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Why so many children in America have ADHD
- j15e 2y agoCan’t read the article even with archive.org. Can someone share it somewhere?
- celsoazevedo 2y agohttps://archive.is/uCdV7 https://archive.is/uCdV7
- j15e 2y agoThanks, I was trying to use the Wayback machine but I couldn’t see the article.
- celsoazevedo 2y agoThe Wayback Machine seems to save the page as it sees it while Archive.Today seems to use some extensions to bypass paywalls and things like that.
- celsoazevedo 2y agohttps://archive.is/uCdV7 https://archive.is/uCdV7
- andoando 2y agoI question even calling it an "over" diagnosis, when its not even clear that the diagnosis has any non-socially constructed objective metrics by which we can call that diagnosis accurate.
- eutropia 2y agoAre you suggesting the condition isn't real? Or that the diagnostic criteria are entirely subjective?
- andoando 2y agoThe diagnostic criteria is entirely subjective. "Often loses thigns", "Often doesn't pay attention" isn't exactly objective. How do we even know what "often" is? But more than that what is the condition, if the only means we have of defining it is a subjective biased interpretation by an individual? I am sure there are differences in brain chemistry that make one more stimulated, more long term goal oriented, and etc, but given the complexity of the human brain, and our lack of understanding/tools to measure, its not clear to me we should be so sure given any patients failure can be directly attributed to a singular condition.
- cmorgan31 2y agoThey used the TOVA test to diagnose mine. It measures what part of the attention paradigm may be deficient or overactive. AFAIK that test isn’t purely subjective.
- andoando 2y agoI heard of this. My immediate criticism, is that even those with diagnosed ADHD aren't just deficient in focus/attention and impulsive in all aspects of their lives. They can drive a car, play video games, read subjects they are interested in, have long conversations, etc. That is to say, focus/attention/arousal are rather complex phenomenons that vary greatly based on circumstances, and aren't simple numbers we can say one is deficient in. Testing someone in a completely artificial environment (sitting in an office during a diagnosis playing some tasks clicking on a computer screen) is hard for me to believe is exactly an accurate metric for revealing any of these things. Most especially, when a lot of people are actively seeking this diagnosis, and are motivated to alter their behavior to get the result they are looking for. Im really curious how this company decided these tests are accurate at all. I assume they did some studies to find some variability in the test results and those who were already diagnosed and then determined those variability were indicative of ADHD. So what test is really doing IMO is just reinforcing the standard diagnostic criteria.
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- KerrAvon 2y ago[flagged]
- jader201 2y ago> The actual reason why America is an outlier is widespread over-diagnosis. > A typical ADHD diagnosis in America is done by a paediatrician or a family doctor in an office visit as brief as 15 minutes. The norm in Europe is an hours-long assessment by a psychiatrist. Anecdotal evidence, but our experience is — and most people/teachers/doctors we talk to say — that most diagnosis are done via similar long tests. I’ve not heard of doctors/teachers trying to address ADHD without a formal test being done. Are others able to confirm that they know of diagnosis from a “15 minute doctor visit”? EDIT: In fact, our insurance won’t even cover medication for our son without a formal checkup — every 3 months. Sure, some may “unofficially” think or claim to have ADHD from talking to their doctor that may say something like “it’s possible you/your child has ADHD”, but I find it hard to believe that actual treatment/IEP (individual education plan) happens without a formal diagnosis.
- andoando 2y ago>Are others able to confirm that they know of diagnosis from a “15 minute doctor visit”? Yes, I got mine this way. Telehealth during Covid was notorious for this, but lot of NP/PA offices now do the same thing, just with a single in person visit.
- jader201 2y agoBut did the diagnosis result in any sort of ongoing treatment (e.g. medication, formal school/work adjustments, etc.)? It may be personal, and you don’t have to answer, but this is the general question I have to these 15-minute diagnosis.
- bongodongobob 2y agoNot parent, but yes I got medication. The work adjustments were me meeting deadlines, not procrastinating, being able to focus on one task at a time, etc. Absolute game changer. For some of us, it's completely obvious. Some, less so.
- andoando 2y agoYeah I got a prescription. IMO, these are pill farms. Everyone talks about how the medical industry is so driven by money, but somehow when it comes to mental health, people seem to shrug off the fact that everyone from the pharma companies down to the doctors office stands to make money by diagnosing and prescribing.
- Julesman 2y ago[flagged]
- dang 2y agoOk, but can you please not fulminate on Hacker News? This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html.
- lanfeust6 2y agoIt's hard to tell what your diatribe is actually in support of. Is it overprescription that is predatory capitalist BS, or somehow skepticism of this entire process?
- vjk800 2y agoScott Alexander's views on Adderall prescriptions (for ADHD) is a good read: https://slatestarcodex.com/2017/12/28/adderall-risks-much-more-than-you-wanted-to-know/ https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...
- cyberax 2y agoThis blog post was what convinced me to actually get on the ADHD meds. And yep, getting the prescription was ridiculously easy. The downsides are just not very downsidey, but the upsides are quite real for many people.
- pcthrowaway 2y agoCurious if you believe you have ADHD (obviously you're prescribed so you "have" it per someone's assessment) If you don't believe you have it, was this why you didn't previously consider taking performance-enhancing drugs?
- cyberax 2y agoI have always had ADHD, but I had zero access to mental health care when growing up. I was lucky because I'm really good at math (including competition-style math) and computer science, so it did not cause a _lot_ of issues at that time. Over time, I adapted on my own. E.g. by buying several sets of things like scissors and screwdrivers so that I don't end up misplacing _all_ of them. Or by structuring the work so that I can switch attention between high-priority tasks. > If you don't believe you have it, was this why you didn't previously consider taking performance-enhancing drugs? I was really apprehensive about using mind-altering drugs, and amphetamines always sounded pretty scary. On a more philosophical basis, should performance-enhancing drugs be available more widely anyway, with appropriate safeguards against abuse?
- dns_snek 2y ago> On a more philosophical basis, should performance-enhancing drugs be available more widely anyway, with appropriate safeguards against abuse? I recently came across this article discussing a study which found that stimulants lower productivity in people without ADHD. > “Our results suggest that these drugs don’t actually make you ‘smarter’,” said Bossaerts. “Because of the dopamine the drugs induce, we expected to see increased motivation, and they do motivate one to try harder. However, we discovered that this exertion caused more erratic thinking — in ways that we could make precise because the knapsack task had been widely studied in computer science. > “Our research shows drugs that are expected to improve cognitive performance in patients may actually be leading to healthy users working harder while producing a lower quality of work in a longer amount of time,” said Bowman. https://www.cam.ac.uk/research/news/smart-drugs-can-decrease-productivity-in-people-who-dont-have-adhd-study-finds https://www.cam.ac.uk/research/news/smart-drugs-can-decrease...
- irrational 2y agoBack in the 1970s I had a bed wetting problem. They tried a medication called Ritalin to address this problem. This medication had an interesting side effect of making me pleasant to be around for the first time in my life. Both my parents and all of my teachers remarked on how much better I was able to pay attention and be kind to other people. Then they took me off the medication and I reverted to my wild ways. I don't think many or any people had heard of ADHD back then, so it didn't occur to anyone to try to medicate me for what I clearly had. Over the decades I've learned to cope with ADHD without medication, but I can't help but wonder how much better my life would have been if I had been able to concentrate and not been so hyperactive. Maybe I would have done better in school and had friends. Even today, I wonder if I should go through the trouble of being diagnosed and getting on medication. The last three days I wasted my time instead of doing the work my company pays me to do and got exactly nothing done. The entire time I kept thinking, "I really should do that work so I can keep my job and provide for me family" but I couldn't concentrate and procrastinated day after day. Most of my children have ADHD. Before they could be diagnosed, they did have to go through extensive testing by a psychiatrist and there were interviews conducted with us as their parents and with their teachers. The 15 minute diagnosis mentioned in the article has not been my experience. We have regular meetings (every 6-8 weeks) with the psychiatrist to evaluate their dosage and how things are going.
- HocusLocus 2y agoI had a bedwetting problem too. It was awful and tormenting, when visiting friends I had to bring clothes and sleep on the floor. Male puberty solved it almost to the day. All of a sudden it was gone and what a relief that was. I think it was just training the lizard brain to hold things a little tighter during sleep, or until then the nerve pathways were not supple enough.
- M4v3R 2y ago> but I couldn't concentrate and procrastinated day after day Please make sure to take care of yourself and try going through with the diagnosis. What you described is very similar to what I was going through - severe procrastination which resulted in worse and worse performance at work, eventually I had to quit my job because of it. Later I’ve learned procrastination of this magnitude is basically your subconscious screaming at you that something is not right and you should be taking care of yourself instead of forcing yourself to work. On a side note - ADHD is hereditary so if your children have it there’s a good chance you and/or your SO have it too.
- ty6853 2y agoThe moral hazard is pretty clear. Testing is profitable and so are the drugs. If they are wrong, there is no penalty. For the same reason an optometrist lied about my perfect vision as a child and conned my parents into glasses I never used paid for by insurance. Remember doctors are there to advise not to command, know the hazards and be willing to say no or consider the data from your own perspective.
- cyberax 2y ago> Testing is profitable and so are the drugs. Amphetamine salts (generic for Adderall) cost less than $20 a month. Generic atomoxetine is $15. The medication for ADHD is _cheap_. A pharmacy will likely get more profit from a bottle of ibuprofen.
- ty6853 2y agoMaybe this varies but people I know with adhd had to see or beg a doc every 6 months to renew a script, which is a money generator for the doctor. The gross margin on amphetamine salts even at $20 must be insanely high. We're talking about what, a couple grams of active amphetamines in a month?
- cyberax 2y agoDoctors in the US do not suffer for the lack of patients. In most cases, psychiatrists are booked for months in advance. A lot of ADHD med prescription renewals are now handled by nurse practitioners as a result. It's literally a 5-minute call: "Do you have any unusual side effects? How would you rate your depression/anxiety? OK, the prescription was sent to your pharmacy". > The gross margin on amphetamine salts even at $20 must be insanely high. We're talking about what, a couple grams of active amphetamines in a month? This is about as low as drug prices go in the US. And for amphetamines there's an additional overhead of having a pharmacist checking your ID, storing the drug in a safe overnight, filling out the DEA forms (for every link in the supply chain), etc. Good Rx shows the price for amphetamine salts at $15 now (in Walgreens in my area). I can definitely tell that the profit basis for ADHD diagnoses is just not there. There isn't much money in it for doctors or pharmacies.
- wkat4242 2y agoIt's weird, I'm sure I have ADHD but it's very hard to get a diagnosis. Several of my friends have it and I'm exactly the same as them. I'm not in America though (very thankful for that considering what's happening there now)
- HocusLocus 2y agoBecause what used to be a generic indicator of distracted early childhoods (whether by nutrition, environment, weird parenting) got a new name. And it is no coincidence or surprise that brain stimulants like amphetamines dominated the first wave of treatment. People 'perform' better on amphetamines, always have. They work so long as you concentrate on the short term and ignore long term issues like increasing tolerance, increasing demand and ultimately schizophrenia from chronic deep sleep deprivation.
- kdmtctl 2y agoIs it possible to develop schizophrenia from sleep deprivation? I always thought it would be acute psychosis.
- globnomulous 2y agoI can't read the article, but I can say (a) that Americans are generally much less opposed than Europeans to treating mental disorders through medication, and (b) the best available information tells us that ADHD is underdiagnosed, not overdiagnosed, even in America.
- vector_spaces 2y ago> A typical ADHD diagnosis in America is done by a paediatrician or a family doctor in an office visit as brief as 15 minutes. I'm in my 30s, and in the process of receiving a diagnosis after it had been suggested to me my entire life by teachers, colleagues, and friends. I avoided diagnosis and medication mainly because I was skeptical of the safety record of medications -- probably because that's why my parents never sought a diagnosis for me when I was younger. After doing more research the past few years, I learned that ADHD medications are the success story of medical management of psychiatric illness, and they have a strong safety record In any case, for me so far it has involved four (4) 2-hour appointments with a clinician, having trusted colleagues and close friends fill out detailed "external rater" forms in which they rated my executive dysfunction, and (yesterday) a marathon 4-hour long testing session in which I took a sequence of standardized tests under the supervision of a clinician. I know that diagnosis of ADHD in children is a different animal, and even for adults there are clinics that provide a diagnosis and prescription in a half hour or so -- but not everyone with ADHD is diagnosed after a single 30 minute session with a provider. And contrary to another sibling comment, there are fairly robust objective metrics for identifying the hallmark features of ADHD and executive dysfunction.
- slothtrop 2y ago> there are fairly robust objective metrics for identifying the hallmark features of ADHD and executive dysfunction What are they?
- vector_spaces 2y agoIf you are truly interested, these can be found with a quick search query -- I won't do that here for you. But you will find that ADHD is one of the most widely studied psychiatric illnesses with strong neurobiological basis and well known measurable correlates, and as I mentioned, has the highest response rates to medication for a psychiatric condition. So you should have no trouble finding out more!
- slothtrop 2y ago
- slothtrop 2y agoI myself was diagnosed twice. I don't have it, at all. Notwithstanding any perverse incentive to diagnose, the process itself is not stringent and borders on pseudo-scientific. It's not to say ADHD doesn't exist, but that they (psychiatrists) egregiously cast too wide a net. You might ask how I know I don't have it. No one really cared about other symptoms I exhibited: chronic insomnia foremost, and some anxiety. Once I got a handle on that with non-pharmaceutical interventions, my focus was fine. And to the extent that insomnia was given any credence, it's to push pills. Generously you could say practitioners default to that because it's so often demanded by clientele, they want to just press a button to make problems go away. But they just don't bother giving you an alternative. edit: would also mention, the first time I was diagnosed as a young child was because I was a bored daydreamer who didn't always pay attention to the teacher. This is what we're treating as a weakness to be rooted out.
- blindriver 2y ago[flagged]
- slothtrop 2y agoWould like if there were an actual history book to verify this.
- qwery 2y agoRegardless of the history of the condition or how the original diagnostic criteria were developed it's widely accepted that ADHD is a neurological (neurodevelopmental) disorder -- i.e. not a psychological one. For the record, to fill in the gaps, ADD and ADHD were treated as separate but related conditions for some time, but eventually were merged under ADHD (in DSM IV?) a bit like that other spectrum disorder. > This is the reason why ADHD isn't the same as other mental health issues, because it was empirically determined instead of finding an actual issue No, it's not. ADHD isn't the same as other "mental health issues" because it's a different one to the other ones. > none of them were told by the doctors what the plan was to remove them off of it. None. Without any guidance on how my child gets off ADHD medication or a reevaluation whether they need it, how can I trust the initial diagnosis? I don't see the logic here. Trust in the diagnosis stems from trust in the diagnostician. You try it and see if it helps (if you think it could)? If it helps keep using it. If it doesn't work, try something else (medication or not). If there are unwanted side effects, balance the pros and cons. Stimulants for ADHD aren't like 80s cartoon drug pusher pills. They also aren't like SSRIs et al. or lithium or anti-psychotics or something where there is pressure from the medical people to stay on it (or get put away).
- blindriver 2y agoThe biggest problem with ADHD is that many kids who are diagnosed with ADHD eventually grow out of it. Your method is to keep medicating them permanently, with no thought or strategy as to how to evaluate whether or not they still need it. And yes, all of the stimulants taken during their formative years has a tremendous effect on them as they get older. It changes their brain. This isn't sugar tablets they're taking.
- outlace 2y ago“America’s ethos of “school achievement above all else” is part of the problem, says Stephen Hinshaw of the University of California at Berkeley” This may be the ethos in elite circles but I don’t think it’s the case in general.
- slothtrop 2y agoIf anything the arms-race of competitive rec sports seems to be given a higher priority.
- qwery 2y ago> Few things agitate Robert F. Kennedy junior, America’s new health secretary, more than the rate of attention-deficit hyperactivity disorder (ADHD) among American children. And for good reason I'm sorry, let me stop you there. What in the world are you talking about? The government's main guy looking after America's health is obsessed with ADHD diagnosis rates -- for good reason? That is absolute madness. Got nothing better to do, I guess. No infinitely long tail of the global pandemic that was ravaging the population a couple of years ago? The threat of bird flu? Dare I mention health insurance?
- tiahura 2y agoHave you seen their parents?
- throwaway12444 2y ago[flagged]
- throwaway12444 2y ago[flagged]
- _zagj 2y agoThere are newer, non-amphetamine drugs for treating ADHD like Strattera, an SNRI (Selective Norepinephrine Re-uptake Inhibitor). It will be interesting to see what happens if and when these drugs displace the amphetamines (the current front-line treatment for ADHD) to the point that getting a prescription for Adderall or Vyvanse or some other form of medicinal speed because you have (or think you have) ADHD becomes difficult or impossible.
- dns_snek 2y agoWhy would that be a desirable state of affairs? Drugs have varying effects on people, including side effects. Making it difficult to get prescription for stimulants guarantees that a lot of people with ADHD (it seems like 50% don't respond to Strattera) won't have access to medication that would help them.
- _zagj 2y ago> Why would that be a desirable state of affairs? You can't see why an ADHD diagnosis (which isn't hard to get) no longer being a quick ticket to getting amphetamines--one of the most commonly sought-after and regularly abused class drugs since the 1930s--would be a desirable state of affairs? Are you not aware of the adverse health affects they have (cardiovascular, neurological, e.g., Parkinson's, dental, bone density)? > it seems like 50% don't respond to Strattera It's seems more like people take longer to respond to Strattera and either don't want to wait, or just want the amphetamines.
- dns_snek 2y agoI think you'd be throwing people with ADHD under the bus which is infinitely worse than letting some fakers get their hands on stimulants. Improve the diagnostic process if needed, but first you have to prove that it's insufficient. I'm not aware of any studies supporting these claims. > It's seems more like people take longer to respond to Strattera and either don't want to wait, or just want the amphetamines. No. Not all drugs are effective for everyone, this includes different stimulants.
- cantrecallmypwd 2y agoUndiagnosed ADHD-PI/-C ruined my life from childhood, teenage years, and early adulthood. I blame by ignorant, opinionated father for espousing conspiracy theories.