear. Get your kids outside, give them a supportive and safe environment, teach them how to behave like adults, give them plenty of sleep, and provide them plenty of opportunities to learn. All those reduce risk of depression and ADHD (hence the correlation above).
> Youth with ADD/ADHD engaged in screen time with an average of 149.1 min/weekday and 59% had a TV in their bedroom. Adjusting for child and family characteristics, having a TV in the bedroom was associated with 25 minute higher daily screen time (95% CI: 12.8–37.4 min/day). A bedroom TV was associated with 32% higher odds of engaging in screen time for over 2 h/day (OR = 1.3; 95% CI: 1.0–1.7).
This does not imply causation. Someone with ADHD is more likely to give in to distraction and dopamine. This study was done with a sample of people who already have ADHD. Nothing in it indicates that television time is going to cause ADHD.
Someone who has a better relationship with exercise, screens, or whatever, doesn't mean they don't have ADHD anymore. Medicated or not. They just have better support and lifestyle habits that minimize how much it might impact them.
> Medicated or not. They just have better support and lifestyle habits that minimize how much it might impact them.
If a disease can be resolved through changes in lifestyle is it a disease needing medication?
I think that is kind of the point, is it not? We can give the kids anti-depressants for being depressed or we can help them change their lifestyles. We can give the kids ADHD drugs or we can change their lifestyles. We can let the kids get diabetes, put them on drugs, or help them lose weight.
This is a ridiculous discussion. Yes, drugs can help and we may need to use them in extreme cases to aid in lifestyle changes, but shouldn’t the goal be improved life style
They're not mutually exclusive, and ideally you mix and match. Being on medication is a bit too polarizing, as there are people who vilify it, or otherwise shame people who need to be on life-long or long-term medication, but there is also a problem with over- or mis-prescribing.
I don't really have much to do with the prescribing part of it (besides my personal medication decisions, and doing my part to not ignore the problem), so I'll leave that to my friends in the medical industry. Though especially having held some uninformed opinions on people who need medication earlier in life, I think it's important to not make people question whether they should take life-changing medication because of stigma or social pressure.
I will say my personal experiences have exposed me to people who need medication but have trouble accepting it a lot more than the latter, so I don't want to pretend my experience is universal.
The links you provided don't support your argument in the way you think it does, but does reveal a gap in your understanding of ADHD.
ADHD has strong correlations with motor control and sleep issues, and is notoriously under-diagnosed amongst girls as they tend to present and be perceived differently.
ADHD is also understood to be hereditary and therefore given that the divorce rate for adults with ADHD is much higher than normal you should expect a higher incidence of children with ADHD growing up in a single family household.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071160/
Your second source is ridiculous, if you actually read the study they looked only at kids diagnosed with ADHD and then found that kids with tvs in their rooms watched more tv. It should seem obvious that this would be the case and im fairly certain you would get the same results if you looked at non-diagnosed kids (which again, they didn't)
None of those studies establish a causal relationship. Correlation is not causation. Even the first study says "Longer time spent in cognitively stimulating activities (>1 hours per day) was associated with lower scores of both ADHD symptoms (0.96, 0.94–0.98) and behavior problems (0.89, 0.83–0.97). Time spent watching TV and engaging in physical activity were not associated with either outcomes."
I have a child with ADHD (age 9) and a child without (age 6). They are both highly intelligent, but compared to each other:
* My ADHD child is significantly more attracted to screens, video games, and quick stimulation in general. If he doesn't have a screen, he's much more likely to engage in simple, lower-focus activities like simply spinning and running in circles or just hitting things against each other. When given the choice, he will always choose screen stimulation.
* My non-ADHD child is more likely to play with clay and building materials, read, write, and draw. He likes TV and video games, but will very often decide to do other, lower-stimulation activities without being prompted. When outside, he explores and examines things, and will play more structured, imaginative games with rules.
* My ADHD child sleeps much less than the non-ADHD child. He has trouble falling asleep, and wakes up very early every morning on his own. It is impossible to "give them plenty of sleep" when they literally can not sleep.
* My ADHD child exercises much more than the non-ADHD child. He is more interested in going outside in general.
* My ADHD child does not like studying and can not focus on learning things. He learns less, he learns slower, he is disruptive in class. He acts more immaturely even when we take much time teaching him to behave like an adult. He is often depressed because he feels like there's something wrong with him because he has a significantly harder time just having fun doing things that other kids his age do. He feels depressed because he wants to learn things that he simply can not make himself sit long enough to focus on. He feels depressed because he knows he is being immature and disruptive and feels like he literally can not control it.
Given the same opportunities and treatment, my ADHD child has more screen time, more time exercising, less time sleeping, learns less, is less mature, and is more depressed. He is on medication now, but I felt the way you do for years, and it set him back severely in school and life, including his friendships and relationships with family. On medication, he is doing much better in every single respect, but he still struggles, and the medications become less effective over time (we're still trying to find something that works better long-term).
I'm going to be frank here. You are taking studies that show correlation, ignorantly assuming causation, and making judgements and giving advice about an area that you clearly do not have any personal connection to. ADHD may be overdiagnosed, it may have been underdiagnosed in the past (note that ADHD is strongly correlated with self-medication and addiction, which has always existed), but it's not something that you can really easily cause or prevent, and dealing with ADHD in a child is stressful and challenging for both the parent and the child. Assuming neglect among parents of children with ADHD is absolutely uncalled for, and contrary to my experience, where parents of children with ADHD are absolutely run ragged from years of trying to fight to keep their kids healthy, sane, and educated.
> Assuming neglect among parents of children with ADHD is absolutely uncalled for, and contrary to my experience, where parents of children with ADHD are absolutely run ragged from years of trying to fight to keep their kids healthy, sane, and educated.
I never once suggested the parents were being neglectful in the sense they weren't giving it their all or trying their hardest. To your point, they're ragged, the ADHD children clearly need more work, etc. Further, I'm sure the "mental health professionals" recommended it to them.
I'm not going to share my personal experiences, but I truly do understand all of this and the struggle. I agree we have no proof about what causes ADHD, and those were all correlations. That said, I can say that in the past 100+ years our entire environment as a species has changed. We have some pretty unreasonable expectations on children and not all of them will want to build, some will want / need to lasso cattle, ride horses, hunt, etc (as we did for tens of thousands of years). They may not learn the way we structure our society, they may not respond well to the chemicals, the change in diet, what have you. It could simply be genetics.
The point I was trying to make was it's clear why depression is often correlated (there was no causation in this paper btw) with ADHD and ADHD drugs. Societal and family support is weaker than it was 80 years ago, there's lack of community, less dual-parent households, constantly being told "the world will end", etc That's kind of my point.
ADHD and depression are a disease, meaning they are a variety of symptoms that when presented together are diagnosed as impeding normal function. Those symptoms can have various causes and unless careful observation is made, it's possible to conflate or miss the cause, there may also be a multitude of causes. Treating the cause will "cure" the disease, much like you can cure (or at least dramatically reduce the risk of) type 2 diabetes with diet and exercise (the issue being your bodies ability to process glucose -- often due weight); but not Type 1 diabetes.
What I want to clarify is that I think this is a societal issue, but expressed it through personal observations. Having one parent clearly has an impact (less energy and capability to give to an ADHD child), having structured education, having screens, etc.
Give the example you stated around screen time; would your son be better off trying to learn to focus or playing outside? I honestly don't know for sure, but what is clear is that you care. I'm 100% sure you're doing your best to make that judgement call. My point, was that many times the parents don't care, they just want their kids out of their hair.
My general point was never to assign blame, it was to point out that diseases such as ADHD, Autism, depression, anxiety, etc to be diagnosed together. Further, that those diseases often correlate with some of the issues I highlighted. That doesn't mean it's all cases, but to ignore reality isn't going to help either. If we don't examine the causes and we just medicate -- it wont work well for the children. Medicate as needed, but if we can, we should try to cure the disease.
As someone with ADHD, who has a kid with ADHD, this dismissive attitude is really unwelcome. Inattentiveness is a real symptom with drastic life-altering effects for which medication is a godsend. Studies have shown that exposure to screen time does not result in ADHD.
To be told "you're just a bad parent who lets their kid watch an iPad too much" is infuriating. (I'm trying to keep things civil per the site rules, but my honest reaction begins with 'F' and ends with 'U', guy.)
Maybe don't take it personally, I think they're saying that much of society is doing it wrong.
EDIT: But yes, they’re also saying that many parents are doing it wrong, and they’re assigning much of the blame to parenting. My point was that when a huge percentage of parents are “doing it wrong”, maybe there’s some wider systemic thing at play. Like economic forces that make people work harder than they should if they have kids, dissolution of support networks that would’ve normally cared for the kids in addition to the parents, etc. I’m not saying that this is a cause of ADHD, because I know little about it, but if you take their opinion as correct, then much of the blame could be laid at the societal structures we’ve created rather than the individual.
No, there's some incredibly broad brush strokes in the parent comment.
* "Every child I know diagnosed with ADHD had parents who didn't want to deal with them."
* "look at the people you know on medication (or ask), look at the troubled children, etc. I guarantee you'll see the same trend"
* "likely have parents who just don't want / know how to deal with issues"
There's only a single phrase "not always the case, but it's a trend" that frames it as a societal issue on average, but that doesn't counter the incredibly general conclusions made by the poster.
I can't believe the responder had the gall to take personal attacks personally. Have they tried going outside more? If they didn't sit on their butt all day they might not be inclined to take my directed insults personally.
I realize that posting that comment wasn't too helpful on my part, but people being dismissive of ADHD is probably the quickest way to get a rise out of me.
Sorry for being snarky. Not sorry for calling out destructive, unscientific bullshit.
Even if I wasn't someone with ADHD, the comment in question is dismissive of what ADHD actually is, as well as the very-valid treatment of getting medication.
Like I said in my comment, they pointed out some real problems, but made sweeping generalizations, mostly negative, about the people in question.
ADHD is not well understood by a lot of people, and someone with or without ADHD who is well-versed in the topic pointing out that their comment is not helpful to discussion about how to treat the disorder, shouldn't be dismissed as them "Taking it personally".
They said it was infuriating and they were very tempted to just say “fuck you”, they’re very clearly taking it personally, it’s not meant as a dismissal. I’m just trying to help them not feel personally attacked, but clearly I did that poorly. Sorry about that.
As the person in question, I understood your intent and I didn't downvote you. But it's also hard to see how (paraphrased:) "Parents of so-called ADHD kids are bad parents and their kids have a made-up disease" is not meant as a personal attack: "You are a bad parent and should feel bad."
To be clear, I'm actually blaming therapists and "mental health experts".
Parents are clearly doing their best and looking for support. The "experts" are paid (in many cases) through recurring attendance and kick-backs from pharma... why would we assume they'd want to resolve the issue any other way? Even the research is often funded by pharma... Note the NIH even receives revenue (and individual scientists) from creating patents associated with drugs.
Here's something I posted in another comment, but ADHD / Depression is a "disease" is a bucket of symptoms that impair an organisms normal function.
1. I would argue that what you describe isn't impairing normal function. It's that we are attempting to make children do abnormal things (sit in a room all day and be lectured at. At the end you have an exam). Society is failing to raise children properly and expecting things that are abnormal for the human animal.
2. A disease is basically diagnosed from a bucket of symptoms. Those symptoms will have different causes. Without taking a measured approach at identifying the causes, you are likely going to see a plethora of factors. These can and do include things like hyperactivity from siting and watching TV (now they have energy and want to move). Things of that nature.
Now to compound the issue, look at how all the parents are responding. There is no way they'd consider alternatives.
One way I try to explain it to people: "We give people insulin because they have diabetes. Diabetes is the disease, but you can cure it through diet and exercise for Type 2 (it's environmental), Type 1 you cannot (it's genetic). Insulin treats the disease, but doesn't cure it".
Why are we giving all the kids medication instead of trying to have them diet and exercise (or what ever equivalent)?
Parents in this thread are taking it very personally, but in reality I'm trying to discuss ways to treat the underlying issue(s). And yes, I am saying that there are societal, family, etc expectations and management that can be employed to remove symptoms of the disease (which in effect would "cure" the disease).
Your diabetes analogy fails, because ADHD does not have an environmentally-caused Type 2.
ADHD is hereditary, genetic, and has to do with how the brain tends to be wired in that individual. ADHD can be helped through environment and habit changes, and impacts can be reduced, but you cannot cure it.
It seems that you think ADHD is not a real disease, given your quotes around the words "disease", "cure", etc. If some people are mis-diagnosed, it doesn't invalidate all the others.
The experts you are blaming are psychiatrist, so they would have on average ten years of university study. Please explain what your credentials are so we can weigh our opinions regarding your statements.
Sounds like you’re not up to date on research, there’s a few citations in later comments.
Anyway, I don’t think the poster was saying it doesn’t exist. They appear to be saying there are correlations and often a diagnosis at a young age is a reflection more on a willingness to accept a hyper child vs not. That is to say, a child can have ADHD, but that doesn’t mean you have to medicate them. Medicating them (again at a young age) for ADHD, indicates a willingness and potentially eagerness to medicate, as opposed to attempting to correct issues. Ie just give the drugs, don’t try to figure out why they’re depressed.
He pointed to a paper which I haven't had time to read yet. At risk of sounding like a general dismissal I'll say three outcomes are possible:
1) The study is right and every doctor and medical institution I've talked to is wrong.
2) The study's results are being generalized too far or misinterpreted. E.g. I've been told (and it's true in my experience) ADHD people tend to be attracted to screens for the dopamine hit and characteristically lack self-control, rather than the screens causing ADHD.
3) The study is cherry-picked and wrong. Either it is an abnormal result that doesn't replicate, or the study was badly constructed.
Given the fact that my doctors gave me multiple studies to look at which showed the exact opposite conclusion, my prior leads me to believe (2) or (3) over the first possibility. I'll skim the study he posted later though when I have time.
My anicdata doesn't constitute medical science, so it's entirely possible that this study is right and I am wrong, and I'm big enough to admit that. I wouldn't bet on that outcome though, in this case.
EDIT: Also one point you may or may not be aware of is that non-medicative interventions for ADHD are at best a coping mechanism and never satisfactorily address the underlying issues. In the words of my doc: if you are diagnosed with ADHD and you can solve your problems completely with therapy and just going outside or whatever, you didn't have ADHD in the first place and the diagnosis was wrong. Actual ADHD is when your brain is wired up a different way, and general lifestyle interventions can't address the problems that causes.
ADHD people have spent their entire lives feeling frustrated and powerless as the well-meaning people around them tell to simply "stop being so distracted!". Believe me, if we could turn it off we would. It's not so simple. The poster above is making essentially the same critique: that it's not the kid's neural chemistry or wiring that is causing them issues; it's the parent's fault. Stop being a bad parent!
indicates a willingness and potentially eagerness to medicate, as opposed to attempting to correct issues. Ie just give the drugs, don’t try to figure out why they’re depressed.
This is speculating on the motivations of a wide class of people without data, and is complete nonsense.
> “ People who are diagnosed with ADHD at a younger age likely have parents who just don't want / know how to deal with issues.”
I have no idea where you take this opinion from or if you can back it up. From my anecdotal evidence exactly the opposite is true: kids from families who do realize there is such a thing as mental health and who care deeply about their kids - those get diagnosed. Kids from other families just get mostly slapped around and screamed at to get their shit together.
You clearly don’t have a clue what you are talking about.
I have a child clinically diagnosed with ADHD. It’s absolutely nothing to do with time spent with him. We have stable family home, active life style. etc
He just has a brain that works differently. Not worse. Different. He might struggle to pay attention at school but he’s written two novels!
PS. Religion is horse shit so if that’s the only other thing you have left for me to help him, I’ll take my chances, thanks
I started medication as an adult, lived in a home with two involved & present parents, never saw any doctor about ADHD until I was an adult, and was never an unhappy child.
Looking back, I clearly had ADHD, but since it's a condition that's unique and specific symptoms vary per person, I just happened to have mechanisms that worked and got lucky with how my brain patterns fit into school from Elementary - High School.
I had plenty of outdoor activity, and plenty of video games / computer use. Not that you mentioned it, but I also read fantasy/sci-fi books like they were daily papers, finished all of my incomplete homework in the morning while waiting for class to start, and was constantly multi-tasking in class (reading, doing homework for an upcoming class, or occasionally fidgeting).
My sample size is 1, but I have 4-5 diagnosed (either as kids or adults) close friends with similar stories.
Your comment takes some generally-well-known positive advice (exercise more, social interaction & supportive relationships are good, parenting kids is a big task that takes time & effort), and identifies some real problems we face today (social isolation, a lack of non-religious adult organizations, sedentary lifestyles) and uses it to disparage people with real, diagnosable conditions, and vilifying those who turn to medication for it.
I'm fine with how my life worked out, but I can't imagine being the kind of kid whose ADHD manifested in a different way that made school exponentially harder than it was for me, and being told that life-changing medicine, that let me participate in school or work just like everyone else does, is something I was given by mistake, or that I just had shit parents or should have played outside more.
As you pointed out ADHD is a disease, what’s the cause?
Do you have adhd, or do the drugs help you focus and you want that?
Calling it a disease implies something is wrong, but having trouble focusing isn’t “wrong”. It’s a skill one can acquire and may have a variety of factors impacting it (from genetics to environment to mental management).
That’s the issue I personally take with these kind of discussions. Medication may help you focus (coffee does that), but do people who need coffee in the morning to focus well have a disease? Hardly.
Not them, and I don't have ADHD, but I am the parent of a child with ADHD and I know plenty of people with ADHD, and it's not just "having trouble focusing". For a lot of people, it's a complete inability to focus on any one thing for any real amount of time. They can try as hard as they can to force themselves, but become disfocused and distracted despite any effort. It also often involves impulsiveness that is incredibly difficult to control, to the point that often it feels like it wasn't even their own choice. A common description I've heard is that it feels like somebody else was controlling them. My son would say when he was younger "My brain made me do it" or "my hands just did it on their own", and at first I thought it was an excuse, but after one destructive incident, he broke down crying at the age of 7 saying that he doesn't know why he does the things he does, and he can't stop or control himself, and he wishes he could stop himself from doing it. He tries to be good but then something takes control and makes him do destructive things or blurt out things he knows are wrong to say.
On medication now, he still has a hard time, but he is actually capable of controlling himself, he is capable of forcing himself to focus, and he's much happier. Now it is just a skill for him to work on, but in the past, it was an actual impossibility. It is a true disorder, not just "trouble focusing", and ADHD medication is a fundamental need for some people to function at all, and not comparable to a morning coffee.
In the past, these people were often assumed to be possessed, or insane, and were institutionalized, killed, or imprisoned. It's not like ADHD is a new epidemic or something.
Thank you for you sympathy and empathetic response. Your son's in good hands.
As an ADHDer, I never understood what it was like for others until I got treatment with stimulants. It's like I can just take this magic pill and for 8 hours I'm "normal."
I wish there was an opposite pill, one which made people inattentive and impulsive. Then everyone else could try it for a day or two and see how debilitating it is. Regular, everyday life is like being falling-down drunk in terms of mental incapacitation, and the pills for the first time let us experience life sober.
Edit: how old is your son now? One thing I worry about as a parent of an ADHDer as well is her eating. I've so far avoided treatment for her because I'm worried she'll eat less and her growth will be stunted. We're cautiously waiting on medication until post-puberty.
My son is 9 now. We only started him on medication this year (we were trying so hard to get it under control without medication, and his doctor was worried about his weight if we put him on the stimulants). Getting him to eat is a challenge, but it always was anyway and he's always been pretty skinny. Fortunately, he loves milk, so we can always get some calories and protein in him that way. We get a low-carb full-fat milk so his sugar intake isn't crazy high.
Dextroamphetamine. Worked great for a few months, but have lessened in effectiveness. Now it still works for focus, but the impulsiveness came back (he was actually able to explain to me that he was having trouble controlling his actions), so he's now on guanfacine too, for impulse control.
We do a couple off days now and then, but not a lot because he feels like it's a wasted day because he can't focus on anything he really wants to. I suggested that he could take weekends off the stimulant, but he says he'd rather be able to operate mostly every day than to have a more focused week and completely wasted weekend, and I feel like he's capable of making that decision for himself.
Ironically, the opposite pill for me is Adderall. I take stimulants for idiopathic hypersomnia and if I take too high of a dose I have a hard time concentrating on just one thing.
I don’t think it gets as bad as ADHD but I definitely get a taste of it.
There's a huge difference between having a little trouble focusing, and struggling all fucking day to focus... then realizing at the end of the day, you have been working all day, but bouncing between tasks so much that you really got nothing done. It's frustrating and debilitating and makes you feel like a complete piece of shit. Then because you're not doing as well as everybody around you, you dwell on it at night, and you don't sleep. And you know what no sleep does? It exacerbates the problem, and so you have to struggle even harder when you're exhausted just to get things done. Then you spend all weekend sleeping, because it's the only 2 nights of the week where you don't have to go back to work the next day, and fail yet again. Then you start to feel like your life is this fucking cycle of struggle every week, with no personal accomplishments.
ADHD is not a disease; our brains are just wired differently. The upsides of ADHD - hyperfocus, strategic planning, ability to readily correlate otherwise unrelated things all contributed to who I am and my success. The drugs help even out the downsides to ADHD.
One way I try to explain it to people: "We give people insulin because they have diabetes. Diabetes is the disease, but you can cure it through diet and exercise for Type 2 (it's environmental), Type 1 you cannot (it's genetic). Insulin treats the disease, but doesn't cure it"
Why is it not the same for ADHD or depression? Type 1 is genetic and Type 2 is environmental.
The argument I was attempting to make is different from what everyone here is saying I think. What is a disease?
> Disease - a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms
Two points:
1. I would argue that what you describe isn't impairing normal function. It's that we are attempting to make you do abnormal things (sit in a room all day and be lectured at. At the end you have an exam). Society is failing to raise children properly and expecting things that are abnormal for the human animal.
2. A disease is basically diagnosed from a bucket of symptoms. Those symptoms will have different causes. Without taking a measured approach at identifying the causes, you are likely going to see a plethora of factors. These can and do include things like hyperactivity from siting and watching TV (now they have energy and want to move). Things of that nature.
Given the above, we're effectively medicating children for personal / societal reasons, not because the human animal is actually suffering or impaired in any way.
“ In this paper, we discuss candidate triggers of islet autoimmunity and factors thought to promote progression from autoimmunity to overt type 1 diabetes (figure 1). These factors seem to have their effect mainly in the genetically predisposed individuals.” [my emphasis]
“ Importantly, environmental factors that trigger islet autoimmunity might differ from those that promote progression from autoimmunity to overt diabetes.”
Let me put it another way then - ADHD meds increase the range of tasks I'm able to do succesfully. They add to my life rather than take something away.
I'm talking about tasks I want to do but would struggle with without medication (mainly coding for pleasure).
Yeah - I could find different things to do with my life, but I love coding and I am delighted to find there's a simple pill I can take that helps me do more of it.
I understand what you're saying, but reread what you said and replace "medication" and "pill" with "cocaine". Amphetamine can be used in the same manner and for the same perceived reasons.
Granted, I am happy for you and I think drug laws are ridiculous.
(Methylphenidate is not amphetamine btw. Other ADHD meds are literally amphetamines but I'm only talking about methylphenidate)
If cocaine had positive effects that outweighed the negatives then it absolutely should be prescribed. But it doesn't. Unlike methylphenidate - which for most people has fairly mild downsides at the doses it is usually prescribed in. It is also largely non-addictive with little evidence of long-term health damage.
Also unlike cocaine.
All in all, I'm not sure how this comparison helps.
Further, as you pointed out does have benefits (which is I assume why it's prescribed). Cocaine and meth have similar effects btw (pros and cons), abuse is what causes the issue(s). People can survive on both for decades though.
My situation mirrors yours pretty closely. I didn't recognize the symptoms or seek treatment until my mid-30's, but looking back I clearly had ADHD symptoms that became serious around high school.
In my case, my grades plummeted and I was unable to get into the colleges I wanted, or to graduate from an engineering program like I had wanted. I ended up graduating with a degree after 7 years and bouncing between 4 different colleges, and I've had a decently good career in Silicon Valley where being a generalist is a solid plus. But my dreams of being a (literal) astronaut were flushed down the toilet in the process.
Kids shouldn't have to sacrifice their dreams or their self-esteem because parents are unwilling or unable to seek proper treatment.
This echos my experience to a T. I struggled as a single parent of a child and I hold myself responsible for them developing ADHD.
I did my best and most days I was too tired to give my child the attention and guidance they needed and he suffered needlessly. I resisted prescription medication for as long as possible until it became absolutely necessary. It works and there are side-effects, including symptoms that overlap with depression.
I am spending more time with my son (especially physical activities) and I hope someday he doesn't need methylphenidate.
I am likely still shadow-banned and nobody will see this message. I hope this message gets out and more single parents get the help they need.
> Every child I know diagnosed with ADHD had parents who didn't want to deal with them
You must not know many parents then.
Parents I know that have children with ADHD recognize their children are struggling beyond simple hyperactivity. These are children that are markedly behind their peers in childhood milestones regardless of their family upbringing, education, and socio-economic status. These are children that have a deficiency in the executive function of their brains where hyperactivity is one of many symptoms, and is not even necessarily the most worrying.
These are children that struggle with simple tasks that other children do not.
Parents of these children are no less loving, caring, or capable than parents without ADHD children. Parents should not be shamed for using effective medications (like MDH) so their children can have positive outcomes in their development and adult-life.
> What we really need is a strong emphasis on family development, courses built around it and support groups
ADHD is generally a disorder that you are born with. No amount of family development can prevent the disease.
> IMO from what I've seen of parents are that people who bring their children at a young-ish age to a therapist have a different issue.
I see this with someone close to me.
Diagnosed with ADHD as a child, medicated, later diagnosed with depression.
The real issue, however, was probably more related to brain development/executive function because their mother smoked a pack of cigarettes a day through pregnancy.
You've struck a nerve with some commenters, but personally I think you're on to something.
It's hard for people to reason when they are fearful they are doing the wrong thing.
I question the same thing everyday for my family.
One way I try to explain it to people: "We give people insulin because they have diabetes. Diabetes is the disease, but you can cure it through diet and exercise for Type 2 (it's environmental), Type 1 you cannot (it's genetic). Giving insulin treats the disease, but doesnt' sure it"
This is the same thing for ADHD or depression. Some people probably have Type 1, others (I think the vast majority) have Type 2.
Sure you can mask the issue, somewhat. But you can't cure it through the medications today.
I grew up in a two-parent household. I had a doting, stay-home mom who spent lots of time with us. I lived in a safe neighborhood where I rode bikes with other kids for miles around during the summer. My family took long road trips to places like Yellowstone National Park for weeks and day trips to the zoo, the botanical gardens, the science museum, etc. I did not have a TV in my room and screen time was limited. I was involved in sports at school, summer swim team, and karate which my dad did with us.
I have ADHD which resulted in crippling depression when I was in college. As soon as I got diagnosed and medicated, I was able to be like the normal people that I always wanted to be, and align my actions with my goals.
> Every child I know diagnosed with ADHD had parents who didn't want to deal with them.
I was diagnosed as an adult. My parents kept me consistently active and engaged. Plenty of play outdoors, fishing, camping, riding bikes. They were involved in my education until, as a teen, I wanted more independence. I’m not saying I had an ideal upbringing, but I have very loving involved parents (dad and stepmom; relevant below).
I don’t know if that’s why my diagnosis came later, but I seriously doubt it. My mom, unlike my dad and stepmom, was deeply skeptical (a) that ADHD even exists and (b) that ADHD medication is safe, effective, or necessary.
That kind of bias is powerful, and easy for kids to pick up on. I was mortified of these meds before my diagnosis. Now I can’t imagine how I lived without them (and I very well may not be alive today had I not sought treatment).
I’m sure there’s often some truth to some of what you’re saying, to be clear. One of the most difficult parts of getting my diagnosis was that the diagnostic criteria are entirely external to the patient being diagnosed: they’re framed around how parents and other adults perceive a child’s behavior. It took a patient and understanding doctor to help me map those criteria to my internal experiences and my adult life.
But I don’t think I benefitted at all from waiting decades for a diagnosis.
>> As an experiment, look at the people you know on medication (or ask), look at the troubled children, etc. I guarantee you'll see the same trend: single parent home, started medication at an early age, regular therapist appointments, etc. They're unhappy and need depressants, ADHD medication, etc.
That sounds like me. My parents are stilled married and about to have their 45th anniversary. The extended family are all on their first marriage and in retirement age or raising families.
I started medication after 30, mental health is not a valid thing in my traditional family. According to them, my struggles were because I hadn't learned my proper place yet. Shame and ridicule from adults, and allowing others in the family to participate, was their idea of proper treatment that would 'fix' me into being a proper young lady. This after their first attempts to keep me in line failed. After that, exclusion within family events, that I was forced to attend, was the treatment of choice. At least less parental attention meant they couldn't keep reminding me how defective I was.
Unsurprisingly, I was very unhappy and depressed. Then I decided to love myself and see the absolute dysfunction this nuclear religious anti-mental health family idea is. Now, I am the most well-traveled, curious, adventurous and financially successful person in the family. That didn't happen until I was able to get the help I needed.
By help, I mean medication to do the core things only I'm responsible for in a world that doesn't fit into the way I function. Provide myself with food and shelter as an adult. I am on the higher end of hyperactive ADHD, also dyslexic - which I learned after getting medication for ADHD. I noticed similarities in my niece, I was told I didn't know what I was talking about and that I couldn't be dyslexic or ADHD since I could read and played video games for hours on end.
I don't like medication and it took me a long time to admit it to others, but the world isn't going to change to fit how I function. So, I use medication to fit myself into it for my basic survival needs.
>> As such we see more: single parent homes, abundance of medication, reduction in religion and adult social clubs, etc.
Reduction in religion is not a negitive, I personally experienced it as mental and shaming child abuse within a roman catholic/protestant home. Even now I experience it as other people overstepping themselves by trying to insert and force their righteous will onto my personhood and that of my nieces/nephews. I have a difficult time understanding how this is still allowed and even valued. Of course my family also doesn't see or remember any of this the way I do.
I can sort of agree then you throw in loose correlations like less worshiping of gods = higher ADHD diagnosis, among others. If you look at the bible belt, there's lots of drug abuse, especially opiates among them. Do you have any data that positively proves more worshiping of gods = less drug use?
Let's be very careful with attributing children's medical conditions to parental failure. This is the same line of thinking that brought us "refrigerator mothers", piling on loads of undeserved and unjust guilt on blameless parents of autistic children that were already trying their hardest to help their kids.
Unless you have solid studies that establish _causation_, not correlation, to back up your assertions, your facile dismissal of all existing medical research in favor of your own personal social prescriptions deserves zero consideration.
As the parent of a child with ADHD that is medicated, it seems completely plausible that it could cause depression. When my kid has had too high a dosage (or accidentally takes a double dose) she's like a zombie, completely flat affect, and very little motivation. It's like it drains her life away.
Part of the problem is that it's very difficult to get the right dosage for any given day because diet, metabolism, and hormones seem to have a big impact on how effective it is. We've found it's better to go with a lower-dose extended release, and then let her self-medicate with 5mg regular tablets as needed. This works great now because she's a fairly responsible teenager (when medicated), but it was really hard when she was younger.
I share this experience myself, in particular the dosage not providing a consistent effect day to day - every specialist I've spoken has told me this is weird and shouldn't be happening and yet it is so. Switching to staged release medication (Medikinet CR) has helped me too.
Unfortunately extended release Methylphenidate of any kind/brand is only partially covered by Dutch health insurance[1], and I'm certain the cost is prohibitive for people who might be less well off.
1: In essence, the government has determined that all Methylphenidate variants are equal, and so you can just take the cheapest instant release variant or else pay the difference out of your own pocket.
Extended release on the lower end of dosage + self-medicating with caffeine as a booster has been my go-to for about 15 years now. As an adult who's been taking it since middle school I can say that, while it's had its ups and downs, overall life is better with it than the times I've had to go without due to insurance disruptions or moving and having to find a new doctor who will prescribe it.
Extended release (XR) is very nice, since it avoids the dopamine peaks and valleys caused by individual doses. I will say, generic XR is usually pretty crappy, since it basically breaks the dose into two parts. Name brand XR is better because they construct the pill to where there is an actual extended release. Which sucks, because it's super expensive as a result.
What I do instead is two lower-dose XR pills per day. The four hits over about 8 hours seems to work pretty well for me.
There's big differences between drugs in the same family. Personally speaking Methylphenidate is much less intense and easier to fit into my normal life than the Lisdexamfetamine (which are probably closer to phentermine)
> The bipolar-level manic highs and depression/lows are very real.
I've had to be very careful about NOT using those terms when talking to doctors and psychiatrists. As a layperson that description seems to fit, but it causes huge red flags for medical professionals and they freak out, resulting unnecessary tests and evaluations for my kid.
The key term for the "manic" phase after the meds wear off is "Rebound Effect". Also when the dose is too high the generally accepted term is "zombie mode" or "zombie-like". Calling it an "overdose" will really cause people to freak the fuck out.
I’ll be honest, I’ve been on adderall (with occasional periods off the drug) for almost 20 years now, and I’ve never experienced anything remotely approaching mania or severe depression (as distinguished from rare bouts of sadness). And I’ve not always been the most careful taker of the medication, frequently alternating between taking too much or lowering my dose.
I’m not saying it’s not possible to have those side effects, I just haven’t experienced them.
Everyone is certainly different; I know people on Adderall (or Vyvanse, which is similar) that have great outcomes, but Adderall gives me manic episodes, raises my resting heart rate by 20bpm, prevents me from sleeping, and causes mild hallucinations. I took it exactly once. Vyvanse had the same side-effects, but much milder and it lasted longer. I ended up on Focalin, which works and the only side effect is mild interference with my sleep.
That’s not true. For example, a lot of Benadryl will make you hallucinate, but that doesn’t mean a normal dose will make you hallucinate a small amount.
Getting horribly fall down drunk as a teenager caused me to shit my pants once. But I didn’t so much as fart when I got tipsy on vacation recently.
I would absolutely be willing to bet that a small dose of Benadryl won't make someone hallucinate "a small amount".
Put it another way if makes you feel better -- a little bit of D3 via direct sunlight and D3 rich foods will improve your mood and health outcomes in a variety of ways. An excessive amount of D3 will give you kidney stones and harm your bones.
This is mostly just scaremongering, but even if I had a noticeable drop in intelligence from taking medication over multiple years, gaining the ability to actually schedule appointments in a calendar, to do focused research on topics that I'm interested in, and to build productive habits like eating regularly, exercising daily, and daily practicing skills I wanted to improve at -- would more than offset the downside.
It's one thing to be worried about subtle effects from medication, but I already know what the long term health and brain effects are from constant insomnia and regularly forgetting to eat. Neither of those are good for brain function.
So yeah, seems like a pretty reasonable risk to take, particularly given the fact that I have a psychiatrist, therapist, and multiple friends and family monitoring me.
Let me flip the question back to you. Would you notice if D3 or iron or protein intake was subtly harming you over the course of multiple years? Is that something that terrifies you?
Still wondering if you have the same concerns about the long-term effects of iron intake as you do about medications, or if you're somewhat selective about which long-term effects of chemicals in the body terrify you.
But yes, I do think the benefits for my mental health very clearly outweigh the theoretical risks you posit. So even if I agreed with what you're saying (which I don't), a subtle hammer tap to the soul is still very clearly and obviously better than the sledgehammer to the soul that is sleep deprivation (something that I concretely know would impact my brain function as I age and that I concretely know makes me less of myself). If that causes you to raise your eyebrows, then I'm not sure what to say other than that you're bad at risk analysis.
Sure they can, people endure and cope with a lot of things. That's a really low and unnecessarily painful approach though. They could do even better, do things they want to do, when they aren't hindered as much by the disorder.
I really think the comparison with glasses is apt, sure someone can squint their eyes and sit a bit closer at times, but why should they? We'd call it neglect to force someone to cope with bad eyesight without correction. Now you're talking about some ADHD kids doing well breaking the rules, so it's fine not to help? Eugh.
Do you know how many without help end up with incredible failure? Teen pregnancies, accidents, addiction, depression? It's more likely to be bad.
I really wish this discussion would revolve around helping, not potentially forcing coping.
I don't know where you're going with your comment. I didn't say anything about whatever you're implying. You might be responding to a different person?
ADHD kids can take medicine, but the rest of the world can also lighten up. That's my point. The rules and benchmarks are stupid and impose unnecessary stress on ADHD individuals. Over half of the time you can ignore it and be fine.
Sometimes I wonder how my life would have turned out if my parents hadn't believed this so strongly. I didn't even know. I never could finish anything I started, never accomplished anything I set out to do, never achieved any of the things I wanted for myself. From outside it looks like laziness and lack of ambition and I internalized that. It predictably led to a lifetime of depression and shame. Would I have started drinking if I had been medicated properly the first time adults around me noticed I could benefit from it? Could it have prevented the years of homelessness, mental institutions, and jails?
We'll never know of course. But decades later now that I have access to these medications I can actually achieve my goals enough of the time to feel ok about myself.
"drugged". You make it sound like kids are slipped roofies
It doesn't make children complacent. It made me stop kicking the shit out of my classmates every day. School is very important. I was depriving myself and others of an education and those other kids shouldn't have to put up with nuisances like me.
My parents were given a choice: put me in special ed classes or medication. They didn't want me to be treated differently so they chose medication. I think it was a good call.
Complacent. Aight. I actually got /feistier/ when I started ADHD meds at 33, because I finally felt confident enough in my brain's function to start actually voicing my opinions to my peers. But go off, I guess.
The brain chemistry altering controlled substances aren't necessarily the problem in my eyes. It's the lack of focus and individuality. School is a system that's supposed to help set people up for life as fellow citizens. If solution A doesn't work then one would hope that they would have the bandwidth to try solution B.
It does feel like there's a lot of "hey that's weird, this one person isn't like everyone else, maybe we should try pumping some drugs into them" going on. Perhaps we could explore the problem space a bit before reaching that conclusion. Of course that sounds like it could take a lot of work and involve understanding the problems on an individual basis. Standard cocktail of drugs, however has an industrial, assembly line feel to it. Why figure anything out when we can just find a way to make the problem go away.
Although, for those who really do need brain chemistry alterations to function, I'm glad we have something that we can actually do to help them. I just wish that the approach would be to actually assist the individual instead of only assisting the assembly line student output. It seems like I only hear about the later, but of course perhaps that makes sense because a story about the former doesn't have very good memetic fitness.
> It does feel like there's a lot of "hey that's weird, this one person isn't like everyone else, maybe we should try pumping some drugs into them" going on.
But it isn't like that.
Just as a thought excercise imagine you're talking about glasses, that's how damaging and silly such arguments are.
Things like bad eyesight or executive dysfunction don't start and end on school grounds, they're just more visible and more obstructive there.
It's more horrifying to me that HN has turned into a kind of place where people will confidently assert their judgment something they have no knowledge about.
My son has ADHD. There are other ADHD cases in the family, so we knew that could be the case with him, but we waited until he was in middle school to even try to check, because we didn't want him to "depend on drugs", as the trope goes.
We got the diagnosis from two different doctors, to be absolutely sure.
The medication makes a stunning difference, and it has nothing to do with complacency at all. It has to do with being able to focus better and to overcome an obstacle that people like me don't have.
And the medication shouldn't be the only thing to use for ADHD. It should be used as a tool to help, but that's just the start. It's important for the parents to work with a psychologist, for two reasons: 1) to help the child develop their own tools and strategies to overcome the cons of ADHD, and 2) to help the parents understand the child better.
Like I said, I don't have ADHD. The things my son has to struggle with are often difficult for me to understand and identify with. The medication helps so he doesn't have to struggle as hard. And he's less "complacent" than ever, and that's a good thing.
What you're saying is the equivalent of "it's horrifying to me that so many children are forced to wear glasses so they become more complacent in school".
In my opinion it's normal for some kids or people to be distracted easily or have more energy than others. They require more attention. Also a child's brain is not fully developed. Why do we expect all kids to be great at focusing? Do you think the focus is worth the reported short and long-term side effects[0]?
It's not simply being "more distracted", that's oversimplification to the extent of belittling people who have the disorder.
Fully developed or not, ADHD doesn't disappear. Neither does it change if someone wants fully working executive functioning or control over their "train of thought".
The "focus" is worth it, especially if you make a fair comparison with those that weren't so lucky to get help.
Glasses are not drugs. That's not at all equivalent.
These drugs are altering brain chemistry and one's natural state so they fit into the unnatural environment that is school. It's horrifying to me that people are doing mental gymnastics to defend drugging kids who don't want to sit at a desk for hours every day memorizing useless information. If I was a kid today I'd fit the qualifications and be drugged to better fit into that environment. It's a crime that future generations will be rightly horrified by. Not unlike how we are starting to be horrified by the treatment of animals in factory farms. We're not treating these kids much better.
Please read up on the diagnostic criteria for ADHD (it's not just "can't sit down"!), and understand that not everybody is born with a brain chemistry that serves them well in life. People with ADHD are affected by it even when they're not in school.
Lucky for those with ADHD, most respond to medication very effectively.
Again, this is not about wanting to sit at a desk for hours every day. He's perfectly content to sit at a desk for hours every day, in front of his computer, and yet he'll have the same problems focusing on most things.
Yes, the medication alters brain chemistry and one's "natural state". Do you honestly think that we have the science to realize that it alters brain chemistry, but we don't have the science to realize that some brain chemistries are drastically different from others?
As for the whole "natural state" thing, let's not indulge in appeals to nature here. I forgot where I heard "dog poop and arsenic are both found in nature, but you wouldn't eat either", but it stuck with me. Schizophrenia is a "natural state" for some people. So is depression, or autism. Should we just leave everyone in their "natural state", because it's sacred for some reason? Hence my comment about glasses: some people are naturally short-sighted, too, but they enjoy being able to see better.
Sure, school is an unnatural environment. Civilization is mostly an unnatural environment, too.
What infuriates me, though, is that people who haven't had to walk in my son's shoes -- or mine, but his are more important -- have the audacity to judge from their position of ignorance and declare all the effort and care we went through "a crime that future generations will be rightly horrified by".
ADHD affects your natural ability to make decisions and control your emotions. Has all kinds of health repercussions from overeating to unnecessary risk taking to difficult relationships with others.
Please stop talking about stuff you don't know like you actually have any knowledge of it, and spend the time you save by reading some science:
Two things can be true at the same time. Some kids truly do have a disorder that benefits from medication. Some kids are prescribed medication they don't need simply so they are able to do something that no child should reasonable be expect to do: sit in a chair and listen to people talk at them for 8+ hours a day. One truth does not preclude the other.
I sat at a desk for 8+ hours a day, then I proceeded to sit at a desk for another 2-4 hours.
I didn't have a singular issue with sitting at a desk. I could - and in fact did - sit at a desk from sun up to sun down 5 days a week without complaint.
Did I resent it? Yes. Do I think schooling should have been done differently? Yes. Could doing school differently have cured my ADHD symptoms? No. Absolutely not.
Living with undiagnosed ADHD is hell, whether you are a child or an adult.
That's true. And it's also true that ADHD is overdiagnosed and overtreated, and the rate is non-negligible.
That is a problem that both the public and the medical community are aware of. I agree with maintaining awareness of that, but I strongly disagree with going to the extremes and stigmatizing ADHD medication and everyone involved.
Look at the comment I objected to. Does it read like a rational, polite way to maintain awareness of that problem? Or does it look like a knee-jerk judgment that's parroting a popular trope?
I wrote that it is horrifying so many children are drugged to be more complacent in school. I saw you objecting to that and assumed I'd need to come back and support the idea that ADHD is over diagnosed and over medicated (e.g. the diagnoses have about doubled in the past couple decades in the US and are substantially higher than in European countries and US pharmaceuticals have a history of being over prescribed). Yet now I find that you are already aware ADHD is overdiagnosed and overtreated - so what exactly are you objecting to in my original comment? You don't think it's horrifying that parents, teachers, and doctors are basically conspiring to drug kids to keep them from acting up in schools?
School is a pretty boring and restrictive place. Children are notoriously poor at dealing with boring things and young boys in particular are particularly prone to the kind of misbehavior that will get them in trouble and drugged.
I've already expressed what I object to: that it's a pithy, kneejerk, judgmental trope-parroting that does more to stigmatize the majority who want to help their kids, than to help combat the abuse perpetrated by the minority of bad parents.
It is remarkably difficult to find any figures even estimating the overdiagnosis and overmedication rates for ADHD. Most of the talk around this issue tends to make a big deal out of the rising rate of ADHD diagnoses.
Those who talk about it responsibly and rationally recognize right away that this doesn't necessarily mean we have an overdiagnosis crisis on our hands, and seek additional information. The best study I've been able to find about this [1] does indicate that there may be some overdiagnosis and overmedication going on, but even there it's not framed as "parents, teachers, and doctors are basically conspiring to drug kids to keep them from acting up in schools", nor does it lend any credibility to that claim.
Are there bad parents who don't want to deal with their kids' behavior and try to get them "drugged into complacence"? Yes, definitely. Do we know how many and how that number compares to other kinds of parental abuse? No, we don't. Is it a problem of epidemic proportions? There's no evidence for that, and the onus is on those of you who make that claim.
More importantly, if we distance ourselves from the sensationalist tropes about "drugging kids into complacence", we can ask a better question: are there currently any perverse incentives in the medical community to overdiagnose ADHD and overprescribe medication? This might be the case, but it remains to be proven and it should be dealt with just like any similar case of perverse incentives.
So what do I object to? I object to the sensationalist "Will Nobody Think Of The Children" overstatement and hyperbole. I object to people bringing up the same trope over and over again, out of ignorance, and doing their best to stigmatize the vast majority of us who are doing our best to provide our kids with the best life we can. I object to not trying to constructively work to slowly evolve the best approach to dealing with a concrete, real and potentially debilitating problem that was discovered too recently to have a perfect solution to it, just because drumming up outrage and spreading FUD is easier and more gratifying.
And yes, school can be a pretty boring and restrictive place, but that's just the tip of the ADHD iceberg. Reducing the whole problem space to just that is not helping, either.
To me you're coming across as defensive when you make these insults and assert that I'm ignorant and don't know what I'm talking about (when, ironically, you have no way of knowing and are therefore ignorant to my level of exposure to the topic). I understand being defensive - you've made a significant decision about your child's health and I hope for your, and his, sake that it's the correct one.
Your defensiveness aside - it's actually not a "trope" or a kneejerk reaction to notice that the rates of ADHD and ADHD medication have doubled in the past couple decades in the US and are significantly higher in the US than in Western Europe. The US has a pattern of over prescribing medications - the current opiod epidemic is an example. My understanding of this is that it's most likely there is over-diagnosing, and therefore overmedicating, of ADHD, and that's bad.
"Are there bad parents who don't want to deal with their kids' behavior" - there are, sure, but that's not what I think is most common. My intuition is that bad parents would just not care what their kids are doing and leave it to the school to handle. If I had to guess, I would guess that the modal problem parent is one who, understandably, wants what is best for their kids and is concerned about what the schools are telling them. The schools, for their part, want kids who don't overly disturb the system. The doctors hear about a problem that they have the pharmaceuticals to treat.
I don't think the people involved are evil and acting out of malice or laziness but I do think that this group works together to create a system where a fundamentally boring place (school) has a problem managing people who are fundamentally bad at being bored (boys) and they, in part, solve that problem by giving them drugs (ADHD medication). I've been thinking about my choice of the word "complacent" from earlier, and maybe it's not quite right - I originally meant it in the sense that the natural state of the boys is to think of school as a problem and rebel against it and their medicated state is to not rebel against school as much or to the same extent.
If I'm coming across as defensive, then I haven't been clear enough. I'm not defensive, I'm furious but I'm trying to channel it into rational discourse. There's nothing "defensive" about wanting to stop the propagation of this trope.
And yes, it's a trope. I said very clearly that this is not about rising rates of ADHD diagnoses and medication. The trope I'm referring to is the tendency to not only jump to a conclusion that it means we have an overdiagnosis crisis, but to present that conclusion as a fact and a significant problem.
The reason why I'm furious about it is because this narrative has been pushed for years and it has a negative impact on those of us who wish to help our children. In my personal case, it created a strong urge to avoid addressing the issue and just hope it would go away with "better parenting". If it hadn't been for the stigma of "you just want to drug your kids into submission", I would have started helping my kid earlier -- not with medication, but by finding a psychologist to help us.
Again, the focus on "school is boring and kids misbehave, so they get drugged" is too narrow and damaging to those who are affected by ADHD. Imagine being interested in many things, but not being able to advance in any of them beyond initial interest because your brain doesn't let you overcome simple obstacles that require concentration and it only lets you do so if you become somewhat obsessed by a particular random thing it settled on.
Yes, the study I (belatedly) linked in my previous post does indicate that there might be some overdiagnosis and overmedication of milder ADHD cases. And yes, that's something that we need to be aware of and work to improve.
I'm not objecting to raising that awareness. I'm objecting to the utterly irresponsible and damaging way to do so.
Do you think society is currently tilted too far in the direction of undermedicating ADHD? That though we went from 5.5% of children diagnosed with ADHD in 1997 to 9.8% in 2018 we still have more ADHD yet to find? More than a tenth of children are so psychologically flawed they need mind-altering medication to address what's wrong with them?
There is a widespread belief in ADHD and that it should be medicated. That's why millions of children are so medicated. There is institutional belief in that idea as well - that's why so many doctors prescribe these drugs to children. It's not the case that treating ADHD is some minority view that needs to be protected from criticism.
I read your comment as suggesting that I shouldn't share my opinion on the topic because my opinion stigmatizes children who need help. I hope I can highlight the problem with that sentiment by giving an example like if I said you shouldn't share your opinion because the children who are over medicated need help and you are silencing and stigmatizing ideas that would help the over medicated kids.
There is no reason to think my comments are "utterly irresponsible" or "damaging" and you are being hyperbolic by describing them so - any more than your comments are damaging because they encourage over medication. Again, I'd refer you to the "defensive" element of my prior comment. And, since you've mentioned tropes, one trope I'd like to point out is the trope of thinking that "Because I strongly hold belief X I will accuse anyone disagreeing with X of being bad or harmful." You are entitled to your opinions, but not to try and silence people who disagree with you.
There is a "widespread belief" in ADHD and that it should be medicated because there is evidence for it. The ADHD my son has and the ADHD my nephew has, among others, are not things I choose to believe in irrationally.
As for where the society is currently tilted, it's possible -- and likely -- that ADHD is being both overdiagnosed and underdiagnosed at the same time. Like I said, it was discovered recently enough that we, as a society, don't yet have a perfect solution for it and we're still learning more and more. The approach is still evolving.
And yeah, going from 5.5% in 1997 to 9.8% in 2018 is the jump everyone loves to quote and panic about, but it doesn't constitute a crisis. Especially if you frame it as "more than a tenth of children are so psychologically flawed they need mind-altering medication to address what's wrong with them". That's exactly the hyperbole I'm objecting to here.
Let's start by acknowledging that 9.8% of children diagnosed does not equate 9.8% of children medicated. Once we hopefully agree on that, I'm also hoping we can agree that ADHD is not this binary thing that manifests exactly the same and in the same degree in every patient. Just like we've discovered that autism is not a binary thing but rather a spectrum (and even more nuanced than that), ADHD can't be reduced to "either you have it and you'll forever medicate, or you don't have it".
So yes, we're still dealing with a developing situation and there's more work to be done. That's not something I dispute and I'm not trying to "silence" that opinion. As I already explained repeatedly, I am objecting to the way you presented that. Or rather, I'm objecting to the way you didn't present that at all.
You just tossed out a judgmental, dismissive comment and got upset when people pointed out that it wasn't constructive -- or even true, on its own. It didn't come across at all as what you're claiming you wanted to say, but instead of recognizing that you communicated wrongly, you're now claiming I'm trying to silence you. Given that, I'm starting to form an impression that we could go back and forth like this forever and nothing will come out of it.
Science generally agrees ADHD is under-diagnosed. Read the statement of consensus. There's some sort of moral panic cause the beautiful souls of a bunch of people can't fathom stimulants can be used for medical purposes cause "all drugs are bad and Concerta is essentially meth" which is absolute BS.
There's no need to spew hearsay and lies when you know next to nothing about a medical condition that affects 5% of the population.
I based what I said on the study by Kazda, Bell, Thomas, et al [1], although there's always a chance that I might have misunderstood it. From what I understood, it seems that there's a certain degree of overdiagnosis in milder cases of ADHD. Again, it's perfectly possible that I either misunderstood it or that they're wrong.
If you look at the rest of my comments in this discussion, you'll see that I'm not pushing the moral panic you mention -- on the contrary, I'm pushing against it strongly -- and that it's definitely not true that I "know next to nothing" about this condition.
It wouldn't surprise me to find that ADHD is being simultaneously over- and under-diagnosed, because it's new enough that we're still discovering more and more about it. That's why I don't dispute that there's probably some degree of overdiagnosis, but I strongly object to pushing the narrative that it's some kind of an overmedication epidemic or crisis.
Do you have any evidence to support that children are prescribed medication to sit in a chair when they don't have ADHD at a high enough clip to warrant the appearance of being concerned about it at equal weight to actually getting those with ADHD help? Comments like this only further stigmatize getting those with ADHD the help they need, so before you make them you'd better be damn sure it's worth it or else you're taking part in stigmatizing parents who get children the help they deserve.
I suggesting reading up on ADHD before making this claim. ADHD is an absolutely deliberating executive function disorder. It is not restlessness or a personality trait.
The biggest difference is in self-motivation. Someone with ADHD will desperately want to focus on something they like, but they can't. For many things, there is no amount of desire that can overcome this limitation.
This is very different from a kid who just isn't interested and wants to do something else.
This is a mass-media trope. It's as reality-based as a complaint that "It's horrifying that so many hackers are allowed to just walk into Pentagon's network with their visual-basic 3D IP viruses".
The reality is that ADHD can cause all kinds of problems with making decisions, planning, perception of time, staying focused on a chosen task, emotional regulation, and sleep. School just happens to be the first place where these difficulties become apparent, but this can be a struggle in all areas of life, and not everything can be helped with environmental accommodations.
I'd make a comment about how office work mirrors education, but if we do decide to treat school as unimportant, it's not like children would be able to get such jobs.
Instead they'd be more likely to get jobs doing manual labor, destroying their bodies before they've past their mid 30's.
> After his [Erdos] mother's death in 1971 he started taking antidepressants and amphetamines, despite the concern of his friends, one of whom (Ron Graham) bet him $500 that he could not stop taking them for a month. Erdős won the bet, but complained that it impacted his performance: "You've showed me I'm not an addict. But I didn't get any work done. I'd get up in the morning and stare at a blank piece of paper. I'd have no ideas, just like an ordinary person. You've set mathematics back a month."
How could we give these to children indeed.
Of course this article is about Ritalin which is not comparable.
School is a place where several people in the same age group and similar social circles are expected to perform the same set of tasks, which makes it really useful as diagnostic criteria.
But treatment isn't (or at least shouldn't be) about only doing well in school. It's about doing well in life.
I finished elementary and high school by the skin of my teeth. I did it without an ADHD diagnosis or treatment.
I finally got diagnosed this year and started treatment. Why? So I can do my hobbies. So I can wash the dishes. So I can live my life instead of staring at it, waiting for my feet to start moving beneath me.
ADHD medication is not about school, because school is not the singular instance where a person's life is affected by the disorder. ADHD affects every aspect of my life, and so does treating it.
Should also note that the return to baseline was only after discontinuation of the MPH. Can't really tell if it would return to baseline if the medication was continued without digging into the study more than I have so far.
Also worth noting for those less familiar with medication names, methylphenidate is sold under the brand names Ritalin and Concerta.
You misread it. It went back to baseline after discontinuing the treatment which means that the increased depression was during the time while taking the medication.
The authors show increased depression risk in the 90 days PRE-exposure (before starting treatment). To me, the authors seems to have dangerously misinterpreted the data. It could easily be the case that a depression diagnosis leads to seeing a psychiatrist and deciding to treat their underlying ADHD with methylphenidate. How could being about to go on methylphenidate in the next 90 days possible be the cause of depression???
Considering stimulants (generally, but also specific ones) only work for a portion of people that try it, I find this very unsurprising. The increase isn't that big and probably down to a mixture of disappointment and side effects without the main effects.
It's one of the main reasons doctors prescribe different stimulants. I've personally heard every mutation of "This one worked for me but the other one gave me bad side effects and little effect".
The study is useful as something to watch for when using medication, not for avoiding medication. We already know starting antidepressants has an increased suicide risk.
Do I really seem so defensive? I really didn't mean to...
I of course know that this is how it's meant to be used.
But having gone through ADHD and trans healthcare I know everything that looks like ammo will be used as ammo. Even the things that explicitly state they are not ammo. By healthcare professionals and those that want to enact change on a higher level.
You'd think by now we would have some way to test the concentration of various things (serotonin, norepinephrine, etc.) in the body BEFORE issuing medications that might modify them, and then measure such concentrations afterwards to get a better idea of what to use, rather than the current "try different things and rely solely on the subjective description provided by the (likely untrained and inarticulate) test subject."
Or maybe we do and I've never been privy to this knowledge nor provided such a test.
The problem is neurotransmitters are signaling devices, there are no "levels". There are only differences in reactivity to signals that differ all over the brain.
It would be like trying to tracks cars by only observing traffic lights.
Looks like the existing methods for measuring neurotrasmitter concentrations in the brain are pretty invasive, e.g. electrodes at best and the analysis of extracted tissue at worst. And I am not sure whether blood concentrations are indicative of anything.
An approximately 30 percent increase in incidence rate ratio that reversed upon discontinuation of methylphenidate is was was reported here. I would be interested to see what the data would be with a nonstimulant like atomoxetine, which has a structure very similar to that of fluoxetine. Could use in combination cancel out this effect?
For what it's worth, as an undiagnosed (and unmedicated) ADHD kid, I was depressed from age 8 to $current_age. Doing much better now with therapy, Adderall, and an SSRI.
Trying to conform to a neurotypical world is hard.
FWIW, ADHD increases the risk of depression too. Executive Function Disorder creates a lot of internal thoughts of "I'm a loser" "I'll never be able to succeed", and so forth.
Though, being fair, those are thoughts other people will direct at those with ADHD as well.
Is it the condition which causes this, or the diagnosis of the condition? I think diagnoses can easily inspire feelings of futility. It's no longer something you can change about yourself by wanting to change, it becomes a medical condition you've been stuck with.
It's the condition that causes it. One of the diagnostic criteria for ADHD is anxiety over not being able to get things done. Your comment sounds dismissive of the real adverse impact of ADHD on one's inherent executive function; rather it's just someone being too "in their head" after they're giving a diagnosis.
> it becomes a medical condition you've been stuck with
90-ish% of people with ADHD respond well to stimulants, and have complete remission of symptoms. And for those who don't respond well to stimulants, we have bupropion, etc.
It's the one class of mental disorders where medication is very effective. For almost all with ADHD, it's not something you're "stuck" with.
If you have to keep taking amphetamines you are stuck with it. It is clear that something dopamergenic is going on with these kids, but no one is trying to find out why they do not have enough dopamine. You know we have biological pathways that produce dopamine which are controlled by things in our environment.
I'm happy with the fact that medication has helped me immensely. That doesn't mean we should stop looking at better ways to address the issue, but until we find something better, i'll keep taking my meds.
It can be because the person will try to do things repeatedly, fail/be unsuccessful (due to executive dysfunction) and just feel shitty about their life overall.
And by doing things it can even be "basic" stuff like laundry etc.
This hasn't been the case for anyone I know who has been diagnosed. For all of us it was immensely empowering:
"Oh all that stuff I've been struggling with wasn't actually my fault? With this magic pill I can get stuff done too and not feel like an imposter all the time? Heck yea!"
I can imagine what you saying applying to some childhood diagnoses. I cannot speak to anyone I know who was diagnosed in childhood thinking that way though.
The condition. It's abso-fucking-lutely the condition.
Executive Dysfunction means you're screaming in your head to stand up and get work done, but your brain just keeps browsing hacker news. And not just monthly or weekly, but hourly. Sometimes even every few minutes.
Well, 5% of the population in general is the expected ratio of people with ADHD, but only 2% of the adult population is diagnosed with it, and it doesn't magically go away when you become an adult.
So, there's definitely a chance. Two thoughts:
- Everyone will occasionally exhibit some ADHD symptoms, the question is how often. Monthly? Probably not a problem. Hourly, or every few minutes? Probably is a problem.
- See a professional. Self diagnosis can't get you the help you need.
Yeah, mine have persisted all day along for as long as I can remember... I guess I'm not the stereotypical hyperactive, but when it comes to the attention span it does fit me a glove.
I should probably get it checked. Thing is I'm afraid of "faking it", if it makes any sense?
I'd personally recommend to go get checked. The evaluation I went through was like 6 hours long (I know, getting checked for ADHD and they want 6 hours of testing?! Seriously.) But it is to rule out other issues, other conditions and to ensure that the results are correct. In fact, they even adjust for "faking it" in the tests (not that someone couldn't do it, but they are looking for common patterns that would indicate someone try to sway the tests).
I'm definitely not, as you put it, the stereotypical "hyperactive", but on learning more, I realized how many little tics I have that I do but in very masked ways so as to not draw attention. But that aside, there is 3 different diagnosis for ADHD - primary hyperactive, primary-inattentive or combination (both to some level). Despite what I said about tics, my diagnosis was for the inattentive side of things. "Head in the clouds", "daydreamer", etc.
It's all relatively new for me, it wasn't something I really seriously considered until a year or two ago (and I'm in my 40s now), despite having a brother who was medicated fairly young and a father who displays many of the same traits (never diagnosed though). It's definitely helped me to know this, puts some puzzle pieces in place, so to speak, and gives me a path forward toward managing something I didn't really realize I needed to manage, but was having a significant impact on my life regardless.
Nice to know they were that comprehensive. I'm definitely considering checking down here in my area one with good reputation.
BTW, when you talk about tics, do you mean physical tics, like fidgeting, walking around, moving your feet, etc? Because it's quite often noticed by others that I'm doing too much of that
Yup - while I don't present as Hyperactive, it turns out that those little tics are a symptom and I never really realized it until it was pointed out. And now I can't really stop noticing it when I'm doing different ones. But also, some of that may be not just awareness, but a level of acceptance that allows me to stop masking them (i.e. noticing I'm doing it and stopping to please others or hide it, probably goes back to school when told to stop fidgeting).
If you identify with these descriptions strongly, it's a pretty conclusive indicator that you have some degree of executive dysfunction. Whether you specifically have ADHD is up to a doctor to determine, but this type of executive dysfunction tends to be a hallmark of the disorder.
A lot of people who get diagnosed are diagnosed without anything near a full understanding of what it is, especially when diagnosed at a young age, so I don't buy this hypothesis.
As I kid I didn't have any inkling of what aspects of my personality and/or abilities were related to ADHD, and most people I've met who were diagnosed young have been in the same bucket.
If anything being diagnosed should help stave off depression since ADHD tends to mimic a mentality most people just refer to as "lazy". You don't have "executive function disorder", you just fixate on things you like and ignore stuff you don't. You don't have ADHD, you're just messy and disorganized.
Futility comes with a lack of understanding when it comes to this disease.
As a 28 year old who was just diagnosed, I can tell you from lived experience that it's the condition, and by extension, the expectations that people have of you that you aren't capable of meeting.
When I was a kid, I constantly described myself as "lazy" and "tired". Now I understand I was really experiencing "executive disfunction" and "understimulation".
Adding those words to my vocabulary didn't cure my ADHD, but it did relieve some internalized shame and anxiety that were caused by living undiagnosed (and therefore untreated).
It's the condition. You can try place your hand on a glowing hot stove. Couldn't? Imagine that with every task, however willing or not you are. Some have it better, some worse. Just one side of the disorder already being a big hindrance.
A diagnosis had completely the opposite effect for me. I stopped blaming my own failings and could compartmentalize those aspects of my life that were holding me back as something external that wasn't my "fault". The result was a big reduction in guilt and a big increase in happiness and productivity.
When I got diagnosed with ADHD I felt empowered. It let me think, no, I'm not uniquely broken, there's a ton of successful people who have similar brain chemistry to me.
I think you're getting downvoted because it sounds like you're encouraging people not to get professional help.
Anecdata: I never considered the case that I have adhd until I chatted with a friend who was diagnosed with it and our experiences and patterns of behaviour were alike.
I'd go as far as to argue that a diagnosis opens the door to solutions even non medical ones.
Annecdotally? The condition. It was actually the opposite of what you described. Getting diagnosed in early adulthood was actually a huge weight off my shoulders, because I suddenly understood why I was struggling and had a path forward for seeking treatment. Prior to that, I was just drowning and overwhelmed, and I didn't know why. It felt like nothing I did helped and I wasn't making any progress towards my goals. I felt like I was barely a functional adult. It felt terrible.
I've had these thoughts as a teenager but got diagnosed at 32.
> it becomes a medical condition you've been stuck with.
It can feel like this. However, for me, it was much more of a "finally, an explanation!". It showed me my limits are a bit lower than I hoped for, but it gave me immense clarity about those limits. Plus finding your limits, realising there are things you'll never achieve... I think that's anyone's fate sooner or later. It's okay.
I can add my anecdata to the pile. Treating my ADHD (with medication) helped eliminate most intrusive thought patterns that put me in a depressive spiral.
The meds are not without their side effects. Every now and then I take a break for a week or so just to reset my biology. As my problems with executive functioning return, so does the depression.
I think the moral of the story is that interaction with your doctor should be ongoing. You should not just get a prescription for Adderal or Ritalin and check back with them in 2 years.
Maybe executive function issues create those thoughts, but it's also tempting to think that maybe there is a contribution from the following from one's childhood:
* Being told you're lazy
* Being told you're stupid
* Being told you don't care
* Being told you aren't trying (when you're trying incredibly hard)
* Being told you must have 'something' wrong with you
* Being told that your parents have given up on you
I hate sounding like an alarmist....but something is extremely wrong with how physicians handle adverse reactions.
So, I took a flouroquinolone and had a text book reaction. 50+ physicians later at mayo and other top US hospitals and I was gaslighted more than helped in any way. I am now in a group for sufferers and meet new people daily, who took the drug and the doctor completely dismissed their neurological issues as anxiety.
After sending documents to my primary he agreed that I suffered an ADR and stopped prescribing it completely unless no other options exist.
"Health care providers/professionals (HCPs) play a critical role in ADR surveillance. Only 6% of all ADRs are reported and under-reporting acts as great impedance in exchange of drug information."
https://www.ijbcp.com/index.php/ijbcp/article/view/1652
Not a drug reaction, but I had a rather dreadful experience with Mayo, where I reported severe digestive problems which had led to me losing a great amount of weight over a few months while being constantly in pain (175 to 118, I’m 5’10”). They did some esophagus tests, they looked okay and Mayo wrote it off as “health anxiety”. It turns out I was actually developing a form of adult onset type 1 diabetes (LADA).
I have no idea what it was when I was at Mayo, but later on, yes. I went into diabetic ketoacidosis and had 650 glucose at the ER, with an HbA1c that indicated an average of 300 for the preceding 3 months.
Primary care in the US is heavily reliant on the most basic heuristics to meet patient throughput requirements. Many clinics are operating at 15 min/patient. And no one wants to spend their free time charting the visit and making necessary orders (pharmacy, radiology, other providers, etc) if it can be avoided - so they try to cram it into that 15 min if possible. So they simply don't have time to ask the necessary questions and perform research.
The quinolone antibiotics in general seem to be a really nasty class of drug, with a long list of rare but serious and potentially permanent side effects in susceptible people:
There is quite a few theories now, such as mitochondrial issues(mayo clinic is doing a study on this). It is actually a Topoisomerase II inhibitor, like some anticancer drugs, but how that all works is a bit above my pay grade and I don't want to mislead anyone about what that could imply.
Edit: I think the reactions are rare but not as rare as we think. The onset of symptoms is anywhere from few hours after a single dose up to 12 months(this is now on the label). If I did not have an instant reaction I don't think I would have believed that a medication I took 6 months ago caused it. I have talked to many individual suffering from SFN, CFS, Fibro, chronic tendonitis issues who had an infection prior and took the drug. The physician never asked and they never made the connection.
Few individuals recovered, only to take the drug again few years later and end up in a worse state.
I'm not a doctor, but as a family member and extended family member, I know that many bipolar children appear with ADHD in their early years and are treated with ADHD medication.
They are treated with stimulants that have no effect on bipolar disorder.
Can you clarify the aversion to lithium? I was under the impression from multiple friends and family on it that out of many of the other drug cocktails prescribed to manage bipolar disorder, lithium was one of the tamer and more effective medications.
It's an effective mood regulator, because it's a mood dampener. You lose the lows, but you also lose the highs. Evanescence has a song about its effects, and they're much more eloquent about it than I could ever be.
Especially as someone who wasn't bi-polar - it was creepy af... kind of like disassociation. It wasn't me.
I'm not them, but Lithium can have an acquired resistance develop over time, which is unfortunate given how stable it is. It will be used as a first step for determining bi-polarism, or when a stable med is immediately needed, from what I've seen.
This happened to me. Symptoms were noticeable when I was 5. First major depressive episode when I was 9. Was on stimulants from age 6 to 19. Didn't get properly diagnosed until I was 35.
Bipolar is often comorbid with ADHD. Stimulants can help, but can they also cause mania if used alone.
This sounds scarier than it actually is, I think. ADHD is vastly more prevalent than bipolar disorder, and although we have various observational surveys to see if a patient ought to be diagnosed ADHD, the real gold-standard test according to the docs I've talked to is to administer medication. If you take stimulants and the symptoms go away, it was ADHD. If it doesn't work, try a few other types of stimulants. If none of those work then it probably wasn't ADHD and it's time to consider if there's something else going on.
Given that stimulants work nearly 100% of the time for ADHD cases, and don't pose a great risk to patients for whom ADHD is not the root cause, this is a sensible approach to take. As long as the psychiatrist follows up and makes sure the medication is working, and investigates if it is not.
In case people don’t know yet, doctors in some sense have an imperative to prescribe medication, regardless of whether it will destroy someone’s life. It’s almost considered mal practice not to prescribe SSRIs to a depressed person. But that prescription may follow them for life, most never get off them. Or don’t even know who they are when they get older, was that drugged person them or someone else?
> More than 60% of Americans taking antidepressant medication have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more.
I used to think like this. I was very anti medication, pro meditation and mindfulness, and then it happened to me. After a significant life event, a lot of things bubbled to the surface. I wasn't as in touch with myself as I used to be but, again, I was anti medication and thought I could fix things myself. It took me a scary amount of time to ask my doctor for meds, and of course they were happy to prescribe but they never pushed them on me in any way. I was worried I'd feel different, not like myself.
Now, 2+ years on SSRIs and I can honestly say I've never felt more like myself. With the meds, I feel like I've unlocked my full potential. Before, I had bouts of heightened success, but they were always weighed down by this underlying instability. I don't consider myself a "drugged" person, but rather the version of myself that I want to be.
On a related by side note, methylphenidate has been shown to have mild neuroprotective effects (unlike some amphetamine derivatives) [1]. Interestingly dopamine can cause/be neurotoxic (presumably at high levels for a long time). [2]
(Both sources were quickly googled, I'm sure there are better papers.
> Although only 8.6% of American males are on antidepressants at any given time, they seem much better represented as a percentage of mass shooters. Here are 39 mass shooters who were either on antidepressants at the time of their rampage, had abruptly quit taking their medication when they went on their spree, or had been prescribed antidepressants at some point in the past.
These drugs can have serious side effects in x/1,000,000 people. What happens when you give them to tens of millions? You'll start to see those edge cases. Why didn't we have many of these mass shootings prior to 1990? When did we start mass dosing our kids? I think we have a lot more research to do, if anyone is actually willing, but you'd be going up against the big guys.
This doesn't surprise me. I've been prescribed Ritalin at times both as a child and an adult in small doses. It is a remarkable strong medication, and operates much like I imagine recreational drugs operate - there's a definite strong high, and an equally brutal comedown afterword. I would be extremely cautious about prescribing this to anyone, especially children unless nearly every other kind of intervention has been explored.
If you are a parent and considering Ritalin for your child, first ask yourself if you'd consider legal cocaine to be a reasonable solution for your child. If that sounds insane to you, then you should consider the fact that Ritalin is probably not so different.
First off, do you are assuming that everyone reacts to drugs in the same way? I was taking 1/5th to 1/10th of a 'normal' dose. Secondly, if you do a few minutes of research online you will find that both issues (the high, and the comedown) is not at all an uncommon complaint. Ritalin is a CNS stimulant.
With respect, you are being a bit too condescending relative to the amount of knowledge of the issue you posses.
They aren't assuming it about you specifically. It's just a common part of the process, with a common solution. It's likely a very valid question.
If you're one of the few for whom it didn't work out, cool. But with equal respect, your anecdotal experience is not sufficient to call it "legal cocaine". Neither is it sufficient to make generilizations about how medical care of ADHD should be approached.
1. Ritalin is a schedule V medication precisely because of the reasons I mentioned.
2. Five minutes of research online shows that my experience is not uncommon. Hell, reading the warning label from the pharmaceutical manufacturer is sufficient to make my point.
3. I am very pro-medication when it comes to treating ADHD, but I also believe many people are not sufficiently educated on the potential consequences of these medications in children.
Ritalin still isn't "cocaine", despite your negative experience with it, and you're going to do more harm to those who would benefit from it by spreading around FUD.
Part of the process of treating ADHD is finding the right medication, and Ritalin works for most, and if it's working as intended, does not produce the "high" feeling that you got. If you're getting high off of it, it's not the drug for you, or you're on the wrong dose.
> Ritalin is a schedule V medication precisely because of the reasons I mentioned.
Doesn't make it okay to call it "legal cocaine".
> Five minutes of research online shows that my experience is not uncommon. Hell, reading the warning label from the pharmaceutical manufacturer is sufficient to make my point.
Obviously it's documented, but it doesn't make your point. As I already said, it's a thing that happens in the process when finding the correct dosage for an individual.
Though for neurotypical people who don't have the disorder, there's no correct dosage and they'll experience what you did.
I did not call it legal cocaine, though I did compare the two, and I stand by that statement. Ritalin's mechanism for action is extremely similar to cocaine - it even competes for the same binding sites on neurons.
It's still a very useful therapeutic, and I strongly believe it should not be stigmatized. But parents absolutely do need to be educated about the sort of prescription drug this is.
I liken this somewhat to the use of opioids for pain control after surgery: they are a fantastic tool that I would certainly not want to forego. But I am grateful that we've become more intentional about educating people on some of the specific dangers around their use so that patients can be more aware. I'd like to see the same thing happen around the use of strong stimulants in children.
What do you consider to be a “normal” dose? I’ve heard of people using 60+ mg of Ritalin and thinking that’s normal. Ritalin is a powerful stimulant at 5 or 10mg. You can get lower doses or different formulations - e.g. 5 or 10mg at extended release to last through the day.
Extended release is usually preferred by doctors in part because you avoid the highs and lows.
Regardless of what “normal” practice is, if you are getting high from methylphenidate, the dose is wrong, and if you can’t get therapeutic effects at a dose low enough to avoid a “brutal” comedown, you should be looking for alternatives.
>if you can’t get therapeutic effects at a dose low enough to avoid a “brutal” comedown, you should be looking for alternatives.
Agreed, this is why I no longer use it to treat my condition. The point I am making is that parents need to be aware of these potential side effects, because a child isn't necessarily in a position to articulate the fact that they are experiencing adverse effects like this. The medication is a CNS stimulant first and foremost. These effects aren't exactly rare.
Methylphenidate and cocaine are very very similar, but the nuance is different. It' like a bank account at -1¢ or +1¢, very similar accounts, how will they differ as time passes?
In particular because cocaine is addictive whereas methylphenidate is not. Cocaine is euphoric while methylphenidate is much less, cocaine is arrogant while methylphenidate is just in-the-zone, just makes you want to work. Makes drudgery feel like a video game.
There is also such a thing as an affine cocaine user, like Maradona, Iceberg Slim, and Sherlock Holmes (whose cocaine use was based on a real guy--a fucking freakish detective whose privacy Arthur Conan Doyle protected). These guys actually have an essentially healthy relationship with the drug, and yeah it's rare but it exists and they should be allowed to have it. Or narcoleptics, they're not going to get heart problems, let them.
Or what? If Sherlock Holmes was on your child's abduction case, would you tell him no cocaine injections for the deduction trances? Nah man, you'd tell him go for it. That's legal cocaine. And the best detective of all time! In that case, would you still argue legal cocaine is bad for your child?
Honestly I'm like, methylphenidate can be taken like in high school, for athletic competitions, tests, and writing essays...that's when I would have taken that or similar. Later on parties, that's medically acceptable, and is a medically-accepted partly-recreational use for a part of the supply, which is mostly intended for work.
So one thing, daily methylphenidate reduces adult height about as much as artistic gymnastics, like two inches. Apart from that, like something milder is better...like coffee with whey protein, that's worth 5 milligrams of methylphenidate. There's vyvanse, that's a good one for kids. There's adderall, too strong I'd say, but typically there's adderall deficits and ritalin deficits, never heard of someone being helped by both.
I would say I would have wanted the choice for myself as a kid.
"Warnings
Ritalin may be habit-forming. Tell your doctor if you have a history of drug or alcohol addiction. Keep the medication where others cannot get to it.
Misuse of Ritalin can cause addiction, overdose, or death. Tell your doctor if you have had problems with drug or alcohol abuse."
Right, so that's the recent warning documentation, that's roughly what appears in the packet given with a dose recently, I've seen those packets. Maybe I got them myself, or similar, or others's packets. I read extensively.
It used to say roughly: don't crush it and snort it or you will surely get addicted.
Meaning, sticking to the doctor's instructions would be fine.
> I would be extremely cautious about prescribing this to anyone, especially children unless nearly every other kind of intervention has been explored.
A well-trained psychiatrist can diagnose me in <10 minutes and ADHD meds are not that strong. I don't know what "intervention" means, but outgrowing ADHD is a common myth [1]. What you describe is not ADHD. I would try elsewhere. Sorry.
I don't claim that people outgrow ADHD, nor do I believe that to be the case. There are a number of other therapeutic drugs for ADHD beyond Ritalin, and there are other useful behavioral interventions including diet, exercise, time outdoors, cognitive therapies etc. That is what I mean by 'interventions'.
I'm trying, probably somewhat poorly, to make the point that there are a lot of potentially useful things to try in terms of managing ADHD beyond Ritalin (though that can be a very useful tool for some).
It’s worth mentioning that ADHD also increases the risk of depression. Along with anxiety, depression is one of the most common comorbidities particularly in people with undiagnosed ADHD.
I didn’t take ADHD meds as a kid, so I can’t speak to their effect on me. But when diagnosed as an adult, I had suffered nearly my whole life with chronic depression and anxiety.
Both reached a crisis level a few years back, which was a major factor in seeking diagnosis. This diagnosis, and treatment, saved my life. I won’t share my medical charts or anything, but I will say that since my meds and dosage have been consistent, depression is still there but barely noticeable. Anxiety much more manageable.
These meds helped me put my life back together. I’m not dismissing the study, or that other people have different experiences. But I share my perspective when things like this come up, in case it benefits others who might have similar struggles and wonder if ADHD might be a factor.
It doesn't matter what you think. It's fairly obvious even without any research that losing some amount of agency and struggling with things others don't can impact someone very negatively.
Consider: ADHD reduces executive functions, which are like the "secretary" of the mind. This means they can not direct attention onto where they need to: work, school, onto family and friends, etc. Those with ADHD have less 3 friendships on average, due to less ability to hold their attention on others. As they age, they may find relief in drugs like cocaine, caffeine, nicotine, and THC, which may lead to more drug abuse than neurotypical people. They're more likely to commit suicide. These are evidence-backed conclusions from the literature, which I reviewed for my MS.
All of these problems then feed into depression and anxiety. Is that so hard to believe? Less friends, less success, more abuse of substances, it's a potentially rough life.
If you don't mind me asking, why are you closeted about your ADHD? I am 30 and was recently diagnosed and it's one of the most liberating things that has ever happened to me.
Last resort normally means the cons are plentiful.
With adderall and Dexedrine, there is high likelihood of habit forming psychological addiction if not physical addiction. There’s the ever increasing tolerance, etc.
But sometimes dopamine and norepinephrine levels are so low you need a firehouse.
Anecdata, but I've been on methylphenidate (Concerta) since age 7, and holy cow has it impacted my life in an insanely positive way. 21 years later, I'm still on Concerta, but excelling in my career, spending meaningful time with friends, family, and hobbies, and generally pretty happy with myself. When I tried dropping the meds in college, my life basically fell apart in a matter of months. My then-girlfriend now-wife almost broke up with me, I started failing classes, I lost contact with friends, and really struggled to feel alive. The Concerta doesn't fix my ADHD, but wow does it make it manageable. Thankfully, I had a supportive and invested family, understanding friends, and support structures all around me. I'm so glad my parents put me on meds instead of making me struggle throughout my childhood due to an outdated believe that "drugging kids bad". I owe my life and success to this drug, and while it doesn't work perfectly for everyone diagnosed with ADHD, it works so well for me that you'd have to pry my prescription from my cold, dead hands.
Same. I've had a low-grade depression for all my adult life, which has worsened in the past 5 years.
I got diagnosed with ADHD 5 months ago, started medication 2 months ago, and last week I told my therapist I'm pretty sure my life-long depression is in remission. There's a definite feeling that my life is now in a slight upwards trajectory, even on the worst of days.
Life tends to become pretty sad when you have no control over your executive function and action.
My come down is only feeling a little more tired. I suspect you are not talking from experience but hearsay.
> Well, a dose doesn’t last forever. It wouldn’t be surprising if it was a net negative.
My near-sightedness returns as soon as I put down my prescription glasses. I've had to wear them every single day to be able to function decently. Imagine that.
As someone who’s been institutionalized in a psychiatric hospital four times in a still living with bipolar schizoaffective disorder I can tell you being nearsighted is no comparison to having a mood disorder. If people were not ignorant enough to ignore all the nutritional facts that go around the production of catecholamines there would be no need for medication.
Your doctors are probably doing more harm than good by not treating an underlying metabolic disorder. It’s quite possible you have an underlying B6 deficiency.
Why don’t you go get your B6 levels tested and ping me when you get them back OK?
Is that why I’ve been able to get off all of my medications? Because I’m a kook and I don’t know anything about neurobiology? Or anything about immunology? Or genetics?
You say your B6 levels are not causing your ADHD, but have you ever had them tested?
Yeah it’s so "kooky" that they keep finding B6 defieicny over and over in children with ADHD.
But I am the kook I guess. No, it’s not crazy at all to take an amphetamine. It’s not crazy to never wonder why they don’t try to find out why you’re not producing enough amphetamines on your own. It's not crazy we give these drugs endlessly yet ADHD keeps rising.
My Schizoaffective Bipolar Disorder is caused by nutrition. Ask me how!
I've been checked for vitamin deficiencies before, though I don't know if B6 was specifically checked. Regardless, they only found that I was low on vitamin D and so I do take a multivitamin, though I have doubts that it helps in practice. I have also indirectly supplemented vitamin B6 and B12 via frequent energy drink usage (not the healthiest thing I admit!). I notice no difference to mood, physical comfort, or ADHD symptoms on or off vitamin supplementation.
> My Schizoaffective Bipolar Disorder is caused by nutrition.
I suppose anything is possible, but from what I know -- I'm not a psychiatric professional but I've lived with one for 20 years -- it sounds unlikely to be true for most people with similar diagnoses. Believe me, psychiatric hospitals would love to make more beds available by "curing" mental illness with diet.
I don't know what everyone else's experiences are, but my psychiatrist definitely ordered blood tests for me before prescribing medication, and I was able to look through the results myself as well. I'm happy for you if you managed to fix your own problems by getting your B6 checked, but vitamin deficiency is not the reason I have ADHD.
I'm near-sighted but when I wear glasses my brain doesn't attempt to achieve homeostasis by altering the way I see with glasses on in order to make my sight closer to how it was before I wore glasses.
I'm not saying you shouldn't be on drugs or that you'll find the drugs stop working. I'm just saying the effects on the brain are pretty complex and shouldn't be compared to wearing glasses.
I almost didn't have a comedown when I started taking Ritalin. Few years later it became a nightmare. I was becoming extremely annoyed every afternoon and was pretty much useless in the evening as a result.
I also started having very annoying anxiety in the morning after taking meds. And all that with a reduced effectiveness of the drug - clear slowdown in the afternoon after lunch which I didn't have in the beginning of treatment (the dosage was more or less constant from the start after initial titration).
Ritalin clearly affects my sleep patterns. On it I never feel rested and wake up with a feeling I haven't slept at all. There was no change, the effect was present from the start. It takes at least three days without meds for it to be gone.
Finally, Ritalin is definitely bad for my creativity. For instance, I have a habit to play piano or guitar as a way to relax since I was a kid. Composing or improvising at least 50% of the time. This invariably stops when I am on meds - it feels like the activity becomes dull and stops being pleasurable.
All in all, I think it is great that the meds exist and work for a large number of people. That being said I can't stand when someone praises stimulants alluding the consequences of taking them are invariably positive and the side-effects are trivial (if they are acknowledged).
Sadly, most internet discussions on ADHD meds (among people who don't deny it) are infected with overly simplistic toxic positivity: "get diagnosed and treated and your life will be fixed while you'll be happy". The first part I agree with but there is no need to trivialize - the life is more nuanced than that.
It's not a high. If you're getting high off of ADHD meds you either don't have ADHD or your dose is way too much. It's more like an assist for task initiation and follow through, as well giving a boost to staying on task, for people who find those things incredibly difficult _even if they want to do those things_.
No, speaking personally I don't consciously notice the effects of Concerta. Far from being a high that I crave, I actually have to set myself reminders in the morning and make a ritual/checklist, and I set my medication out on a visible shelf in the bathroom, otherwise I'll forget to take it.
I'm not sure how many people with addictions are regularly forgetting to take their drugs without a phone reminder.
The point of the delay release is that you don't have the same kind of ramp up to extreme effects and then come-down. Instead the goal is to get a (roughly) consistent dose that helps with executive dysfunction, and doesn't do much else. As always, that's something you work out with the help of a psychiatrist, not everyone reacts to methylphenidate the same way.
Who said it's strange? I didn't know I had ADHD, and if I hadn't and still was depressed, probably an anti-depressive would have been more suitable.
My point is, of course AMPH helps depression from ADHD, because ADHD is a debilitating disorder. But AMPH probably doesn't help in other types of depression not caused by executive function disorders.
Amphetamines has an established history in depression treatment, with some emphasis on light depression. They fell out of favor with the introduction of then state-of-the-art SSRI's (1980s I think).
Somewhat before that – US context late 1970s – there was political pushback against the largely unrestrained (but legal) amphetamine production by the pharma industry, which supplied more than enough to saturate all the recreational and abuse cases.
DEA brought amphetamines into the Scheduled drugs, manufacturing became quota limited. Incidently, the medical community found that psychostimulants does not have any medical value in treating depression.
Some studies have found them beneficial, some not. The pharma industry has since transitioned into opioids but stimulants have been making a comeback for 20 years with record numbers in ADHD,ADD diagnoses.
How much did you sleep before. I'm reading these kinds of threads and finding lots of similarities with my life. I generally sleep 10 hours a day and have trouble getting out of bed.
I would delay sleeping to 3am, and then need to get up for real life. Over time it became a real sleep debt. So around 6 hours typically. Delaying going to sleep and getting out of bed are signs (but you need to collect many signs of ADHD to be diagnosed). Some people keep pills by their bed so they can do that even if they can't get out of bed.
Apologies for the late reply, HN doesn't really notify me
> The Concerta doesn't fix my ADHD, but wow does it make it manageable.
Methylphenidate affects me in fairly subtle ways and I'm constantly wondering whether it's actually working or if it's a placebo effect. However, my general experience when I look at the tracking data I collect in my own life mirrors this sentiment.
Methylphenidate doesn't get rid of my distractability or make it easy for me to focus whenever I want, but it does help with my executive dysfunction just enough that I can now set timers more reliably, I can now use calendars more effectively. It's not that the medication made the problem go away, but it seems to have helped enough that it "unlocked" a bunch of additional coping strategies that I had never been able to access in the past no matter how much I tried.
Definitely not for everyone, but also that's what a psychiatrist is for -- to help you experiment with different medications to see if there is one that will help, and to monitor you to see what the side effects are and what the long-term effects are, and to figure out and advise you on what your risk factors are. For some people it can be life-changing.
I think a lot of people see this as a question of medication vs therapy, but for a lot of people with ADHD the two parts work together -- the medication makes the therapy more effective and more productive.
I did the same thing as you. I wasn't on Concerta for as long; I started on Ritalin in 3rd grade, and switched to Concerta my senior year of high school. I dropped all meds in college.
I actually tried TWICE to drop my meds. Each time my life fell apart, as you described.
The second time, however, I did not interpret my life falling apart the way you did: instead of interpreting it as validation of the medication's effectiveness, I interpreted it as a withdrawal period. So the second time I quit, I expected going into it that the process of adapting to life without medication would probably last at least 2-3 years.
I can't say what would've happened had I taken your path and not mine. But fifteen years in, I have no regrets. I still don't do what I'm told, but I'm productive and happy and useful. I've found my own way, and it's been a good way.
I have said this many times already: the downside of medicating children is that they never have a chance of learning how dysfunctional ADHD is. Then they blame the medication because they find they can't function without it. No shit, that's why you were taking it.
I have been diagnosed in my 30s and when I stop medication, my life returns to the same exact shit it's been for 30 years. It feels like falling apart, because that's how it was for three decades for me.
That said, I'm happy you found a path without needing the medication. One of the positive aspects of ADHD medication is that you actually learn to function without them, because it gives you the mental energy and fortitude to build healthy habits that can help keeping you ticking along even without the boost of increased dopamine.
My personal view is that this worldview, the one that that views my inability to "function" in school, work, etc. as attributable to a clinical disorder treatable by medication, was incorrect.
ADHD is defined as a disorder of executive function: that is, an individual with ADHD is unable to do what they wish to do. This was an accurate description of me; to this day, finding and working toward my goals is something I'm constantly working on.
But if I look back on my childhood, I see that there was never a time when I had space to figure out how to understand and execute my own wishes in the world. Indeed, within my own family it was not recognized that I had a will of my own at all.
Medication helped cope with this state of affairs, but it never helped repair it. So e.g. if I found I didn’t much like being a student, I could take a stimulant and improve my ability to perform as a student. But taking that medication did nothing to help me solve that key equation: to do something I want to do, that other people also want me to do for them.
So my answer to the problem posed by an ADHD diagnosis is growth: I had to start as an autodidact, but as I’ve grown into my adulthood I’ve found friends, mentors, and peers along the way who help me find my way. The world is making it harder and harder to get, but it’s out there.
That's kind of the work of life, isn't it? So it's a long story.
It probably started with reading _Delivered From Distraction_ years ago. I tried a bunch of stuff in that book. Nothing was a silver bullet (because there is no silver bullet), but I have to give credit to that book for inspiring me.
Nowadays if I'm writing, journalling, praying, and getting honest feedback from friends regularly I'm probably on the straight and narrow. But I try not to be too hard on myself: life isn't a contest, after all.
You ever get over the feeling of regret for not knowing and feeling like you've wasted potential and valuable time in your 20s? Diagnosed 2 years ago and I still catch myself regretting it atleast 5-6 times a week, it's like the thought never goes away.
Opposite here - only have been taking medication for several years and growing up had one of those parents fearful of “drugging” but eager to punish and berate for crappy performance.
I’ve only just finally started actually fulfilling my potential and reading your comment fills me with the regret that things were not different for me…
What worries me more for lifetime-use like this are epigenetic effects (generational-level adaptations to DNA via methylation) that will be felt by anyone inheriting the outcome of their parents behavior.
Epigenetic mechanisms are what turn pigs into boars when released into the wild. In humans, if someone undergoes drastic starvation in their childhood, their children will often be fat. Their bodies hold onto fat more readily because it essentially expects to undergo a similar level of starvation. Evolutionarily, people who's epigenetics could benefit their children in this way were selected for via easier survival.
There are no studies, due to a lack of understanding in the past, of the effects of lifetime use on future generations. It could, potentially, be a positive effect - or none at all.
But that's optimistic for biological mechanisms imo, I'm remaining a pessimist and preferring the route of non-lifetime medication. If someone else wants to test this on their life and family, I would be happy to read about it.
Hey, this is really bad. I am disabled for Bipolar Schizoaffective disorder, living with it for 30 years, hospitalized quite a few times. I was on countless meds. They told me I needed them or I would get worse. But I kept getting worse.
Now, for the last 8 years I am med free and showing signs of recovery.
You do not need meds. You need to find out why you need them biologically. We know that ADHD is primarily caused by low dopamine. So why are you not making enough dopamine?
I am always happy for people who can work without meds, but extracting out from that to assume that every physical/chemical balance can just be cured by addressing some reversible root cause isn't really sound logic. There are lots of situations where our bodies don't produce enough of a chemical and there isn't really a solution for that other than to introduce more of that chemical.
I also feel like:
> We know that ADHD is primarily caused by low dopamine
is a bit of an oversimplification. ADHD is not always caused by low dopamine/norepinephrine/etc production, it's often in part caused by faster than normal reuptake of those chemicals. But when arguing that ADHD is entirely caused by environmental deficiencies, "you're not producing enough dopamine" sounds better than "your brain is absorbing dopamine too quickly so it's not signaling as effectively as it should even when it's released in the same amounts as other people."
And again, this is complicated and different people's brains work differently, medication isn't right for everyone. That's why doctors should be involved. But what's going on is a lot more complicated than "something in the environment is making you depressed so you don't release dopamine" or "you don't have enough of X vitamin so your body can't produce the chemicals it needs"; it's more accurate to say that ADHD is often caused by differences in how actual neurons and synapses interact.
If reabsorption is happening prematurely, it's not necessarily that less dopamine/norepinephrine is being produced, it's that the chemicals being produced aren't as able to be used to do the things they're supposed to do.
And that more complicated explanation ends up being a lot more useful to describe some of the less well-known symptoms of ADHD that sometimes pop up for some people; symptoms like hyperfocusing, poor interoception. It paints a more complicated, multi-faceted picture of how the body can find itself unable to stop focusing on things when neurotransmitters do manage to finally bond, or why certain bodily signals just don't seem to reach the brain reliably. I am not a doctor, but I think it's a lot easier to understand what ADHD does when you look at through the lens of a physical difference in the brain that has knock-on effects on how the brain continues to develop as it learns to rely on other signals and coping mechanisms and strengthen those pathways.
TLDR I kind of disagree with the explanation of people with ADHD as if they're dopamine-deficient, I think where modern research is leaning is that they (often, everyone is unique) have brains that aren't able to make use of the dopamine (and other chemicals, not everything in the world is dopamine) that is produced.
Have you considered that you're an outlier and that policy and approaches shouldn't be based on your outcome?
It's clear you're an evangelist for this approach, but your complete dismissal of people who have issues with drugging children doesn't add anything to the discussion.
> Have you considered that you're an outlier and that policy and approaches shouldn't be based on your outcome?
I don't think it's reasonable for OP to advocate for policy that would materially make their life worse. I'm not sure what you expect their response to be, but it's not going to be, "medication doesn't work for everyone? Great, I'll just go back to being miserable then so no one accidentally takes it unnecessarily."
Prescription medication is something you should work out with a doctor/psychiatrist who monitors your behavior and figures out whether the approach is right for you. But even if methylphenidate only worked for even just 10% of the people who have ADHD -- those people should have access to it. And the rest of the people don't need to take it, that's something their psychiatrist/doctor can work out with them.
> complete dismissal of people who have issues with drugging children
It bothers me that people read "hey, medication worked for me and didn't give me depression" as "literally everybody and their dog should be on this." I don't think that OP is the person here who's dismissing or generalizing.
Can someone comment on whether ADHD medication leads to 'loss' of the unfiltered imagination that I have come to associate with my perpetually distracted self ?
A friend on ADHD meds told me that it feels like trading unbridled creativity for stability. He found it to be an essential drug for functioning, but I got a sense that it involved losing something really central to your sense of self. Almost like being made sedated/compliant by force.
I have long dealt with the double edged sword of ADHD (diagnosed at 27, obvious symptoms since early age). I have had my best ideas / 1st author papers during moments of hyperfocus. At the same time, I struggle to do mundane busy-work with any level of reliability and have had bouts of depression tied to ADHD derived perfectionism/procrastination (if you know, you know).
I have yet to make the leap to medication as I have managed to 'hang on' through the different things I have tried in life. I often joke that I will start medication if I get fired. I am grappling with the decision of making the leap over to medication, and if the cons are worth it in any situation that isn't incredibly desperate.
Some perspective here would really help.
edit: Thanks a lot for sharing your personal experiences. It really helps in at least convincing me to give meds a try. I'll set up an appointment .... tomorrow, soon, surely
I used it for a while and it was life changing. I learned a number of lessons about how my mind makes things harder, and since, have been able to for example shop at the grocery store when before it was infeasible.
However, I felt I lost a subtle intuition edge.
When I stopped I was a mess, until I found Chen Style Tai Chi, which somehow mitigated my worst symptoms without any (negative) side effects.
From there, I’ve been able through (simply aging) and deliberate practice of various techniques to make it so ADD is rarely an issue for me anymore.
That has always been my fear and objection. I worshipped my own crazy creative engine. But after decades of failing to complete those awesome ideas, failure to execute, follow through I would suggest that you experiment. It's not some permanent contract.
Currently I take L Tyrosine, CDP Choline, coffee, lionsmane and kava. My focus and ease of attention are amazing, and I've been very productive.
Even if I get diagnosed and get a prescription, I would still take these supplements as they support the core problem: low dopamine, low acetylcholine. Eat well, exercise too.
I'm 24, and started on meds about six months ago. My experience with the double-edged sword sounds similar to your own.
I had the same concerns, but I found them to be unwarranted; there was no 'trade'. For me, it's more like being given access to a dial to control the speed of all the scattered thoughts flying around in my head. I can space out and get distracted just as effectively as I do without meds, but when I need to focus, I can nudge that dial. Focus is an active process, and it's one that I maintain control over.
I recently started Vyvanse, and I don't really notice that much of a difference. I have a slight boost in my mood, I still hyperfocus on things, but I also have slightly more ability to do busy work.
I was only given 1/3 the recommended starting dose though, so it'll likely get increased when I see my doctor again.
Diagnosed at 25, started Vyvanse right away. My ADHD is similar to what you describe, and the medication has helped with the mandatory chores of day to day life. If anything it has the effect of feeling that nothing is “too hard” for me and that I am not “too dumb to learn or do X”.
Side effects are light to moderately sever headache if I don’t drink enough water, IBM, high blood pressure and a pinch of insomnia.
> If anything it has the effect of feeling that nothing is “too hard” for me and that I am not “too dumb to learn or do X”.
This is a good way to put it. Prior to starting medication (vyvanse specifically, although I tried concerta) initiating a task or trying to learn something was, most of the time, "too hard" so I spun my wheels doing random stuff and occasionally doing just enough work to keep myself employed. Now, nothing is "too hard" because it's possible for me to get over the activation barrier and start doing the thing.
> A friend on ADHD meds told me that it feels like trading unbridled creativity for stability
As someone who has been diagnosed as an adult and been on meds for a few years I could not agree more.
I recommend trying treatment though, I can't see any downsides if it is an option for you. Highly likely there will be clear physiological side effects, but nothing to be scared about.
I'm 32 and was diagnosed at 11. I received behavior help but no meds.
Until earlier this year, when a variety of factors pushed me to finally try them.
All of a sudden, I could focus on things without having to have all of the stars aligned. I never realized the extent and complication of my self-medication until I tried meds. I don't think I've lost my "sparkle." Instead meds help it come out because my follow-through is so much better.
It took me a few months to find the right med - finally on the right one + dose now, but it took some time, so be prepared to experiment with your doc if you choose to try meds.
It's not the right choice for everyone, but it's definitely been the right choice for me, and it's one I wish I had made a lot sooner.
I still feel as creative as my normal self, but I definitely feel less "in the clouds" in general, and that's a marked improvement. There's some feeling of being serious when I have to (i.e. home alone writing code), while previously my emotional state was always in foreground distracting me.
The lightning storm of thoughts disappears with proper ADHD treatment, but I think the focus/attention allows me to be more creative/productive, not less.
A bit of perspective from speed user (amphetamine, not meth) who I know:
Been into it for 10+ years. Usual weekend binge on 3.5 grams of good quality amphetamine.
Can last from Friday evening till Tuesday, will little sleep between.
Lots of things get done.
Rest of the week head and brain is out service, depression you call it, nothing is been done, hard to go to work, any excuse willdo, sort out yourself some food or a takeaway, watch some youtube, sleep a lot till you get better.
Current state, 5 weeks clean: go to work, no problem 8 hours shift, do your duty to pay the bills. After work - eat, relax for a bit, read a lot be it books or just daily news. Bed time. Personal projects be it coding or electronics just put on hold....
As context for readers who might not know normal dosing, the maximum therapeutic Adderall dosage in the US is 60mg per day. So what this commenter is describing is between 15x and 20x the maximum therapeutic dosage based on whether you count this as 3 or 4 days.
As a semi-regular user of speed, I can almost guarantee you that a gram of street amphetamine is nowhere near 100% concentrated. You would be lucky to find it at 20% (cut with half caffeine half random white powder). I've done acetone washes of amphetamine paste, and it's almost unbelievable how little amph there is in it.
A few times I was able to get my hands on really pure dextroamphetamine (>90% validated by a lab test), and even with a tolerance, there is no way you're consuming more than 100mg over the course of a day. 10-15mg was my sweetspot to get enough focus without getting locked into tasks and feeling wired. Although speed like that is pretty hard to find and quite pricey (~60-70€/g).
I've also realized that most of the unpleasant physical side effects of speed (palpitations, jittering, elevated cardiac rythm, anxiety, etc) are actually due to the massive amount of caffeine in it and not the amphetamine themselves (tho I'm sure there is a synergy between them). Even while feeling pretty high on pure amphetamine, my bpm only rose by about 4-5 bpms (compared to 15+ on street speed). For anyone in the same case, L-theanine works wonders to calm down the caffeine side effects, highly recommend you keep some around just in case.
From personal experience, I feel like the crash following a multi-day binge isn't necessarily due to amphetamine withdrawls, but more so the consequences of multi-day sleep deprivation, dehydration, under-nutrition; all the while having over-exerted yourself.
On the comedown of a multi-day binge, I don't feel depressed per se. I'm constantly tired while awake, which I can only keep at bay if I'm physically active. Also, my ability to focus and get motivated dips below baseline, inversely proportional to how high over baseline I was. (And I would speculate that it is mostly due to a depletion of dopamine & its precursors rather than a withdrawl, as it can be alleviated through a decent diet).
From what I've read as well, most of the long term side effects of amphetamine abuse stem from chronic lack of sleep, food & water rather than damage from the molecule itself. Although repeated overstimulation of your reward/dopaminergic system definitely can't be good for you, be it through adaptation or damage of the dopaminergic neurons (I remember reading somewhere that long term meth users are more prone to Parkinson's).
So, I had a psychologist tell me that I have many ADHD markers and referred me to the central mental health agency for an official diagnosis.
Unfortunately, In Sweden, an official diagnosis means higher insurance (fine), higher mortgages (not fine) and the inability to hold certain licenses.
Of course those markers of ADHD are pretty severely affecting my life, which is why I was seeing the Psychologist in the first place...
Would anyone recommend seeking a diagnosis in those conditions? Has anyone done this in Sweden and then gotten a mortgage? Is there anything else I can do?
That is horrifying that your medical issues could be used against you in insurance, mortgages, and licensing... I'd suggest just leaving the country at this rate or getting the diagnosis in a sane country that won't share this information and getting the medication from over there (assuming you can move somewhere close to the border)
> I'd suggest just leaving the country at this rate or getting the diagnosis in a sane country that won't share this information and getting the medication from over there (assuming you can move somewhere close to the border)
I live on the border with Denmark, I’m not sure if it’s ok for me to access healthcare in Denmark without a “CPR Number” https://international.kk.dk/cpr-number
Perhaps a higher risk of unemployment due to impulsive decisions - be it getting fired or quitting? I wonder if bipolar patients also get penalised for their condition.
In general Sweden treats as much data as possible as being open. As such you can find my home address, who I live with and my phone number (and what car I drive) with a simple google search of my name.
Salary data is also publicly available, but as a nominal fee and you buy a “book” which is an area of the country.
When it comes to mortgages, banks ask for extended rights to look into your data on your behalf, you have to sign this with your digital ID (BankID).
This information is centralised and you give permission because they are ostensibly looking for outstanding debts and bankruptcies.
Unfortunately I only learned about the health discrimination when I was applying for an official diagnosis, I received a letter from a company “Modigo” warning me against getting a diagnosis because it can negatively impact my life in this way.
Dude, you have to respond to these comments. I'm dying to know. That is the most dystopian thing I've heard of coming from the land of "socialized medicine is the panacea".
ADHD is not a disease. Expecting children to pay attention to boring adults is. A good portion of teachers are incredibly unanimated and boring. They should not be teaching ADHD kids.
Look, my mother has ADHD (or something like it), and she had no problem teaching the (mostly boys) in her class with ADHD. A few even went off their meds in her class. Unfortunately, the next year, they were put right back on with a new teacher.
ADHD (and associated things like autism) is not just a problem for children in school, but also for adults at work and in their personal lives. I would argue that society should be changed to better accommodate neurodivergent people, but until then medication is really helpful for most people.
ADHD is when you have trouble paying attention to most teachers, not just the boring ones.
Happy for the kids, but when they're adults, they'll find out that they have many other executive functions impaired, not just attention management, and the cool teacher won't fix these.
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[ 3.7 ms ] story [ 264 ms ] threadChildren are supposed to be outside moving 8-12 hours a day, have you seen puppies? They need something similar. Instead many parents give their children tablets, plop them in front of the TV and do something else. Kick them into the back yard or go throw a ball with them.
Every child I know diagnosed with ADHD had parents who didn't want to deal with them. Bringing them to the gym, to the park, playing in the backyard; it's a lot of work. Kids who have trouble focusing are likely tired and overstimulated. Reduce the number of toys, remove TV / tablets, and send them outside. It'll probably solve itself.
As an experiment, look at the people you know on medication (or ask), look at the troubled children, etc. I guarantee you'll see the same trend: single parent home, started medication at an early age, regular therapist appointments, etc. They're unhappy and need depressants, ADHD medication, etc.
It's not always the case, but it's a trend. People who are diagnosed with ADHD at a younger age likely have parents who just don't want / know how to deal with issues. Mental health "experts" treat the symptoms via medication, but the underlying issue(s) just continue to fester.
What we really need is a strong emphasis on family development, courses built around it and support groups. Parents naturally do this, but I think it's been severely broken down the past 50-60 years and is getting exponentially worse. As such we see more: single parent homes, abundance of medication, reduction in religion and adult social clubs, etc.
I take daily medication and it has been literally life saving as I was able to turn things around and keep my marriage from falling apart, not to mention my happiness from being able to accomplish much, much more. I'm holding off medication for my daughter only because it lessens appetite and she is very skinny already. Once she's grown to her full height we'll get her meds she can use too.
I agree with your point but as I’m wrapping up raising my own children I’m coming to the conclusion that I made it a lot harder in myself. Driving them to a million activities, even driving them to playgrounds several times per week, Home Depot kids workshops and so much more.
Sometimes I think a better thing would’ve been to simply say, “Go play outside.”
Once you have a child with ADHD, or if you are someone with ADHD, you will understand just how wrong you are. Until then, enjoy your bliss.
https://link.springer.com/article/10.1186/1471-2431-12-50
> Approximately 10% of the sample was classified as having ADHD. We found depression, anxiety, healthcare coverage, and male sex of child to have increased odds of being diagnosed with ADHD. One of the salient features of this study was observing a significant association between ADHD and variables such as TV usage, participation in sports, two-parent family structure, and family members’ smoking status. Obesity was not found to be significantly associated with ADHD, contrary to some previous studies.
https://www.sciencedirect.com/science/article/pii/S221133551...
> Youth with ADD/ADHD engaged in screen time with an average of 149.1 min/weekday and 59% had a TV in their bedroom. Adjusting for child and family characteristics, having a TV in the bedroom was associated with 25 minute higher daily screen time (95% CI: 12.8–37.4 min/day). A bedroom TV was associated with 32% higher odds of engaging in screen time for over 2 h/day (OR = 1.3; 95% CI: 1.0–1.7).
https://journals.lww.com/jrnldbp/Abstract/2018/04000/Sleepin...
> A shorter sleep duration and less time spent in cognitively stimulating activities were associated with an increased risk of developing ADHD symptoms and behavior problems.
There's plenty more, but the gist is pretty clear. Get your kids outside, give them a supportive and safe environment, teach them how to behave like adults, give them plenty of sleep, and provide them plenty of opportunities to learn. All those reduce risk of depression and ADHD (hence the correlation above).
This does not imply causation. Someone with ADHD is more likely to give in to distraction and dopamine. This study was done with a sample of people who already have ADHD. Nothing in it indicates that television time is going to cause ADHD.
Someone who has a better relationship with exercise, screens, or whatever, doesn't mean they don't have ADHD anymore. Medicated or not. They just have better support and lifestyle habits that minimize how much it might impact them.
If a disease can be resolved through changes in lifestyle is it a disease needing medication?
I think that is kind of the point, is it not? We can give the kids anti-depressants for being depressed or we can help them change their lifestyles. We can give the kids ADHD drugs or we can change their lifestyles. We can let the kids get diabetes, put them on drugs, or help them lose weight.
This is a ridiculous discussion. Yes, drugs can help and we may need to use them in extreme cases to aid in lifestyle changes, but shouldn’t the goal be improved life style
I don't really have much to do with the prescribing part of it (besides my personal medication decisions, and doing my part to not ignore the problem), so I'll leave that to my friends in the medical industry. Though especially having held some uninformed opinions on people who need medication earlier in life, I think it's important to not make people question whether they should take life-changing medication because of stigma or social pressure.
I will say my personal experiences have exposed me to people who need medication but have trouble accepting it a lot more than the latter, so I don't want to pretend my experience is universal.
ADHD has strong correlations with motor control and sleep issues, and is notoriously under-diagnosed amongst girls as they tend to present and be perceived differently.
ADHD is also understood to be hereditary and therefore given that the divorce rate for adults with ADHD is much higher than normal you should expect a higher incidence of children with ADHD growing up in a single family household. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071160/
Your second source is ridiculous, if you actually read the study they looked only at kids diagnosed with ADHD and then found that kids with tvs in their rooms watched more tv. It should seem obvious that this would be the case and im fairly certain you would get the same results if you looked at non-diagnosed kids (which again, they didn't)
I have a child with ADHD (age 9) and a child without (age 6). They are both highly intelligent, but compared to each other:
* My ADHD child is significantly more attracted to screens, video games, and quick stimulation in general. If he doesn't have a screen, he's much more likely to engage in simple, lower-focus activities like simply spinning and running in circles or just hitting things against each other. When given the choice, he will always choose screen stimulation.
* My non-ADHD child is more likely to play with clay and building materials, read, write, and draw. He likes TV and video games, but will very often decide to do other, lower-stimulation activities without being prompted. When outside, he explores and examines things, and will play more structured, imaginative games with rules.
* My ADHD child sleeps much less than the non-ADHD child. He has trouble falling asleep, and wakes up very early every morning on his own. It is impossible to "give them plenty of sleep" when they literally can not sleep.
* My ADHD child exercises much more than the non-ADHD child. He is more interested in going outside in general.
* My ADHD child does not like studying and can not focus on learning things. He learns less, he learns slower, he is disruptive in class. He acts more immaturely even when we take much time teaching him to behave like an adult. He is often depressed because he feels like there's something wrong with him because he has a significantly harder time just having fun doing things that other kids his age do. He feels depressed because he wants to learn things that he simply can not make himself sit long enough to focus on. He feels depressed because he knows he is being immature and disruptive and feels like he literally can not control it.
Given the same opportunities and treatment, my ADHD child has more screen time, more time exercising, less time sleeping, learns less, is less mature, and is more depressed. He is on medication now, but I felt the way you do for years, and it set him back severely in school and life, including his friendships and relationships with family. On medication, he is doing much better in every single respect, but he still struggles, and the medications become less effective over time (we're still trying to find something that works better long-term).
I'm going to be frank here. You are taking studies that show correlation, ignorantly assuming causation, and making judgements and giving advice about an area that you clearly do not have any personal connection to. ADHD may be overdiagnosed, it may have been underdiagnosed in the past (note that ADHD is strongly correlated with self-medication and addiction, which has always existed), but it's not something that you can really easily cause or prevent, and dealing with ADHD in a child is stressful and challenging for both the parent and the child. Assuming neglect among parents of children with ADHD is absolutely uncalled for, and contrary to my experience, where parents of children with ADHD are absolutely run ragged from years of trying to fight to keep their kids healthy, sane, and educated.
I never once suggested the parents were being neglectful in the sense they weren't giving it their all or trying their hardest. To your point, they're ragged, the ADHD children clearly need more work, etc. Further, I'm sure the "mental health professionals" recommended it to them.
I'm not going to share my personal experiences, but I truly do understand all of this and the struggle. I agree we have no proof about what causes ADHD, and those were all correlations. That said, I can say that in the past 100+ years our entire environment as a species has changed. We have some pretty unreasonable expectations on children and not all of them will want to build, some will want / need to lasso cattle, ride horses, hunt, etc (as we did for tens of thousands of years). They may not learn the way we structure our society, they may not respond well to the chemicals, the change in diet, what have you. It could simply be genetics.
The point I was trying to make was it's clear why depression is often correlated (there was no causation in this paper btw) with ADHD and ADHD drugs. Societal and family support is weaker than it was 80 years ago, there's lack of community, less dual-parent households, constantly being told "the world will end", etc That's kind of my point.
ADHD and depression are a disease, meaning they are a variety of symptoms that when presented together are diagnosed as impeding normal function. Those symptoms can have various causes and unless careful observation is made, it's possible to conflate or miss the cause, there may also be a multitude of causes. Treating the cause will "cure" the disease, much like you can cure (or at least dramatically reduce the risk of) type 2 diabetes with diet and exercise (the issue being your bodies ability to process glucose -- often due weight); but not Type 1 diabetes.
What I want to clarify is that I think this is a societal issue, but expressed it through personal observations. Having one parent clearly has an impact (less energy and capability to give to an ADHD child), having structured education, having screens, etc.
Give the example you stated around screen time; would your son be better off trying to learn to focus or playing outside? I honestly don't know for sure, but what is clear is that you care. I'm 100% sure you're doing your best to make that judgement call. My point, was that many times the parents don't care, they just want their kids out of their hair.
My general point was never to assign blame, it was to point out that diseases such as ADHD, Autism, depression, anxiety, etc to be diagnosed together. Further, that those diseases often correlate with some of the issues I highlighted. That doesn't mean it's all cases, but to ignore reality isn't going to help either. If we don't examine the causes and we just medicate -- it wont work well for the children. Medicate as needed, but if we can, we should try to cure the disease.
To be told "you're just a bad parent who lets their kid watch an iPad too much" is infuriating. (I'm trying to keep things civil per the site rules, but my honest reaction begins with 'F' and ends with 'U', guy.)
EDIT: But yes, they’re also saying that many parents are doing it wrong, and they’re assigning much of the blame to parenting. My point was that when a huge percentage of parents are “doing it wrong”, maybe there’s some wider systemic thing at play. Like economic forces that make people work harder than they should if they have kids, dissolution of support networks that would’ve normally cared for the kids in addition to the parents, etc. I’m not saying that this is a cause of ADHD, because I know little about it, but if you take their opinion as correct, then much of the blame could be laid at the societal structures we’ve created rather than the individual.
* "Every child I know diagnosed with ADHD had parents who didn't want to deal with them."
* "look at the people you know on medication (or ask), look at the troubled children, etc. I guarantee you'll see the same trend"
* "likely have parents who just don't want / know how to deal with issues"
There's only a single phrase "not always the case, but it's a trend" that frames it as a societal issue on average, but that doesn't counter the incredibly general conclusions made by the poster.
Sorry for being snarky. Not sorry for calling out destructive, unscientific bullshit.
Like I said in my comment, they pointed out some real problems, but made sweeping generalizations, mostly negative, about the people in question.
ADHD is not well understood by a lot of people, and someone with or without ADHD who is well-versed in the topic pointing out that their comment is not helpful to discussion about how to treat the disorder, shouldn't be dismissed as them "Taking it personally".
Parents are clearly doing their best and looking for support. The "experts" are paid (in many cases) through recurring attendance and kick-backs from pharma... why would we assume they'd want to resolve the issue any other way? Even the research is often funded by pharma... Note the NIH even receives revenue (and individual scientists) from creating patents associated with drugs.
Here's something I posted in another comment, but ADHD / Depression is a "disease" is a bucket of symptoms that impair an organisms normal function.
1. I would argue that what you describe isn't impairing normal function. It's that we are attempting to make children do abnormal things (sit in a room all day and be lectured at. At the end you have an exam). Society is failing to raise children properly and expecting things that are abnormal for the human animal.
2. A disease is basically diagnosed from a bucket of symptoms. Those symptoms will have different causes. Without taking a measured approach at identifying the causes, you are likely going to see a plethora of factors. These can and do include things like hyperactivity from siting and watching TV (now they have energy and want to move). Things of that nature.
Now to compound the issue, look at how all the parents are responding. There is no way they'd consider alternatives.
One way I try to explain it to people: "We give people insulin because they have diabetes. Diabetes is the disease, but you can cure it through diet and exercise for Type 2 (it's environmental), Type 1 you cannot (it's genetic). Insulin treats the disease, but doesn't cure it".
Why are we giving all the kids medication instead of trying to have them diet and exercise (or what ever equivalent)?
Parents in this thread are taking it very personally, but in reality I'm trying to discuss ways to treat the underlying issue(s). And yes, I am saying that there are societal, family, etc expectations and management that can be employed to remove symptoms of the disease (which in effect would "cure" the disease).
ADHD is hereditary, genetic, and has to do with how the brain tends to be wired in that individual. ADHD can be helped through environment and habit changes, and impacts can be reduced, but you cannot cure it.
It seems that you think ADHD is not a real disease, given your quotes around the words "disease", "cure", etc. If some people are mis-diagnosed, it doesn't invalidate all the others.
https://pubmed.ncbi.nlm.nih.gov/31810593/
And ADHD is not a disease, it is a disorder. There is no biological markers yet for a diagnosis either.
Anyway, I don’t think the poster was saying it doesn’t exist. They appear to be saying there are correlations and often a diagnosis at a young age is a reflection more on a willingness to accept a hyper child vs not. That is to say, a child can have ADHD, but that doesn’t mean you have to medicate them. Medicating them (again at a young age) for ADHD, indicates a willingness and potentially eagerness to medicate, as opposed to attempting to correct issues. Ie just give the drugs, don’t try to figure out why they’re depressed.
1) The study is right and every doctor and medical institution I've talked to is wrong.
2) The study's results are being generalized too far or misinterpreted. E.g. I've been told (and it's true in my experience) ADHD people tend to be attracted to screens for the dopamine hit and characteristically lack self-control, rather than the screens causing ADHD.
3) The study is cherry-picked and wrong. Either it is an abnormal result that doesn't replicate, or the study was badly constructed.
Given the fact that my doctors gave me multiple studies to look at which showed the exact opposite conclusion, my prior leads me to believe (2) or (3) over the first possibility. I'll skim the study he posted later though when I have time.
My anicdata doesn't constitute medical science, so it's entirely possible that this study is right and I am wrong, and I'm big enough to admit that. I wouldn't bet on that outcome though, in this case.
EDIT: Also one point you may or may not be aware of is that non-medicative interventions for ADHD are at best a coping mechanism and never satisfactorily address the underlying issues. In the words of my doc: if you are diagnosed with ADHD and you can solve your problems completely with therapy and just going outside or whatever, you didn't have ADHD in the first place and the diagnosis was wrong. Actual ADHD is when your brain is wired up a different way, and general lifestyle interventions can't address the problems that causes.
ADHD people have spent their entire lives feeling frustrated and powerless as the well-meaning people around them tell to simply "stop being so distracted!". Believe me, if we could turn it off we would. It's not so simple. The poster above is making essentially the same critique: that it's not the kid's neural chemistry or wiring that is causing them issues; it's the parent's fault. Stop being a bad parent!
That's worse than unhelpful.
This is speculating on the motivations of a wide class of people without data, and is complete nonsense.
I have no idea where you take this opinion from or if you can back it up. From my anecdotal evidence exactly the opposite is true: kids from families who do realize there is such a thing as mental health and who care deeply about their kids - those get diagnosed. Kids from other families just get mostly slapped around and screamed at to get their shit together.
https://www.sciencedirect.com/science/article/pii/S014976342...
I have a child clinically diagnosed with ADHD. It’s absolutely nothing to do with time spent with him. We have stable family home, active life style. etc
He just has a brain that works differently. Not worse. Different. He might struggle to pay attention at school but he’s written two novels!
PS. Religion is horse shit so if that’s the only other thing you have left for me to help him, I’ll take my chances, thanks
Looking back, I clearly had ADHD, but since it's a condition that's unique and specific symptoms vary per person, I just happened to have mechanisms that worked and got lucky with how my brain patterns fit into school from Elementary - High School.
I had plenty of outdoor activity, and plenty of video games / computer use. Not that you mentioned it, but I also read fantasy/sci-fi books like they were daily papers, finished all of my incomplete homework in the morning while waiting for class to start, and was constantly multi-tasking in class (reading, doing homework for an upcoming class, or occasionally fidgeting).
My sample size is 1, but I have 4-5 diagnosed (either as kids or adults) close friends with similar stories.
Your comment takes some generally-well-known positive advice (exercise more, social interaction & supportive relationships are good, parenting kids is a big task that takes time & effort), and identifies some real problems we face today (social isolation, a lack of non-religious adult organizations, sedentary lifestyles) and uses it to disparage people with real, diagnosable conditions, and vilifying those who turn to medication for it.
I'm fine with how my life worked out, but I can't imagine being the kind of kid whose ADHD manifested in a different way that made school exponentially harder than it was for me, and being told that life-changing medicine, that let me participate in school or work just like everyone else does, is something I was given by mistake, or that I just had shit parents or should have played outside more.
Do you have adhd, or do the drugs help you focus and you want that?
Calling it a disease implies something is wrong, but having trouble focusing isn’t “wrong”. It’s a skill one can acquire and may have a variety of factors impacting it (from genetics to environment to mental management).
That’s the issue I personally take with these kind of discussions. Medication may help you focus (coffee does that), but do people who need coffee in the morning to focus well have a disease? Hardly.
On medication now, he still has a hard time, but he is actually capable of controlling himself, he is capable of forcing himself to focus, and he's much happier. Now it is just a skill for him to work on, but in the past, it was an actual impossibility. It is a true disorder, not just "trouble focusing", and ADHD medication is a fundamental need for some people to function at all, and not comparable to a morning coffee.
In the past, these people were often assumed to be possessed, or insane, and were institutionalized, killed, or imprisoned. It's not like ADHD is a new epidemic or something.
As an ADHDer, I never understood what it was like for others until I got treatment with stimulants. It's like I can just take this magic pill and for 8 hours I'm "normal."
I wish there was an opposite pill, one which made people inattentive and impulsive. Then everyone else could try it for a day or two and see how debilitating it is. Regular, everyday life is like being falling-down drunk in terms of mental incapacitation, and the pills for the first time let us experience life sober.
Edit: how old is your son now? One thing I worry about as a parent of an ADHDer as well is her eating. I've so far avoided treatment for her because I'm worried she'll eat less and her growth will be stunted. We're cautiously waiting on medication until post-puberty.
We do a couple off days now and then, but not a lot because he feels like it's a wasted day because he can't focus on anything he really wants to. I suggested that he could take weekends off the stimulant, but he says he'd rather be able to operate mostly every day than to have a more focused week and completely wasted weekend, and I feel like he's capable of making that decision for himself.
I suggest you have someone sleep 4 hours a night for a week. You'll often see the same symptoms as someone with ADHD.
I don’t think it gets as bad as ADHD but I definitely get a taste of it.
Why is it not the same for ADHD or depression? Type 1 is genetic and Type 2 is environmental.
The argument I was attempting to make is different from what everyone here is saying I think. What is a disease?
> Disease - a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms
Two points:
1. I would argue that what you describe isn't impairing normal function. It's that we are attempting to make you do abnormal things (sit in a room all day and be lectured at. At the end you have an exam). Society is failing to raise children properly and expecting things that are abnormal for the human animal.
2. A disease is basically diagnosed from a bucket of symptoms. Those symptoms will have different causes. Without taking a measured approach at identifying the causes, you are likely going to see a plethora of factors. These can and do include things like hyperactivity from siting and watching TV (now they have energy and want to move). Things of that nature.
Given the above, we're effectively medicating children for personal / societal reasons, not because the human animal is actually suffering or impaired in any way.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571740/
“ In this paper, we discuss candidate triggers of islet autoimmunity and factors thought to promote progression from autoimmunity to overt type 1 diabetes (figure 1). These factors seem to have their effect mainly in the genetically predisposed individuals.” [my emphasis]
I'm talking about tasks I want to do but would struggle with without medication (mainly coding for pleasure).
Yeah - I could find different things to do with my life, but I love coding and I am delighted to find there's a simple pill I can take that helps me do more of it.
Granted, I am happy for you and I think drug laws are ridiculous.
If cocaine had positive effects that outweighed the negatives then it absolutely should be prescribed. But it doesn't. Unlike methylphenidate - which for most people has fairly mild downsides at the doses it is usually prescribed in. It is also largely non-addictive with little evidence of long-term health damage.
Also unlike cocaine.
All in all, I'm not sure how this comparison helps.
https://en.wikipedia.org/wiki/Methylphenidate
Though I'll grant you we don't have data for long-term effects.
https://www.sciencedirect.com/science/article/pii/S014976341...
Further, as you pointed out does have benefits (which is I assume why it's prescribed). Cocaine and meth have similar effects btw (pros and cons), abuse is what causes the issue(s). People can survive on both for decades though.
In my case, my grades plummeted and I was unable to get into the colleges I wanted, or to graduate from an engineering program like I had wanted. I ended up graduating with a degree after 7 years and bouncing between 4 different colleges, and I've had a decently good career in Silicon Valley where being a generalist is a solid plus. But my dreams of being a (literal) astronaut were flushed down the toilet in the process.
Kids shouldn't have to sacrifice their dreams or their self-esteem because parents are unwilling or unable to seek proper treatment.
I did my best and most days I was too tired to give my child the attention and guidance they needed and he suffered needlessly. I resisted prescription medication for as long as possible until it became absolutely necessary. It works and there are side-effects, including symptoms that overlap with depression.
I am spending more time with my son (especially physical activities) and I hope someday he doesn't need methylphenidate.
I am likely still shadow-banned and nobody will see this message. I hope this message gets out and more single parents get the help they need.
You must not know many parents then.
Parents I know that have children with ADHD recognize their children are struggling beyond simple hyperactivity. These are children that are markedly behind their peers in childhood milestones regardless of their family upbringing, education, and socio-economic status. These are children that have a deficiency in the executive function of their brains where hyperactivity is one of many symptoms, and is not even necessarily the most worrying.
These are children that struggle with simple tasks that other children do not.
Parents of these children are no less loving, caring, or capable than parents without ADHD children. Parents should not be shamed for using effective medications (like MDH) so their children can have positive outcomes in their development and adult-life.
> What we really need is a strong emphasis on family development, courses built around it and support groups
ADHD is generally a disorder that you are born with. No amount of family development can prevent the disease.
Educate yourself by watching this: https://www.youtube.com/watch?v=NUQu-OPrzUc&t=137s
I’m sorry, it doesn’t seem like you’re really challenging the argument.
That's probably because it's an argument uninformed by even the slightest bit of research into how a brain with ADHD works.
Also you're sealioning, so :reported:
huh hadn't heard that before -- good to know
I see this with someone close to me.
Diagnosed with ADHD as a child, medicated, later diagnosed with depression.
The real issue, however, was probably more related to brain development/executive function because their mother smoked a pack of cigarettes a day through pregnancy.
You've struck a nerve with some commenters, but personally I think you're on to something.
I question the same thing everyday for my family.
One way I try to explain it to people: "We give people insulin because they have diabetes. Diabetes is the disease, but you can cure it through diet and exercise for Type 2 (it's environmental), Type 1 you cannot (it's genetic). Giving insulin treats the disease, but doesnt' sure it"
This is the same thing for ADHD or depression. Some people probably have Type 1, others (I think the vast majority) have Type 2.
Sure you can mask the issue, somewhat. But you can't cure it through the medications today.
I grew up in a two-parent household. I had a doting, stay-home mom who spent lots of time with us. I lived in a safe neighborhood where I rode bikes with other kids for miles around during the summer. My family took long road trips to places like Yellowstone National Park for weeks and day trips to the zoo, the botanical gardens, the science museum, etc. I did not have a TV in my room and screen time was limited. I was involved in sports at school, summer swim team, and karate which my dad did with us.
I have ADHD which resulted in crippling depression when I was in college. As soon as I got diagnosed and medicated, I was able to be like the normal people that I always wanted to be, and align my actions with my goals.
I was diagnosed as an adult. My parents kept me consistently active and engaged. Plenty of play outdoors, fishing, camping, riding bikes. They were involved in my education until, as a teen, I wanted more independence. I’m not saying I had an ideal upbringing, but I have very loving involved parents (dad and stepmom; relevant below).
I don’t know if that’s why my diagnosis came later, but I seriously doubt it. My mom, unlike my dad and stepmom, was deeply skeptical (a) that ADHD even exists and (b) that ADHD medication is safe, effective, or necessary.
That kind of bias is powerful, and easy for kids to pick up on. I was mortified of these meds before my diagnosis. Now I can’t imagine how I lived without them (and I very well may not be alive today had I not sought treatment).
I’m sure there’s often some truth to some of what you’re saying, to be clear. One of the most difficult parts of getting my diagnosis was that the diagnostic criteria are entirely external to the patient being diagnosed: they’re framed around how parents and other adults perceive a child’s behavior. It took a patient and understanding doctor to help me map those criteria to my internal experiences and my adult life.
But I don’t think I benefitted at all from waiting decades for a diagnosis.
That sounds like me. My parents are stilled married and about to have their 45th anniversary. The extended family are all on their first marriage and in retirement age or raising families.
I started medication after 30, mental health is not a valid thing in my traditional family. According to them, my struggles were because I hadn't learned my proper place yet. Shame and ridicule from adults, and allowing others in the family to participate, was their idea of proper treatment that would 'fix' me into being a proper young lady. This after their first attempts to keep me in line failed. After that, exclusion within family events, that I was forced to attend, was the treatment of choice. At least less parental attention meant they couldn't keep reminding me how defective I was.
Unsurprisingly, I was very unhappy and depressed. Then I decided to love myself and see the absolute dysfunction this nuclear religious anti-mental health family idea is. Now, I am the most well-traveled, curious, adventurous and financially successful person in the family. That didn't happen until I was able to get the help I needed.
By help, I mean medication to do the core things only I'm responsible for in a world that doesn't fit into the way I function. Provide myself with food and shelter as an adult. I am on the higher end of hyperactive ADHD, also dyslexic - which I learned after getting medication for ADHD. I noticed similarities in my niece, I was told I didn't know what I was talking about and that I couldn't be dyslexic or ADHD since I could read and played video games for hours on end.
I don't like medication and it took me a long time to admit it to others, but the world isn't going to change to fit how I function. So, I use medication to fit myself into it for my basic survival needs.
>> As such we see more: single parent homes, abundance of medication, reduction in religion and adult social clubs, etc.
Reduction in religion is not a negitive, I personally experienced it as mental and shaming child abuse within a roman catholic/protestant home. Even now I experience it as other people overstepping themselves by trying to insert and force their righteous will onto my personhood and that of my nieces/nephews. I have a difficult time understanding how this is still allowed and even valued. Of course my family also doesn't see or remember any of this the way I do.
Unless you have solid studies that establish _causation_, not correlation, to back up your assertions, your facile dismissal of all existing medical research in favor of your own personal social prescriptions deserves zero consideration.
Part of the problem is that it's very difficult to get the right dosage for any given day because diet, metabolism, and hormones seem to have a big impact on how effective it is. We've found it's better to go with a lower-dose extended release, and then let her self-medicate with 5mg regular tablets as needed. This works great now because she's a fairly responsible teenager (when medicated), but it was really hard when she was younger.
Unfortunately extended release Methylphenidate of any kind/brand is only partially covered by Dutch health insurance[1], and I'm certain the cost is prohibitive for people who might be less well off.
1: In essence, the government has determined that all Methylphenidate variants are equal, and so you can just take the cheapest instant release variant or else pay the difference out of your own pocket.
What I do instead is two lower-dose XR pills per day. The four hits over about 8 hours seems to work pretty well for me.
The bipolar-level manic highs and depression/lows are very real.
The feelings of suicide and hopelessness creep up; I have enough personal awareness and grit to ignore it but it feels awful.
To avoid that creep-up, the best thing I found is to have “break” days at least once or twice a week. That is, no pills.
I doubt your daughter or others with ADHD have that luxury though.
I've had to be very careful about NOT using those terms when talking to doctors and psychiatrists. As a layperson that description seems to fit, but it causes huge red flags for medical professionals and they freak out, resulting unnecessary tests and evaluations for my kid.
The key term for the "manic" phase after the meds wear off is "Rebound Effect". Also when the dose is too high the generally accepted term is "zombie mode" or "zombie-like". Calling it an "overdose" will really cause people to freak the fuck out.
I’m not saying it’s not possible to have those side effects, I just haven’t experienced them.
Surely any zombie is too much zombie.
Getting horribly fall down drunk as a teenager caused me to shit my pants once. But I didn’t so much as fart when I got tipsy on vacation recently.
Put it another way if makes you feel better -- a little bit of D3 via direct sunlight and D3 rich foods will improve your mood and health outcomes in a variety of ways. An excessive amount of D3 will give you kidney stones and harm your bones.
It's one thing to be worried about subtle effects from medication, but I already know what the long term health and brain effects are from constant insomnia and regularly forgetting to eat. Neither of those are good for brain function.
So yeah, seems like a pretty reasonable risk to take, particularly given the fact that I have a psychiatrist, therapist, and multiple friends and family monitoring me.
Let me flip the question back to you. Would you notice if D3 or iron or protein intake was subtly harming you over the course of multiple years? Is that something that terrifies you?
But you tell me it feels good. And you are more productive etc. And all the experts agree. So who am I to argue?
But yes, I do think the benefits for my mental health very clearly outweigh the theoretical risks you posit. So even if I agreed with what you're saying (which I don't), a subtle hammer tap to the soul is still very clearly and obviously better than the sledgehammer to the soul that is sleep deprivation (something that I concretely know would impact my brain function as I age and that I concretely know makes me less of myself). If that causes you to raise your eyebrows, then I'm not sure what to say other than that you're bad at risk analysis.
Wikipedia has quite a lot of information on it: https://en.wikipedia.org/wiki/Methylphenidate
Kids with ADHD can go on to find incredible success in breaking the rules.
I really think the comparison with glasses is apt, sure someone can squint their eyes and sit a bit closer at times, but why should they? We'd call it neglect to force someone to cope with bad eyesight without correction. Now you're talking about some ADHD kids doing well breaking the rules, so it's fine not to help? Eugh.
Do you know how many without help end up with incredible failure? Teen pregnancies, accidents, addiction, depression? It's more likely to be bad.
I really wish this discussion would revolve around helping, not potentially forcing coping.
Because that mask can never really be taken off.
ADHD kids can take medicine, but the rest of the world can also lighten up. That's my point. The rules and benchmarks are stupid and impose unnecessary stress on ADHD individuals. Over half of the time you can ignore it and be fine.
We'll never know of course. But decades later now that I have access to these medications I can actually achieve my goals enough of the time to feel ok about myself.
But yeah, complacency in school, totally.
It doesn't make children complacent. It made me stop kicking the shit out of my classmates every day. School is very important. I was depriving myself and others of an education and those other kids shouldn't have to put up with nuisances like me.
My parents were given a choice: put me in special ed classes or medication. They didn't want me to be treated differently so they chose medication. I think it was a good call.
It does feel like there's a lot of "hey that's weird, this one person isn't like everyone else, maybe we should try pumping some drugs into them" going on. Perhaps we could explore the problem space a bit before reaching that conclusion. Of course that sounds like it could take a lot of work and involve understanding the problems on an individual basis. Standard cocktail of drugs, however has an industrial, assembly line feel to it. Why figure anything out when we can just find a way to make the problem go away.
Although, for those who really do need brain chemistry alterations to function, I'm glad we have something that we can actually do to help them. I just wish that the approach would be to actually assist the individual instead of only assisting the assembly line student output. It seems like I only hear about the later, but of course perhaps that makes sense because a story about the former doesn't have very good memetic fitness.
But it isn't like that.
Just as a thought excercise imagine you're talking about glasses, that's how damaging and silly such arguments are.
Things like bad eyesight or executive dysfunction don't start and end on school grounds, they're just more visible and more obstructive there.
My son has ADHD. There are other ADHD cases in the family, so we knew that could be the case with him, but we waited until he was in middle school to even try to check, because we didn't want him to "depend on drugs", as the trope goes.
We got the diagnosis from two different doctors, to be absolutely sure.
The medication makes a stunning difference, and it has nothing to do with complacency at all. It has to do with being able to focus better and to overcome an obstacle that people like me don't have.
And the medication shouldn't be the only thing to use for ADHD. It should be used as a tool to help, but that's just the start. It's important for the parents to work with a psychologist, for two reasons: 1) to help the child develop their own tools and strategies to overcome the cons of ADHD, and 2) to help the parents understand the child better.
Like I said, I don't have ADHD. The things my son has to struggle with are often difficult for me to understand and identify with. The medication helps so he doesn't have to struggle as hard. And he's less "complacent" than ever, and that's a good thing.
What you're saying is the equivalent of "it's horrifying to me that so many children are forced to wear glasses so they become more complacent in school".
[0] https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=aff...
Fully developed or not, ADHD doesn't disappear. Neither does it change if someone wants fully working executive functioning or control over their "train of thought".
The "focus" is worth it, especially if you make a fair comparison with those that weren't so lucky to get help.
These drugs are altering brain chemistry and one's natural state so they fit into the unnatural environment that is school. It's horrifying to me that people are doing mental gymnastics to defend drugging kids who don't want to sit at a desk for hours every day memorizing useless information. If I was a kid today I'd fit the qualifications and be drugged to better fit into that environment. It's a crime that future generations will be rightly horrified by. Not unlike how we are starting to be horrified by the treatment of animals in factory farms. We're not treating these kids much better.
Lucky for those with ADHD, most respond to medication very effectively.
Yes, the medication alters brain chemistry and one's "natural state". Do you honestly think that we have the science to realize that it alters brain chemistry, but we don't have the science to realize that some brain chemistries are drastically different from others?
As for the whole "natural state" thing, let's not indulge in appeals to nature here. I forgot where I heard "dog poop and arsenic are both found in nature, but you wouldn't eat either", but it stuck with me. Schizophrenia is a "natural state" for some people. So is depression, or autism. Should we just leave everyone in their "natural state", because it's sacred for some reason? Hence my comment about glasses: some people are naturally short-sighted, too, but they enjoy being able to see better.
Sure, school is an unnatural environment. Civilization is mostly an unnatural environment, too.
What infuriates me, though, is that people who haven't had to walk in my son's shoes -- or mine, but his are more important -- have the audacity to judge from their position of ignorance and declare all the effort and care we went through "a crime that future generations will be rightly horrified by".
Wish I could have been a proper part of this world we live in as a kid but my diagnosis and treatment only came in adulthood.
ADHD affects your natural ability to make decisions and control your emotions. Has all kinds of health repercussions from overeating to unnecessary risk taking to difficult relationships with others.
Please stop talking about stuff you don't know like you actually have any knowledge of it, and spend the time you save by reading some science:
https://www.sciencedirect.com/science/article/pii/S014976342...
I didn't have a singular issue with sitting at a desk. I could - and in fact did - sit at a desk from sun up to sun down 5 days a week without complaint.
Did I resent it? Yes. Do I think schooling should have been done differently? Yes. Could doing school differently have cured my ADHD symptoms? No. Absolutely not.
Living with undiagnosed ADHD is hell, whether you are a child or an adult.
That is a problem that both the public and the medical community are aware of. I agree with maintaining awareness of that, but I strongly disagree with going to the extremes and stigmatizing ADHD medication and everyone involved.
Look at the comment I objected to. Does it read like a rational, polite way to maintain awareness of that problem? Or does it look like a knee-jerk judgment that's parroting a popular trope?
School is a pretty boring and restrictive place. Children are notoriously poor at dealing with boring things and young boys in particular are particularly prone to the kind of misbehavior that will get them in trouble and drugged.
It is remarkably difficult to find any figures even estimating the overdiagnosis and overmedication rates for ADHD. Most of the talk around this issue tends to make a big deal out of the rising rate of ADHD diagnoses.
Those who talk about it responsibly and rationally recognize right away that this doesn't necessarily mean we have an overdiagnosis crisis on our hands, and seek additional information. The best study I've been able to find about this [1] does indicate that there may be some overdiagnosis and overmedication going on, but even there it's not framed as "parents, teachers, and doctors are basically conspiring to drug kids to keep them from acting up in schools", nor does it lend any credibility to that claim.
Are there bad parents who don't want to deal with their kids' behavior and try to get them "drugged into complacence"? Yes, definitely. Do we know how many and how that number compares to other kinds of parental abuse? No, we don't. Is it a problem of epidemic proportions? There's no evidence for that, and the onus is on those of you who make that claim.
More importantly, if we distance ourselves from the sensationalist tropes about "drugging kids into complacence", we can ask a better question: are there currently any perverse incentives in the medical community to overdiagnose ADHD and overprescribe medication? This might be the case, but it remains to be proven and it should be dealt with just like any similar case of perverse incentives.
So what do I object to? I object to the sensationalist "Will Nobody Think Of The Children" overstatement and hyperbole. I object to people bringing up the same trope over and over again, out of ignorance, and doing their best to stigmatize the vast majority of us who are doing our best to provide our kids with the best life we can. I object to not trying to constructively work to slowly evolve the best approach to dealing with a concrete, real and potentially debilitating problem that was discovered too recently to have a perfect solution to it, just because drumming up outrage and spreading FUD is easier and more gratifying.
And yes, school can be a pretty boring and restrictive place, but that's just the tip of the ADHD iceberg. Reducing the whole problem space to just that is not helping, either.
[1]: https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
EDIT: I realized that I forgot to provide the link for [1], so I'm adding it now. My apologies for the oversight.
Your defensiveness aside - it's actually not a "trope" or a kneejerk reaction to notice that the rates of ADHD and ADHD medication have doubled in the past couple decades in the US and are significantly higher in the US than in Western Europe. The US has a pattern of over prescribing medications - the current opiod epidemic is an example. My understanding of this is that it's most likely there is over-diagnosing, and therefore overmedicating, of ADHD, and that's bad.
"Are there bad parents who don't want to deal with their kids' behavior" - there are, sure, but that's not what I think is most common. My intuition is that bad parents would just not care what their kids are doing and leave it to the school to handle. If I had to guess, I would guess that the modal problem parent is one who, understandably, wants what is best for their kids and is concerned about what the schools are telling them. The schools, for their part, want kids who don't overly disturb the system. The doctors hear about a problem that they have the pharmaceuticals to treat.
I don't think the people involved are evil and acting out of malice or laziness but I do think that this group works together to create a system where a fundamentally boring place (school) has a problem managing people who are fundamentally bad at being bored (boys) and they, in part, solve that problem by giving them drugs (ADHD medication). I've been thinking about my choice of the word "complacent" from earlier, and maybe it's not quite right - I originally meant it in the sense that the natural state of the boys is to think of school as a problem and rebel against it and their medicated state is to not rebel against school as much or to the same extent.
And yes, it's a trope. I said very clearly that this is not about rising rates of ADHD diagnoses and medication. The trope I'm referring to is the tendency to not only jump to a conclusion that it means we have an overdiagnosis crisis, but to present that conclusion as a fact and a significant problem.
The reason why I'm furious about it is because this narrative has been pushed for years and it has a negative impact on those of us who wish to help our children. In my personal case, it created a strong urge to avoid addressing the issue and just hope it would go away with "better parenting". If it hadn't been for the stigma of "you just want to drug your kids into submission", I would have started helping my kid earlier -- not with medication, but by finding a psychologist to help us.
Again, the focus on "school is boring and kids misbehave, so they get drugged" is too narrow and damaging to those who are affected by ADHD. Imagine being interested in many things, but not being able to advance in any of them beyond initial interest because your brain doesn't let you overcome simple obstacles that require concentration and it only lets you do so if you become somewhat obsessed by a particular random thing it settled on.
Yes, the study I (belatedly) linked in my previous post does indicate that there might be some overdiagnosis and overmedication of milder ADHD cases. And yes, that's something that we need to be aware of and work to improve.
I'm not objecting to raising that awareness. I'm objecting to the utterly irresponsible and damaging way to do so.
There is a widespread belief in ADHD and that it should be medicated. That's why millions of children are so medicated. There is institutional belief in that idea as well - that's why so many doctors prescribe these drugs to children. It's not the case that treating ADHD is some minority view that needs to be protected from criticism.
I read your comment as suggesting that I shouldn't share my opinion on the topic because my opinion stigmatizes children who need help. I hope I can highlight the problem with that sentiment by giving an example like if I said you shouldn't share your opinion because the children who are over medicated need help and you are silencing and stigmatizing ideas that would help the over medicated kids.
There is no reason to think my comments are "utterly irresponsible" or "damaging" and you are being hyperbolic by describing them so - any more than your comments are damaging because they encourage over medication. Again, I'd refer you to the "defensive" element of my prior comment. And, since you've mentioned tropes, one trope I'd like to point out is the trope of thinking that "Because I strongly hold belief X I will accuse anyone disagreeing with X of being bad or harmful." You are entitled to your opinions, but not to try and silence people who disagree with you.
As for where the society is currently tilted, it's possible -- and likely -- that ADHD is being both overdiagnosed and underdiagnosed at the same time. Like I said, it was discovered recently enough that we, as a society, don't yet have a perfect solution for it and we're still learning more and more. The approach is still evolving.
And yeah, going from 5.5% in 1997 to 9.8% in 2018 is the jump everyone loves to quote and panic about, but it doesn't constitute a crisis. Especially if you frame it as "more than a tenth of children are so psychologically flawed they need mind-altering medication to address what's wrong with them". That's exactly the hyperbole I'm objecting to here.
Let's start by acknowledging that 9.8% of children diagnosed does not equate 9.8% of children medicated. Once we hopefully agree on that, I'm also hoping we can agree that ADHD is not this binary thing that manifests exactly the same and in the same degree in every patient. Just like we've discovered that autism is not a binary thing but rather a spectrum (and even more nuanced than that), ADHD can't be reduced to "either you have it and you'll forever medicate, or you don't have it".
So yes, we're still dealing with a developing situation and there's more work to be done. That's not something I dispute and I'm not trying to "silence" that opinion. As I already explained repeatedly, I am objecting to the way you presented that. Or rather, I'm objecting to the way you didn't present that at all.
You just tossed out a judgmental, dismissive comment and got upset when people pointed out that it wasn't constructive -- or even true, on its own. It didn't come across at all as what you're claiming you wanted to say, but instead of recognizing that you communicated wrongly, you're now claiming I'm trying to silence you. Given that, I'm starting to form an impression that we could go back and forth like this forever and nothing will come out of it.
Science generally agrees ADHD is under-diagnosed. Read the statement of consensus. There's some sort of moral panic cause the beautiful souls of a bunch of people can't fathom stimulants can be used for medical purposes cause "all drugs are bad and Concerta is essentially meth" which is absolute BS.
There's no need to spew hearsay and lies when you know next to nothing about a medical condition that affects 5% of the population.
If you look at the rest of my comments in this discussion, you'll see that I'm not pushing the moral panic you mention -- on the contrary, I'm pushing against it strongly -- and that it's definitely not true that I "know next to nothing" about this condition.
It wouldn't surprise me to find that ADHD is being simultaneously over- and under-diagnosed, because it's new enough that we're still discovering more and more about it. That's why I don't dispute that there's probably some degree of overdiagnosis, but I strongly object to pushing the narrative that it's some kind of an overmedication epidemic or crisis.
[1]: https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
Do you have any evidence to support that children are prescribed medication to sit in a chair when they don't have ADHD at a high enough clip to warrant the appearance of being concerned about it at equal weight to actually getting those with ADHD help? Comments like this only further stigmatize getting those with ADHD the help they need, so before you make them you'd better be damn sure it's worth it or else you're taking part in stigmatizing parents who get children the help they deserve.
The biggest difference is in self-motivation. Someone with ADHD will desperately want to focus on something they like, but they can't. For many things, there is no amount of desire that can overcome this limitation.
This is very different from a kid who just isn't interested and wants to do something else.
The reality is that ADHD can cause all kinds of problems with making decisions, planning, perception of time, staying focused on a chosen task, emotional regulation, and sleep. School just happens to be the first place where these difficulties become apparent, but this can be a struggle in all areas of life, and not everything can be helped with environmental accommodations.
I'd make a comment about how office work mirrors education, but if we do decide to treat school as unimportant, it's not like children would be able to get such jobs.
Instead they'd be more likely to get jobs doing manual labor, destroying their bodies before they've past their mid 30's.
How could we give these to children indeed.
Of course this article is about Ritalin which is not comparable.
School is a place where several people in the same age group and similar social circles are expected to perform the same set of tasks, which makes it really useful as diagnostic criteria.
But treatment isn't (or at least shouldn't be) about only doing well in school. It's about doing well in life.
I finished elementary and high school by the skin of my teeth. I did it without an ADHD diagnosis or treatment.
I finally got diagnosed this year and started treatment. Why? So I can do my hobbies. So I can wash the dishes. So I can live my life instead of staring at it, waiting for my feet to start moving beneath me.
ADHD medication is not about school, because school is not the singular instance where a person's life is affected by the disorder. ADHD affects every aspect of my life, and so does treating it.
Also worth noting for those less familiar with medication names, methylphenidate is sold under the brand names Ritalin and Concerta.
It's one of the main reasons doctors prescribe different stimulants. I've personally heard every mutation of "This one worked for me but the other one gave me bad side effects and little effect".
I of course know that this is how it's meant to be used.
But having gone through ADHD and trans healthcare I know everything that looks like ammo will be used as ammo. Even the things that explicitly state they are not ammo. By healthcare professionals and those that want to enact change on a higher level.
Or maybe we do and I've never been privy to this knowledge nor provided such a test.
It would be like trying to tracks cars by only observing traffic lights.
Trying to conform to a neurotypical world is hard.
Though, being fair, those are thoughts other people will direct at those with ADHD as well.
Is it the condition which causes this, or the diagnosis of the condition? I think diagnoses can easily inspire feelings of futility. It's no longer something you can change about yourself by wanting to change, it becomes a medical condition you've been stuck with.
> it becomes a medical condition you've been stuck with
90-ish% of people with ADHD respond well to stimulants, and have complete remission of symptoms. And for those who don't respond well to stimulants, we have bupropion, etc.
It's the one class of mental disorders where medication is very effective. For almost all with ADHD, it's not something you're "stuck" with.
No, it is not.
https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_to...
If you have to keep taking amphetamines you are stuck with it. It is clear that something dopamergenic is going on with these kids, but no one is trying to find out why they do not have enough dopamine. You know we have biological pathways that produce dopamine which are controlled by things in our environment.
https://www.researchgate.net/figure/he-biosynthetic-pathway-...
Yeah, I said it, you can control ADHD by changing the environment. Zinc, B6, air pollution, protein intake, etc...
Yet all we get is a pill? And you are all happy with that?
And by doing things it can even be "basic" stuff like laundry etc.
"Oh all that stuff I've been struggling with wasn't actually my fault? With this magic pill I can get stuff done too and not feel like an imposter all the time? Heck yea!"
I can imagine what you saying applying to some childhood diagnoses. I cannot speak to anyone I know who was diagnosed in childhood thinking that way though.
Executive Dysfunction means you're screaming in your head to stand up and get work done, but your brain just keeps browsing hacker news. And not just monthly or weekly, but hourly. Sometimes even every few minutes.
Diagnosed or undiagnosed.
So, there's definitely a chance. Two thoughts:
- Everyone will occasionally exhibit some ADHD symptoms, the question is how often. Monthly? Probably not a problem. Hourly, or every few minutes? Probably is a problem.
- See a professional. Self diagnosis can't get you the help you need.
I should probably get it checked. Thing is I'm afraid of "faking it", if it makes any sense?
I'm definitely not, as you put it, the stereotypical "hyperactive", but on learning more, I realized how many little tics I have that I do but in very masked ways so as to not draw attention. But that aside, there is 3 different diagnosis for ADHD - primary hyperactive, primary-inattentive or combination (both to some level). Despite what I said about tics, my diagnosis was for the inattentive side of things. "Head in the clouds", "daydreamer", etc.
It's all relatively new for me, it wasn't something I really seriously considered until a year or two ago (and I'm in my 40s now), despite having a brother who was medicated fairly young and a father who displays many of the same traits (never diagnosed though). It's definitely helped me to know this, puts some puzzle pieces in place, so to speak, and gives me a path forward toward managing something I didn't really realize I needed to manage, but was having a significant impact on my life regardless.
BTW, when you talk about tics, do you mean physical tics, like fidgeting, walking around, moving your feet, etc? Because it's quite often noticed by others that I'm doing too much of that
As I kid I didn't have any inkling of what aspects of my personality and/or abilities were related to ADHD, and most people I've met who were diagnosed young have been in the same bucket.
If anything being diagnosed should help stave off depression since ADHD tends to mimic a mentality most people just refer to as "lazy". You don't have "executive function disorder", you just fixate on things you like and ignore stuff you don't. You don't have ADHD, you're just messy and disorganized.
Futility comes with a lack of understanding when it comes to this disease.
When I was a kid, I constantly described myself as "lazy" and "tired". Now I understand I was really experiencing "executive disfunction" and "understimulation".
Adding those words to my vocabulary didn't cure my ADHD, but it did relieve some internalized shame and anxiety that were caused by living undiagnosed (and therefore untreated).
All that's missing is how there's no consequence underlying that hesitation; how you can't justify why you can't do the task.
I think you're getting downvoted because it sounds like you're encouraging people not to get professional help.
I'd go as far as to argue that a diagnosis opens the door to solutions even non medical ones.
> it becomes a medical condition you've been stuck with.
It can feel like this. However, for me, it was much more of a "finally, an explanation!". It showed me my limits are a bit lower than I hoped for, but it gave me immense clarity about those limits. Plus finding your limits, realising there are things you'll never achieve... I think that's anyone's fate sooner or later. It's okay.
The meds are not without their side effects. Every now and then I take a break for a week or so just to reset my biology. As my problems with executive functioning return, so does the depression.
I think the moral of the story is that interaction with your doctor should be ongoing. You should not just get a prescription for Adderal or Ritalin and check back with them in 2 years.
* Being told you're lazy
* Being told you're stupid
* Being told you don't care
* Being told you aren't trying (when you're trying incredibly hard)
* Being told you must have 'something' wrong with you
* Being told that your parents have given up on you
So, I took a flouroquinolone and had a text book reaction. 50+ physicians later at mayo and other top US hospitals and I was gaslighted more than helped in any way. I am now in a group for sufferers and meet new people daily, who took the drug and the doctor completely dismissed their neurological issues as anxiety.
After sending documents to my primary he agreed that I suffered an ADR and stopped prescribing it completely unless no other options exist.
"Health care providers/professionals (HCPs) play a critical role in ADR surveillance. Only 6% of all ADRs are reported and under-reporting acts as great impedance in exchange of drug information." https://www.ijbcp.com/index.php/ijbcp/article/view/1652
https://en.wikipedia.org/wiki/Quinolone_antibiotic#Adverse_e...
https://www.nature.com/articles/d41586-018-03267-5
Edit: I think the reactions are rare but not as rare as we think. The onset of symptoms is anywhere from few hours after a single dose up to 12 months(this is now on the label). If I did not have an instant reaction I don't think I would have believed that a medication I took 6 months ago caused it. I have talked to many individual suffering from SFN, CFS, Fibro, chronic tendonitis issues who had an infection prior and took the drug. The physician never asked and they never made the connection.
Few individuals recovered, only to take the drug again few years later and end up in a worse state.
They are treated with stimulants that have no effect on bipolar disorder.
I'd rather be on a small methamphetamine dose than Lithium if I got to choose my misdiagnosis.
Especially as someone who wasn't bi-polar - it was creepy af... kind of like disassociation. It wasn't me.
Bipolar is often comorbid with ADHD. Stimulants can help, but can they also cause mania if used alone.
Given that stimulants work nearly 100% of the time for ADHD cases, and don't pose a great risk to patients for whom ADHD is not the root cause, this is a sensible approach to take. As long as the psychiatrist follows up and makes sure the medication is working, and investigates if it is not.
https://www.cdc.gov/nchs/products/databriefs/db76.htm
It seems like most people do stop using them with time.
Now, 2+ years on SSRIs and I can honestly say I've never felt more like myself. With the meds, I feel like I've unlocked my full potential. Before, I had bouts of heightened success, but they were always weighed down by this underlying instability. I don't consider myself a "drugged" person, but rather the version of myself that I want to be.
(Both sources were quickly googled, I'm sure there are better papers.
1 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2701286/ 2 - https://link.springer.com/chapter/10.1007/978-1-59259-006-3_...
> Although only 8.6% of American males are on antidepressants at any given time, they seem much better represented as a percentage of mass shooters. Here are 39 mass shooters who were either on antidepressants at the time of their rampage, had abruptly quit taking their medication when they went on their spree, or had been prescribed antidepressants at some point in the past.
https://thoughtcatalog.com/jeremy-london/2019/09/37-mass-sho...
Michael Moore came to the same conclusion when researching for his movie, Bowling for Columbine: https://www.youtube.com/watch?v=04UqzYOdGNs
These drugs can have serious side effects in x/1,000,000 people. What happens when you give them to tens of millions? You'll start to see those edge cases. Why didn't we have many of these mass shootings prior to 1990? When did we start mass dosing our kids? I think we have a lot more research to do, if anyone is actually willing, but you'd be going up against the big guys.
Unless you are in great pain, or can't walk, stay completely away from doctors and hospitals.
If you are a parent and considering Ritalin for your child, first ask yourself if you'd consider legal cocaine to be a reasonable solution for your child. If that sounds insane to you, then you should consider the fact that Ritalin is probably not so different.
What do you consider a “small” dose?
With respect, you are being a bit too condescending relative to the amount of knowledge of the issue you posses.
If you're one of the few for whom it didn't work out, cool. But with equal respect, your anecdotal experience is not sufficient to call it "legal cocaine". Neither is it sufficient to make generilizations about how medical care of ADHD should be approached.
2. Five minutes of research online shows that my experience is not uncommon. Hell, reading the warning label from the pharmaceutical manufacturer is sufficient to make my point.
3. I am very pro-medication when it comes to treating ADHD, but I also believe many people are not sufficiently educated on the potential consequences of these medications in children.
Part of the process of treating ADHD is finding the right medication, and Ritalin works for most, and if it's working as intended, does not produce the "high" feeling that you got. If you're getting high off of it, it's not the drug for you, or you're on the wrong dose.
Doesn't make it okay to call it "legal cocaine".
> Five minutes of research online shows that my experience is not uncommon. Hell, reading the warning label from the pharmaceutical manufacturer is sufficient to make my point.
Obviously it's documented, but it doesn't make your point. As I already said, it's a thing that happens in the process when finding the correct dosage for an individual.
Though for neurotypical people who don't have the disorder, there's no correct dosage and they'll experience what you did.
It's still a very useful therapeutic, and I strongly believe it should not be stigmatized. But parents absolutely do need to be educated about the sort of prescription drug this is.
I liken this somewhat to the use of opioids for pain control after surgery: they are a fantastic tool that I would certainly not want to forego. But I am grateful that we've become more intentional about educating people on some of the specific dangers around their use so that patients can be more aware. I'd like to see the same thing happen around the use of strong stimulants in children.
Extended release is usually preferred by doctors in part because you avoid the highs and lows.
Regardless of what “normal” practice is, if you are getting high from methylphenidate, the dose is wrong, and if you can’t get therapeutic effects at a dose low enough to avoid a “brutal” comedown, you should be looking for alternatives.
Agreed, this is why I no longer use it to treat my condition. The point I am making is that parents need to be aware of these potential side effects, because a child isn't necessarily in a position to articulate the fact that they are experiencing adverse effects like this. The medication is a CNS stimulant first and foremost. These effects aren't exactly rare.
Hello. That's me. I can sleep on that dose. Is that not normal?
In particular because cocaine is addictive whereas methylphenidate is not. Cocaine is euphoric while methylphenidate is much less, cocaine is arrogant while methylphenidate is just in-the-zone, just makes you want to work. Makes drudgery feel like a video game.
There is also such a thing as an affine cocaine user, like Maradona, Iceberg Slim, and Sherlock Holmes (whose cocaine use was based on a real guy--a fucking freakish detective whose privacy Arthur Conan Doyle protected). These guys actually have an essentially healthy relationship with the drug, and yeah it's rare but it exists and they should be allowed to have it. Or narcoleptics, they're not going to get heart problems, let them.
Or what? If Sherlock Holmes was on your child's abduction case, would you tell him no cocaine injections for the deduction trances? Nah man, you'd tell him go for it. That's legal cocaine. And the best detective of all time! In that case, would you still argue legal cocaine is bad for your child?
Honestly I'm like, methylphenidate can be taken like in high school, for athletic competitions, tests, and writing essays...that's when I would have taken that or similar. Later on parties, that's medically acceptable, and is a medically-accepted partly-recreational use for a part of the supply, which is mostly intended for work.
So one thing, daily methylphenidate reduces adult height about as much as artistic gymnastics, like two inches. Apart from that, like something milder is better...like coffee with whey protein, that's worth 5 milligrams of methylphenidate. There's vyvanse, that's a good one for kids. There's adderall, too strong I'd say, but typically there's adderall deficits and ritalin deficits, never heard of someone being helped by both.
I would say I would have wanted the choice for myself as a kid.
"Warnings Ritalin may be habit-forming. Tell your doctor if you have a history of drug or alcohol addiction. Keep the medication where others cannot get to it.
Misuse of Ritalin can cause addiction, overdose, or death. Tell your doctor if you have had problems with drug or alcohol abuse."
https://www.drugs.com/ritalin.html
It used to say roughly: don't crush it and snort it or you will surely get addicted.
Meaning, sticking to the doctor's instructions would be fine.
That warning is recent.
A well-trained psychiatrist can diagnose me in <10 minutes and ADHD meds are not that strong. I don't know what "intervention" means, but outgrowing ADHD is a common myth [1]. What you describe is not ADHD. I would try elsewhere. Sorry.
[1] https://chadd.org/about-adhd/myths-and-misunderstandings/
I'm trying, probably somewhat poorly, to make the point that there are a lot of potentially useful things to try in terms of managing ADHD beyond Ritalin (though that can be a very useful tool for some).
I didn’t take ADHD meds as a kid, so I can’t speak to their effect on me. But when diagnosed as an adult, I had suffered nearly my whole life with chronic depression and anxiety.
Both reached a crisis level a few years back, which was a major factor in seeking diagnosis. This diagnosis, and treatment, saved my life. I won’t share my medical charts or anything, but I will say that since my meds and dosage have been consistent, depression is still there but barely noticeable. Anxiety much more manageable.
These meds helped me put my life back together. I’m not dismissing the study, or that other people have different experiences. But I share my perspective when things like this come up, in case it benefits others who might have similar struggles and wonder if ADHD might be a factor.
I don’t think that’s true, I thought it was a correlation, not causation.
All of these problems then feed into depression and anxiety. Is that so hard to believe? Less friends, less success, more abuse of substances, it's a potentially rough life.
If so, look at these articles, which review the hard evidence and find there's very strong links between ADHD and depression, and anxiety: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990565/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6493806/
- ('if You Have ADHD, You Are Likely To Be depressed'): https://www.youtube.com/watch?v=xkXpcs_an80
- ('why does your adhd make things so hard'): https://www.youtube.com/watch?v=svD71EJWOBU
I'm a "closet'ed" adhd person and these books have helped:
- Anxiety and Panic: How to Reshape Your Anxious Mind and Brain by Harry Barry
- ADHD 2.0 by Edward M. Hallowell M.D. & John J. Ratey M.D.
In the case of ADHD, amphetamine helps the dopamine dysfunction which in turns alleviates the depressive symptoms.
With adderall and Dexedrine, there is high likelihood of habit forming psychological addiction if not physical addiction. There’s the ever increasing tolerance, etc.
But sometimes dopamine and norepinephrine levels are so low you need a firehouse.
I got diagnosed with ADHD 5 months ago, started medication 2 months ago, and last week I told my therapist I'm pretty sure my life-long depression is in remission. There's a definite feeling that my life is now in a slight upwards trajectory, even on the worst of days.
Life tends to become pretty sad when you have no control over your executive function and action.
> Well, a dose doesn’t last forever. It wouldn’t be surprising if it was a net negative.
My near-sightedness returns as soon as I put down my prescription glasses. I've had to wear them every single day to be able to function decently. Imagine that.
Your doctors are probably doing more harm than good by not treating an underlying metabolic disorder. It’s quite possible you have an underlying B6 deficiency.
Why don’t you go get your B6 levels tested and ping me when you get them back OK?
https://pubmed.ncbi.nlm.nih.gov/16846100/
Most psychiatric problems are not due to a nutritional deficiency. My B6 levels aren’t causing my adhd.
Is that why I’ve been able to get off all of my medications? Because I’m a kook and I don’t know anything about neurobiology? Or anything about immunology? Or genetics?
You say your B6 levels are not causing your ADHD, but have you ever had them tested?
Yeah it’s so "kooky" that they keep finding B6 defieicny over and over in children with ADHD.
https://hrcak.srce.hr/file/303406
And heck, you might try to take it with your meds, it might help: http://sjh.umsha.ac.ir/download.php?mod=a_atch&atch_id=253&a...
And I suppose it is nothing that polymorphisms in a gene that makes dopamine (DDC) is implicated in ADHD and also needs B6 as a cofactor.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4946061/
But I am the kook I guess. No, it’s not crazy at all to take an amphetamine. It’s not crazy to never wonder why they don’t try to find out why you’re not producing enough amphetamines on your own. It's not crazy we give these drugs endlessly yet ADHD keeps rising.
My Schizoaffective Bipolar Disorder is caused by nutrition. Ask me how!
> My Schizoaffective Bipolar Disorder is caused by nutrition.
I suppose anything is possible, but from what I know -- I'm not a psychiatric professional but I've lived with one for 20 years -- it sounds unlikely to be true for most people with similar diagnoses. Believe me, psychiatric hospitals would love to make more beds available by "curing" mental illness with diet.
I'm not saying you shouldn't be on drugs or that you'll find the drugs stop working. I'm just saying the effects on the brain are pretty complex and shouldn't be compared to wearing glasses.
I also started having very annoying anxiety in the morning after taking meds. And all that with a reduced effectiveness of the drug - clear slowdown in the afternoon after lunch which I didn't have in the beginning of treatment (the dosage was more or less constant from the start after initial titration).
Ritalin clearly affects my sleep patterns. On it I never feel rested and wake up with a feeling I haven't slept at all. There was no change, the effect was present from the start. It takes at least three days without meds for it to be gone.
Finally, Ritalin is definitely bad for my creativity. For instance, I have a habit to play piano or guitar as a way to relax since I was a kid. Composing or improvising at least 50% of the time. This invariably stops when I am on meds - it feels like the activity becomes dull and stops being pleasurable.
All in all, I think it is great that the meds exist and work for a large number of people. That being said I can't stand when someone praises stimulants alluding the consequences of taking them are invariably positive and the side-effects are trivial (if they are acknowledged).
Sadly, most internet discussions on ADHD meds (among people who don't deny it) are infected with overly simplistic toxic positivity: "get diagnosed and treated and your life will be fixed while you'll be happy". The first part I agree with but there is no need to trivialize - the life is more nuanced than that.
I'm not sure how many people with addictions are regularly forgetting to take their drugs without a phone reminder.
The point of the delay release is that you don't have the same kind of ramp up to extreme effects and then come-down. Instead the goal is to get a (roughly) consistent dose that helps with executive dysfunction, and doesn't do much else. As always, that's something you work out with the help of a psychiatrist, not everyone reacts to methylphenidate the same way.
My point is, of course AMPH helps depression from ADHD, because ADHD is a debilitating disorder. But AMPH probably doesn't help in other types of depression not caused by executive function disorders.
Somewhat before that – US context late 1970s – there was political pushback against the largely unrestrained (but legal) amphetamine production by the pharma industry, which supplied more than enough to saturate all the recreational and abuse cases.
DEA brought amphetamines into the Scheduled drugs, manufacturing became quota limited. Incidently, the medical community found that psychostimulants does not have any medical value in treating depression.
Some studies have found them beneficial, some not. The pharma industry has since transitioned into opioids but stimulants have been making a comeback for 20 years with record numbers in ADHD,ADD diagnoses.
Apologies for the late reply, HN doesn't really notify me
Apologies for the late reply, HN doesn't really notify me
Methylphenidate affects me in fairly subtle ways and I'm constantly wondering whether it's actually working or if it's a placebo effect. However, my general experience when I look at the tracking data I collect in my own life mirrors this sentiment.
Methylphenidate doesn't get rid of my distractability or make it easy for me to focus whenever I want, but it does help with my executive dysfunction just enough that I can now set timers more reliably, I can now use calendars more effectively. It's not that the medication made the problem go away, but it seems to have helped enough that it "unlocked" a bunch of additional coping strategies that I had never been able to access in the past no matter how much I tried.
Definitely not for everyone, but also that's what a psychiatrist is for -- to help you experiment with different medications to see if there is one that will help, and to monitor you to see what the side effects are and what the long-term effects are, and to figure out and advise you on what your risk factors are. For some people it can be life-changing.
I think a lot of people see this as a question of medication vs therapy, but for a lot of people with ADHD the two parts work together -- the medication makes the therapy more effective and more productive.
I actually tried TWICE to drop my meds. Each time my life fell apart, as you described.
The second time, however, I did not interpret my life falling apart the way you did: instead of interpreting it as validation of the medication's effectiveness, I interpreted it as a withdrawal period. So the second time I quit, I expected going into it that the process of adapting to life without medication would probably last at least 2-3 years.
I can't say what would've happened had I taken your path and not mine. But fifteen years in, I have no regrets. I still don't do what I'm told, but I'm productive and happy and useful. I've found my own way, and it's been a good way.
I have been diagnosed in my 30s and when I stop medication, my life returns to the same exact shit it's been for 30 years. It feels like falling apart, because that's how it was for three decades for me.
That said, I'm happy you found a path without needing the medication. One of the positive aspects of ADHD medication is that you actually learn to function without them, because it gives you the mental energy and fortitude to build healthy habits that can help keeping you ticking along even without the boost of increased dopamine.
ADHD is defined as a disorder of executive function: that is, an individual with ADHD is unable to do what they wish to do. This was an accurate description of me; to this day, finding and working toward my goals is something I'm constantly working on.
But if I look back on my childhood, I see that there was never a time when I had space to figure out how to understand and execute my own wishes in the world. Indeed, within my own family it was not recognized that I had a will of my own at all.
Medication helped cope with this state of affairs, but it never helped repair it. So e.g. if I found I didn’t much like being a student, I could take a stimulant and improve my ability to perform as a student. But taking that medication did nothing to help me solve that key equation: to do something I want to do, that other people also want me to do for them.
So my answer to the problem posed by an ADHD diagnosis is growth: I had to start as an autodidact, but as I’ve grown into my adulthood I’ve found friends, mentors, and peers along the way who help me find my way. The world is making it harder and harder to get, but it’s out there.
It probably started with reading _Delivered From Distraction_ years ago. I tried a bunch of stuff in that book. Nothing was a silver bullet (because there is no silver bullet), but I have to give credit to that book for inspiring me.
Nowadays if I'm writing, journalling, praying, and getting honest feedback from friends regularly I'm probably on the straight and narrow. But I try not to be too hard on myself: life isn't a contest, after all.
Cheers and kudos!
I’ve only just finally started actually fulfilling my potential and reading your comment fills me with the regret that things were not different for me…
Epigenetic mechanisms are what turn pigs into boars when released into the wild. In humans, if someone undergoes drastic starvation in their childhood, their children will often be fat. Their bodies hold onto fat more readily because it essentially expects to undergo a similar level of starvation. Evolutionarily, people who's epigenetics could benefit their children in this way were selected for via easier survival.
There are no studies, due to a lack of understanding in the past, of the effects of lifetime use on future generations. It could, potentially, be a positive effect - or none at all.
But that's optimistic for biological mechanisms imo, I'm remaining a pessimist and preferring the route of non-lifetime medication. If someone else wants to test this on their life and family, I would be happy to read about it.
Now, for the last 8 years I am med free and showing signs of recovery.
You do not need meds. You need to find out why you need them biologically. We know that ADHD is primarily caused by low dopamine. So why are you not making enough dopamine?
I also feel like:
> We know that ADHD is primarily caused by low dopamine
is a bit of an oversimplification. ADHD is not always caused by low dopamine/norepinephrine/etc production, it's often in part caused by faster than normal reuptake of those chemicals. But when arguing that ADHD is entirely caused by environmental deficiencies, "you're not producing enough dopamine" sounds better than "your brain is absorbing dopamine too quickly so it's not signaling as effectively as it should even when it's released in the same amounts as other people."
And again, this is complicated and different people's brains work differently, medication isn't right for everyone. That's why doctors should be involved. But what's going on is a lot more complicated than "something in the environment is making you depressed so you don't release dopamine" or "you don't have enough of X vitamin so your body can't produce the chemicals it needs"; it's more accurate to say that ADHD is often caused by differences in how actual neurons and synapses interact.
If reabsorption is happening prematurely, it's not necessarily that less dopamine/norepinephrine is being produced, it's that the chemicals being produced aren't as able to be used to do the things they're supposed to do.
And that more complicated explanation ends up being a lot more useful to describe some of the less well-known symptoms of ADHD that sometimes pop up for some people; symptoms like hyperfocusing, poor interoception. It paints a more complicated, multi-faceted picture of how the body can find itself unable to stop focusing on things when neurotransmitters do manage to finally bond, or why certain bodily signals just don't seem to reach the brain reliably. I am not a doctor, but I think it's a lot easier to understand what ADHD does when you look at through the lens of a physical difference in the brain that has knock-on effects on how the brain continues to develop as it learns to rely on other signals and coping mechanisms and strengthen those pathways.
TLDR I kind of disagree with the explanation of people with ADHD as if they're dopamine-deficient, I think where modern research is leaning is that they (often, everyone is unique) have brains that aren't able to make use of the dopamine (and other chemicals, not everything in the world is dopamine) that is produced.
It's clear you're an evangelist for this approach, but your complete dismissal of people who have issues with drugging children doesn't add anything to the discussion.
I don't think it's reasonable for OP to advocate for policy that would materially make their life worse. I'm not sure what you expect their response to be, but it's not going to be, "medication doesn't work for everyone? Great, I'll just go back to being miserable then so no one accidentally takes it unnecessarily."
Prescription medication is something you should work out with a doctor/psychiatrist who monitors your behavior and figures out whether the approach is right for you. But even if methylphenidate only worked for even just 10% of the people who have ADHD -- those people should have access to it. And the rest of the people don't need to take it, that's something their psychiatrist/doctor can work out with them.
> complete dismissal of people who have issues with drugging children
It bothers me that people read "hey, medication worked for me and didn't give me depression" as "literally everybody and their dog should be on this." I don't think that OP is the person here who's dismissing or generalizing.
My nephew was diagnosed with ADHD and was given Ritalin. He hung himself a week later.
> After MPH treatment discontinuation... returned to baseline levels by 31 to 60 days
A friend on ADHD meds told me that it feels like trading unbridled creativity for stability. He found it to be an essential drug for functioning, but I got a sense that it involved losing something really central to your sense of self. Almost like being made sedated/compliant by force.
I have long dealt with the double edged sword of ADHD (diagnosed at 27, obvious symptoms since early age). I have had my best ideas / 1st author papers during moments of hyperfocus. At the same time, I struggle to do mundane busy-work with any level of reliability and have had bouts of depression tied to ADHD derived perfectionism/procrastination (if you know, you know).
I have yet to make the leap to medication as I have managed to 'hang on' through the different things I have tried in life. I often joke that I will start medication if I get fired. I am grappling with the decision of making the leap over to medication, and if the cons are worth it in any situation that isn't incredibly desperate.
Some perspective here would really help.
edit: Thanks a lot for sharing your personal experiences. It really helps in at least convincing me to give meds a try. I'll set up an appointment .... tomorrow, soon, surely
However, I felt I lost a subtle intuition edge.
When I stopped I was a mess, until I found Chen Style Tai Chi, which somehow mitigated my worst symptoms without any (negative) side effects.
From there, I’ve been able through (simply aging) and deliberate practice of various techniques to make it so ADD is rarely an issue for me anymore.
Currently I take L Tyrosine, CDP Choline, coffee, lionsmane and kava. My focus and ease of attention are amazing, and I've been very productive.
Even if I get diagnosed and get a prescription, I would still take these supplements as they support the core problem: low dopamine, low acetylcholine. Eat well, exercise too.
I had the same concerns, but I found them to be unwarranted; there was no 'trade'. For me, it's more like being given access to a dial to control the speed of all the scattered thoughts flying around in my head. I can space out and get distracted just as effectively as I do without meds, but when I need to focus, I can nudge that dial. Focus is an active process, and it's one that I maintain control over.
I was only given 1/3 the recommended starting dose though, so it'll likely get increased when I see my doctor again.
Side effects are light to moderately sever headache if I don’t drink enough water, IBM, high blood pressure and a pinch of insomnia.
It’s all worth it.
This is a good way to put it. Prior to starting medication (vyvanse specifically, although I tried concerta) initiating a task or trying to learn something was, most of the time, "too hard" so I spun my wheels doing random stuff and occasionally doing just enough work to keep myself employed. Now, nothing is "too hard" because it's possible for me to get over the activation barrier and start doing the thing.
As someone who has been diagnosed as an adult and been on meds for a few years I could not agree more.
I recommend trying treatment though, I can't see any downsides if it is an option for you. Highly likely there will be clear physiological side effects, but nothing to be scared about.
Until earlier this year, when a variety of factors pushed me to finally try them.
All of a sudden, I could focus on things without having to have all of the stars aligned. I never realized the extent and complication of my self-medication until I tried meds. I don't think I've lost my "sparkle." Instead meds help it come out because my follow-through is so much better.
It took me a few months to find the right med - finally on the right one + dose now, but it took some time, so be prepared to experiment with your doc if you choose to try meds.
It's not the right choice for everyone, but it's definitely been the right choice for me, and it's one I wish I had made a lot sooner.
A few times I was able to get my hands on really pure dextroamphetamine (>90% validated by a lab test), and even with a tolerance, there is no way you're consuming more than 100mg over the course of a day. 10-15mg was my sweetspot to get enough focus without getting locked into tasks and feeling wired. Although speed like that is pretty hard to find and quite pricey (~60-70€/g).
I've also realized that most of the unpleasant physical side effects of speed (palpitations, jittering, elevated cardiac rythm, anxiety, etc) are actually due to the massive amount of caffeine in it and not the amphetamine themselves (tho I'm sure there is a synergy between them). Even while feeling pretty high on pure amphetamine, my bpm only rose by about 4-5 bpms (compared to 15+ on street speed). For anyone in the same case, L-theanine works wonders to calm down the caffeine side effects, highly recommend you keep some around just in case.
On the comedown of a multi-day binge, I don't feel depressed per se. I'm constantly tired while awake, which I can only keep at bay if I'm physically active. Also, my ability to focus and get motivated dips below baseline, inversely proportional to how high over baseline I was. (And I would speculate that it is mostly due to a depletion of dopamine & its precursors rather than a withdrawl, as it can be alleviated through a decent diet).
From what I've read as well, most of the long term side effects of amphetamine abuse stem from chronic lack of sleep, food & water rather than damage from the molecule itself. Although repeated overstimulation of your reward/dopaminergic system definitely can't be good for you, be it through adaptation or damage of the dopaminergic neurons (I remember reading somewhere that long term meth users are more prone to Parkinson's).
Unfortunately, In Sweden, an official diagnosis means higher insurance (fine), higher mortgages (not fine) and the inability to hold certain licenses.
Of course those markers of ADHD are pretty severely affecting my life, which is why I was seeing the Psychologist in the first place...
Would anyone recommend seeking a diagnosis in those conditions? Has anyone done this in Sweden and then gotten a mortgage? Is there anything else I can do?
I live on the border with Denmark, I’m not sure if it’s ok for me to access healthcare in Denmark without a “CPR Number” https://international.kk.dk/cpr-number
The idea that ADHD affects mortgage rates! How terribly absurd. I'm sorry to hear that.
Salary data is also publicly available, but as a nominal fee and you buy a “book” which is an area of the country.
When it comes to mortgages, banks ask for extended rights to look into your data on your behalf, you have to sign this with your digital ID (BankID).
This information is centralised and you give permission because they are ostensibly looking for outstanding debts and bankruptcies.
Unfortunately I only learned about the health discrimination when I was applying for an official diagnosis, I received a letter from a company “Modigo” warning me against getting a diagnosis because it can negatively impact my life in this way.
I heeded the warning of course.
I elaborated more about it but I got downvotes after that, so…
Look, my mother has ADHD (or something like it), and she had no problem teaching the (mostly boys) in her class with ADHD. A few even went off their meds in her class. Unfortunately, the next year, they were put right back on with a new teacher.
Happy for the kids, but when they're adults, they'll find out that they have many other executive functions impaired, not just attention management, and the cool teacher won't fix these.