Many studies have been done with regard to treatment and diagnosis, and at this point we are better able to treat ADHD than we are able to treat depression
There might be a bit of an over-treatment culture (I'm not sure, though), but the science is extremely well developed and tested
There are huge regional variations to rates of ADHD diagnosis. For example, it's 3.5x higher in North Carolina vs. Nevada. There doesn't seem to be any reason why this would be given that ADHD is believed to be almost entirely genetic.
It's frustrating to think about the lack of consistency in ADHD diagnosises and treatment. In /r/ADHD (ADHD subreddit), some people get diagnosed after a few minutes of talking with a psych. Others live in countries where ADHD isn't even considered a thing. Many went through the same rounds of tests that I did. Even after diagnosis, I had the same problem as several /r/ADHD members in that the first psychiatrist I went to looked at my psychologist's diagnosis and was like "Meh, you got decent grades in high school anyway. You're just stressed/tired/depressed/etc." Wasted my time with four months on four different depression medications before I got a second opinion.
Overdiagnosis is almost a cliché. This might happen in some places. There are just as many that the diagnosis is painful and thorough.
Also, you're assuming two things: 1) that genes are evenly distributed among the population, which they're not. And, 2) that diagnosis and treatment options are the same everywhere, which they're not.
Obviously, the diagnostic protocol that allows such a situation needs some work.
Medicated treatment for ADHD has hit even higher numbers. Something like 70% of patients respond positively to medication (sometimes takes a while to get the right medication though), and 45% achieve full recovery (that is to say, ADHD stops being an issue for them if they're on their meds).
I mentioned this because conventional wisdom is something like: "Yes, depression as a chemical imbalance is a thing that exists, and you can kind of do something with it through treatment." But a lot of people are also "ADHD might not even be a real thing and is a result of helicopter parenting and lazy kids". But the science is much further ahead on understanding ADHD and treating it on ADHD than depression.
So the logic is:
- evolution is this amazingly powerful process that has resulted in the development of a vast diversity of astonishingly sophisticated and beautiful species of plants and animals, with the most advanced observed to exist in the known universe being the human inhabitants of planet Earth. However...
- a significant portion of this most beautifully evolved and advanced species are unable to function successfully without the use of medication to alter the naturally evolved chemical activity of their brain.
Personally I believe the first statement too much to be able to accept the second.
That is: I believe that conditions like depression and ADHD have evolved for a reason, and to suppress them with chemicals rather than understanding the reasons for their existence and responding to those reasons is to devolve or suspend evolution.
Where the paradox becomes so profound and damaging is that the people who go to serious effort to understand these conditions and to develop and advocate non-pharmaceutical methods of treatment, are often condemned and mocked as un-scientific.
But mercifully the tides are changing, and I can see a time in the future, not all that far off, in which we look back on the practice of dealing with non-compliant kids by feeding them amphetamines as one to be viewed with great shame.
If you're a first world schlub, however, it prevents you from sitting tidily in your little box and people get mad and you get sad, because conformity is identity. Your genes only get passed on to a sports sock. There are no new valleys to discover.
So it works with both ideas - and depression isnt dissimilar - old adaptation for dealing with sickness, injury and winter that just isn't helpful anymore.
Cage a bird and you need to adapt its diet and care. Same with humans.
There are no new valleys to discover.
Except there are.
It just needs the right kind of awareness and encouragement.
Cage a bird and you need to adapt its diet and care. Same with humans.
Indeed. And my hope (and belief) is that we'll soon see much better techniques than amphetamines for providing said care. Opening that metaphorical cage is probably a big part of it.
Evolution doesn't happen for a reason. The whole point of evolution is that our biology and the way our brains work is bafflingly random at times. Depression is a crippling mental illness, it doesn't happen for a reason.
Responding to your points...
Do you also advocate stopping cancer treatments?
No and that's a misrepresentation of what I said.
I didn't say we shouldn't treat mental illness.
I said we can do better than giving amphetamines to children as a way of dealing with aberrant behavior, and that perhaps the key to finding the best treatment is likely to be found by understanding (not denying) its evolutionary origins.
I believe this to be true as I've seen this approach work on myself and others.
Stopping vaccinations, because not getting smallpox is interfering with evolution?
Again, I didn't say we shouldn't treat. And I'm not antivax, no.
When done right, vaccination enhances evolution. (FWIW I'm less convinced about giving flu shots to people with healthy immune systems for the same reason most sensible people are concerned about over-prescription of antibiotics).
In short, I'm fine with any medical intervention that steers the world further down the right path (I.e., enhances evolution).
I'm very confident that the widespread prescription of amphetamines to children will one day be shown not to be good for the world.
Evolution doesn't happen for a reason. The whole point of evolution is that our biology and the way our brains work is bafflingly random at times.
This not a statement of established fact; it is a statement of your understanding of evolution, which may or may not be complete or correct.
But natural selection is not a random process. It is a very deliberate process of adoption and distribution of traits that benefit the species.
So the fact that depressive and ADHD-like behaviours exist in so many people across many different regions and cultures, indicates that they have been positively selected and reinforced over many generations.
Another commenter in this subthread has offered a very plausible explanation as to why this may be.
Depression is a crippling mental illness
Trust me, I know, I've had it for much of my life and have witnessed many other lives be destroyed by it.
it doesn't happen for a reason.
Well for me the key to overcoming depression was discovering that it does have a reason, then addressing that reason at the most fundamental level (genetic expression).
And now I plan to devote as much of the rest of my life and available resources as I can spare, to researching the topic so more people have the chance to be saved from this menace.
Assuming that what you want is a complete end to mental illness - for everybody, regardless of their genetic predisposition - we both want the same thing.
In England the recommended treatment for ADD / ADHD isn't amphetamine as a first response.
Here's what NICE say: http://pathways.nice.org.uk/pathways/attention-deficit-hyper...
http://pathways.nice.org.uk/pathways/attention-deficit-hyper...
> Drug treatment is not indicated as first-line treatment for moderate ADHD.
> Offer parents or carers referral to a group parent-training/education programme on its own or with other group treatment (CBT and/or social skills training) for the child or young person.
> Consider individual psychological interventions (such as CBT or social skills training) for older adolescents.
> Where ADHD is present with a learning disability, offer referral to an individual or group parent training/education programme according to the preference of the child or young person and the parents or carers.
In England children should only be getting medication if they've been through a rigorous assessment and are seen as needing those meds.
Of course I oversimplify; I know not all people/doctors/regions are like that.
And I do see some of that kind of attitude among some in Australia too, but societal attitudes and the government controls on pharmaceuticals that exist here and the U.K. keep things more moderate.
I cannot speak for those with depression, but ADHD has easily tripled the amount of stress I have in my life, if not more. It causes impulsive behaviour that can wreck relationships(both personal and professional), and makes it extremely hard to concentrate on many things that aren't totally gamified from the outset.
There's a trope about how ADHD ends up being a gift because of creative thoughts coming to you, and that the medication will dull your senses... but I don't buy it too much. There have been studies that have measured no noticable difference in "creative capabilities"(hard to measure, granted) when being medicated and non-medicated.
Before being put on medication, I had never finished a single piece of homework in my life. Afterwards I was able to finish the homework assignments before class was even over. I would study autonomously, and was able to reach my full potential because I was able to manage my thoughts for the first time in my life.
There is no moral high-ground to not medicating oneself, just like there is no moral high-ground to using crutches when you have a broken leg. Asking me not to medicate is the same as asking me to go through meaningless suffering in almost every social interaction. Countless studies have shown that medication is much much more effective than any form of behavioural therapy (and that BT has an extremely high failure/"relapse" rate).
I don't think it's right to mock people looking for non-medical treatment, because various reasons mean you cannot have access to alternatives.
But medication has been proven to be very effective, and BT has proven to be a very difficult path... if you are a parent of a child suffering from ADHD it is your duty to at least explore the medication option in my opinion.
There is likely to be no higher reason for ADHD and depression to exist. We have looked at "normal people's" brains, and see that for depression/ADHD some things work differently. And that these people tend to have lower-quality lives because of a lack of something... It's hard to argue that there's a reason for it all except in some religious context. It's not like there's a higher reason for brain tumors either.
As an aside, despite the fact that I currently love where I live (Japan), I always consider moving back to the US if only to get access to medication that is illegal here. My life is a lot shittier (still great overall though) because of some drug laws. I have spent a lot of time working on different non-medical coping techniques that have helped out a lot, but nothing matched the chemicals.
I'm sorry to give the impression that I think you and those like you should suffer without treatment.
I really don't.
And I don't believe ADHD is a myth or anything like that. Quite the opposite.
I just believe we can do better that what the medical profession currently offers.
I mean, don't you think it would be a shame if we couldn't?
Don't you think it would be great if we could come to fully understand mental illness at a fundamental level, then develop treatments that gave you even better health than what you've already experienced, without the need for stimulant drugs?
There is likely to be no higher reason for ADHD and depression to exist.
Not wanting to labor the point on a topic that's clearly sensitive to you, but in short: evolutionary theory says there must be a reason why these traits are so widespread.
I'll leave it there for now.
Countless studies have shown that medication is much much more effective than any form of behavioural therapy (and that BT has an extremely high failure/"relapse" rate).
Yes I can accept that. Behavioural therapies tend to be formalised ways of telling patients to "just try harder". They fail because the real issue is below the conscious mind (where "trying harder" works), in the subconscious mind and in the physiology (organ function, gene expression).
My personal experience is that there is a highly effective approach to treatment that works both on a physiological (all the way down to gene expression) level and a subconscious emotional level.
It may not be widely known or adopted yet, but it is attracting growing interest among ordinary people looking for better answers, if not mainstream science researchers, yet (due, I think, to the perverse economic incentives that prevail in that field, and the professional disincentives to pursue unconventional theories).
But from what I can see, it's just a matter of time.
I've tried looking into alternatives but because ADHD isn't recognized in adults here it can be difficult to convince a physician
If you're unsure if ADHD really exists, it may be useful to read the genetic studies that show ADHD correlation with specific SNPs, and decide for yourself [1]. Personally, I find the evidence satisfactory.
That said, I personally believe that ADHD type symptoms could be caused by several different disorders. ADHD is kind of like bipolar disorder - it covers a lot of areas and is sort of a fallback category when other diagnosis don't fit.
My roommate was one of the largest Adderall prescribers in the United States. He has 20 cars, 3 homes and brags that he spends money "like a trillionaire". If you ask him where he lives, his response is, "what day?"
He is about 150 pounds overweight, dresses like a 90s rockstar and usually drives a Lamborghini Aventador. I don't trust he is impartial or an expert in his prescribing people what is effectively a daily routine of methamphetamine.
I know a few people who are prescribed Adderall who have attempted suicide. It's very easy to abuse amphetamines and abusing them makes one irrational. Meth has destroyed my hometown and as Dr. Carl Hart states, there is really no difference between Adderall and methamphetamine.
It is very dangerous to suggest that you can cure lack of focus by amphetamines, or that somehow this "ADHD" disease can only be cured by amphetamines.
As unfair as that seems to the students who took their finals in stadium seating, that's a pretty sweet hack. The system is fucked up, but I can't help but admire your friends deciding to use it to their advantage.
Really? Lying about having serious developmental disorders is a 'sweet hack' now?
I mean, the comments below are overstating things but the danger of amphetamine addiction (especially for people who are using the meds off prescription and are more likely to do especially risky behaviors like snort it) is there and selling the Ritalin is a felony and everything about this story is actually pretty terrible.
Your perspective on this will depend on whether you lean towards legalizing substances and taxing them. I personally think the prohibition of drugs does far more damage than consumption, and I consider this scenario to be similar to the easy access to medical marijuana - all it took was filling out a quiz and getting an easy diagnosis. Reselling marijuana is illegal, but it's an everyday occurrence that fills DEMAND.
> using the meds off prescription and are more likely to do especially risky behaviors like snort it
As long as you support the legality of alcohol, your worry about someone hurting themselves on drugs ignores the everyday harm already done by the most dangerous yet easily acquired behavior-altering substance. As for snorting amphetamines - people have been snorting, smoking, and imbibing things since the early days of humanity. It won't be going away soon and, until it affects you directly, it's none of your business really.
Fairly libertarian, but thanks for your patronizing attitude.
Lying to get an unfair advantage over other students isn't positive sum behavior. It's zero sum behavior that leads to things like red queen races (https://en.wikipedia.org/wiki/Red_Queen%27s_race) and everybody having to compete for unlimited time related benefits. A competition which then eats up the supply of this resource for the people it exists for: Actually disabled people with ADHD.
Your perspective here is akin to saying that in a busy parking lot there's demand for the disabled parking spaces, so people who go out and lie about their ability so they can park in the handicap spot are performing a 'sweet hack' to get around a 'fucked up' system.
If the system is so flimsy that the only thing preventing abuse is a quiz and a doctors certificate, who are the "Actually disabled people with ADHD"? If diagnosis is so easily achieved and the rates of diagnosis around the world fluctuate so greatly, you should ask whether it's a largely inflated phenomenon and we need to reassess what it is and how we deal with it. Similar to depression, we seem to be medicating for slight deviations from what has been deemed normal, which is quite scary.
As for the act itself, if they were stealing the answers to a test then I wouldn't say it was a sweet hack, I'd say they were cheating. However if you're willing to provide the benefit of an office, additional time, adequate cooling and access to reference material to a specific group of people, I say take what the system will happily give you or anyone else who goes through similar motions.
You're right, the biggest lesson to take from that story is perhaps we should give patients a bit more scrutiny before giving them an ADHD diagnosis. This is still not a 'sweet hack', nor is it laudable behavior.
> However if you're willing to provide the benefit of an office, additional time, adequate cooling and access to reference material to a specific group of people, I say take what the system will happily give you or anyone else who goes through similar motions.
You're right, from a game theory perspective in the long run we should expect 'rational' actors who aren't punished for doing this to do it until we start punishing them for doing it. That is completely orthogonal to the question of whether this is the incentive structure and behavior we actually want. You're basically saying people should push any system as far as they can before the system pushes back. This is what a low-trust society looks like and it's not pretty. One of the major benefits you get living in a 1st world country is the reasonable expectation of good behavior from most people you interact with.
Part of maintaining that is social disapproval of people who are cheating off the charity of others.
IMO, the problem with taking a complex situation and reducing it to game theory is that you can miss some of the nuance and end up with binary results that don't fully agree with the mushy reality of human society. It's useful for constrained scenarios. Perhaps if you were dealing with a purely psychopathic, transaction-focused population it would be suitable.
> You're basically saying people should push any system as far as they can before the system pushes back.
Not at all - perhaps what's ultimately learned is that better conditions should be provided to all students. Just as we might want basic care extended for all persons, rich and poor, rather than means testing it. That way security is baked right in, everybody benefits, and there's less administrative process.
> a pretty sweet hack.
At a high level, it contains: a label (the name of the condition you have), some proof (anecdotes demonstrating that you meet the criteria for the condition), and some recommendations (accommodations that the expert thinks are reasonable, such as a separate room or extra time).
When I was a kid, my psychiatrist got the anecdata from the parents. But write-ups are only valid for something like 5-10 years, so I had to get a second one when I got into college -- and for that, my school sent me to a local psychologist (non-doctor) to get an "updated" write-up. The psychologist did the write-up mostly with stories I retold during our meetings.
When I was in school, the accommodation I wanted was permission to leave the exam room early when I finished my exams. The accommodation that was written in my file was "write in a separate room" (which, in practice, meant that the special education staff who supervised me had the discretion to let me out early), and "30 min extra time for every 1 hr of exam time" (because this is the "normal" accommodation that justifies writing in a separate room).
http://www.amazon.com/Attention-Deficit-Hyperactivity-Disord...
I'm going to edit my comment with my studies copy paste that I prepare every time someone "doubts" ADHD.
http://www.filedropper.com/russellabarkley-attention-deficit...
Here's the entire epub buddy. Please edit your post, gosh.
""By adolescence, these chronic and cumulative experiences with school failure, learning disorders, school misbehavior, and sometimes lower intelligence begin to generate other adverse educational outcomes. For instance, the academic outcome of the hyperactive (ADHD) adolescents was considerably poorer in Barkley and Fischer’s Milwaukee follow-up study at the teen follow-up than that of the typically developing adolescents followed concurrently. At least three times as many hyperactive (ADHD) children had failed a grade (29.3 vs. 10.0%) or been suspended (46.3 vs. 15.2%) or expelled (10.6% vs. 1.5%) (Fischer, Barkley, Edelbrock, & Smallish, 1990). Others have also identified such high educational risks in longitudinal studies dating back as much as 40 years (Ackerman, Dykman, & Peters, 1977; Mendelson, Johnson, & Stewart, 1971; Stewart, Mendelson, & Johnson, 1973; Weiss, Minde, Werry, Douglas, & Nemeth, 1971; Wilson & Marcotte, 1996). In another sample of clinic-referred teenagers with ADHD, a similar risk for school retention and suspension was documented (Barkley, Anastopoulos, Guevremont, & Fletcher, 1991). Almost 10% of the hyperactive sample followed into adolescence had quit school at this follow-up point in the Milwaukee Study, compared to none of the normal sample (Barkley, Fischer, et al., 1990). Fischer and colleagues (1990) also found that the levels of academic achievement on standard tests were significantly below normal on tests of math, reading, and spelling, falling toward the lower end of the normal range (standard scores between 90 and 95)." (Quoted from the 4th edition)"
"Substantially fewer hyperactive than control children had ever enrolled in college (21 vs. 78%) or were currently attending at this follow-up point (15 vs. 66%). These findings were reaffirmed 6 years later at the age 27 follow-up (Barkley et al., 2008). In the Canadian follow-up study, approximately 20% attempted a college program, yet only 5% completed a university degree program, compared to over 41% of control children (Weiss & Hechtman, 1993). The longest running (30-year) follow-up study of hyperactive children into midlife likewise indicates that less education is an outcome of childhood ADHD, with 30% either not completing high school or getting a general equivalency diploma (GED), compared to just 4% of the control group (Klein et al., 2012). These findings demonstrate that the educational domain is major in terms of impaired functioning and reduced attainment for children growing up with ADHD."
We've moved to a model where "raising standards" in education and increased evaluation of teachers equates to formulaic, inflexible school curriculum that younger kids cannot handle. So they act out and get referred for evaluation. My public school district begins assessing children using computerized testing starting in November of the kindergarten year. There's a big difference between a 5 year old born on January 1 and a five year old born on August 1, and those later born kids are going to get labeled with mental health conditions for life and drugged because they are square pegs that don't fit in the prescribed round hole.
The article didn't claim that ADHD doesn't exist either. A key quote:
> Zoëga says the only country studied so far where the relative age of young children doesn't seem to have an effect on ADHD diagnosis is Denmark, where there's more flexibility for when children enter school
Bullshit ADHD diagnosis are bad for people like you who are genuinely affected, as the resources available to help you end up getting shared and stretched to cover disciplinary and structural educational problems. A non-ADHD child isn't helped by ADHD prescription and unnecessary services, and an ADHD child isn't helped by not getting the attention he needs.
I'm interested in you developing the last thought you had.
This is just classical bayes rule dude, there will be a lot of false positives _no matter what_ unless the diagnosis rate is an absurdly high number. You're blaming other people for not knowing that's the way the numbers always come out?
https://www.math.hmc.edu/funfacts/ffiles/30002.6.shtml
> Suppose that you are worried that you might have a rare disease. You decide to get tested, and suppose that the testing methods for this disease are correct 99 percent of the time (in other words, if you have the disease, it shows that you do with 99 percent probability, and if you don't have the disease, it shows that you do not with 99 percent probability). Suppose this disease is actually quite rare, occurring randomly in the general population in only one of every 10,000 people.
My college provided significant benefits to ADHD diagnosed students. Rather than take finals in stadium seating, you got a personal, air conditioned office, received unlimited time and could use reference material.
A few of my friends found a "Do you need Ritalin" quizzes in a magazine, went to a doc-in-the-box and got the diagnosis. They sold the Ritalin and got better grades.