> will want to give them a pill as it's easier.

Well yea, sometimes pills help people.

> Reminds to be seen what is the effect of such medicines on kids under development

I mean adderall (amphetamine) is pretty well studied. Yea they have some adverse effects (stunted growth, not good if you have a pre-existing heart condition, etc.) but as with literally every medicine, the decision to take them or not take them requires you to balance the adverse effects (which can be monitored) with the adverse effects of the illness. It frustrates me so much to see people just flippantly ignore the actual underlying problem that the pill is supposed to be treating as though it's "healthier" to not take the pill. Depressed people can kill themselves or if they don't their lives are pretty crappy. ADHD can cause all sorts of real problems. If you think pills are just an "easy way out" then that's really insulting to people who actually benefit from using them and really don't want to have to deal with judgement from other people who clearly have no idea what it means to suffer from a serious mental illness (ADHD can be debilitating). If you do happen to suffer from a serious mental illness and do not take pills, that's great (maybe?) for you, but that doesn't mean that's the "right" way. In fact I had two parents with mental illnesses that took that route and it was really not fun growing up with that, though it was a great lesson in how not to deal with mental illness.

> the actual underlying problem

For many the “actual underlying problem” is that forcing small children to sit and focus on unmotivated externally assigned busywork while being passively monitored by a stressed out and outnumbered authority figure is a cruel waste of time. Many of the same kids would be just fine if their day consisted primarily of free play, especially outdoors.

" Many of the same kids would be just fine if their day consisted primarily of free play, especially outdoors."

Not if they have ADHD. Then they often can't focus on things they want to focus on for their own reasons.

A lot of things that people with ADHD would like to do include boring parts if you want to get good at them. Practicing scales three hours a day, or whatever.

> Then they often can't focus on things they want to focus on for their own reasons.

Ding ding ding, winner. You know what sucks? Not being physically capable of paying enough attention to a piece of paperwork to be sure you've read all the instructions right and spelled everything perfectly and copied over every number with no transcription errors. Even when you desperately want to be able to focus that hard on anything in your life. Now take that and apply it to programming, watching TV, finishing video games so you get the whole story, remembering your SO's favorite things... Yeah.

Hmm. I'm a little skeptical when medical phenomenon are ascribed to social factors, but I don't really know either way.

I wonder if anyone has studied whether ADHD rates are influenced at all by type of schooling. I'd love to know whether KIPP (which is very heavy on "sit and focus") or Montessori (which isn't) have particularly different rates of ADHD diagnosis for their students.

Could go either way. Maybe focus is a skill that can be learned, and by drilling it you would reduce rates of ADHD? Maybe focusing is annoying, and if kids have to do it too often, they'll stop wanting to learn or focus on anything? Or maybe it's mostly biological or chemical, and the rates would be roughly the same?

I don't strongly share your intuitions, but I'd absolutely support someone giving a shot at testing the impact of schooling type on ADHD rates, validating you if your intuitions are right, or just adding more information if you aren't.

Some ADHDers will do worse in Montessori because it requires more executive function that regular school. Look up "hyperfocusing". The student might do one thing that interests them and nothing else. That will be a huge problem in Montessori, which expects the child to by themselves go from activity to activity. Some ADHDers will do better in more structured environments.

"Requiring every building to have a ramp instead of stairs wastes everyone's time and money. Many of the people that need them could get along in crutches long enough to use the occasional building."

People like you are why I went undiagnosed until I was 27. Everyone around me thought that I just needed to focus harder and take better notes and get some exercise. Hell, I thought those things too, which meant I was dealing with burnout and depression on top of everything else. It ruined grad school and it's going to take me decades to catch up with my life goals. You should find a way to contribute that doesn't involve sweeping generalities that make it impossible for people with real problems to realize that they have them.

> You should find a way to contribute that doesn't involve sweeping generalities that make it impossible for people with real problems to realize that they have them.

You think that me arguing for more free play for 4–8 year olds makes it impossible for adults with ADHD to realize they “have real problems”?

You think it would have made your life significantly better if teachers had started medicating you at age 6 and forced you to spend more time memorizing spelling lists or whatever?

I’m not talking about people in grad school here. Or even high school.

For whatever it is worth: I am 32, and have undiagnosed ADHD, probably more extreme than yours.

More free play is not exclusive with school. More free play does not solve ADHD. ADHD kid I know have hours of free play every day and he still have trouble to behave in school - while other kids don't have such problem. He has good days and bad days and that is not correlated to type of work. And when he has bad day, the other kids in class essentially sit bored waiting, because all teachers attention necessary goes toward that one out of control kid (he is too disruptive to be just ignore when he has that). When he has good day, he is fine boy trying to please those around. He is trying to not have bad day I think, he seems unable to.

Also, while there are some shitty schools with "forcing small children to sit and focus on unmotivated externally assigned busywork while being passively monitored by a stressed out and outnumbered authority figure", ADHD happen in non shitty ones.

When kids universally hate the school and there are problems with everyone then it is one thing. When there are few kids who behave differently then other kids, then we maybe should accept that there is something different about them. Because that is the thing - many many kids like to go to school at that age. Or are indifferent to school. Or don't like it, but don't have problem to sit while class is going on. And some kids have problem to control their behavior regardless of whether they like the school, teacher and other kids.

> Also, while there are some shitty schools with "forcing small children to sit and focus on unmotivated externally assigned busywork while being passively monitored by a stressed out and outnumbered authority figure", ADHD happen in non shitty ones.

Op wasn't describing shitty schools. He was just describing schools.

> For whatever it is worth: I am 32, and have undiagnosed ADHD, probably more extreme than yours.

If you think that it's significantly affecting your quality of life and none of your existing coping strategies are helping - which is the actual definition of "severity", by the way, not anything about how much you think your brain sucks - you should talk to a competent doctor and/or counselor or therapist. Medical professionals have access to far better ways to address real neurological problems than you can get hold of, ranging from referrals to specialists that work 8-hour days helping people test coping strategies to medication that will directly address the underlying cause to simply being able to approach the problem with a calibrated idea of what "normal" is and deal with it with a brain that isn't affected by the problem. They can probably help you keep your job or your marriage or whatever else it is that's continuously at risk of being derailed and collapsing around you.

Yes, I know that it's hard to do. It's hard to remember to make phone calls while businesses are open. It's hard to remember when you have appointments. I know that paperwork is terrifying. It sucks. It gets better if you do it and get help. Get a good friend to sit down and help you do it. Seriously, not having gone to the doctor in years because you couldn't pull together the functional executive capacity to deal with analysis paralysis when you search for "primary care providers $mycity" is unhealthy in a ton of ways. Just call one at random. At worst you'll pick a terrible doctor and have to try again. Get friends to help. They're not crippled like you are.

(Though, if I'm going to be honest, I will say that someone self-diagnosing severe ADHD in a thread about overdiagnosis of ADHD is hilariously ironic. Nothing says that the office lifestyle is any better for adults than it is for children, after all. Go read Dilbert or watch The Office or something, we're just as bad at handling it in cubicles as we are at our assigned seats in history class! Get some fresh air, go hiking on the weekends, get your macros right and lose 20 pounds. /s)

> You think it would have made your life significantly better if teachers had started medicating you at age 6 and forced you to spend more time memorizing spelling lists or whatever?

I did perfectly well on spelling tests and homework and projects during school. In fact, I barely needed to "study" anything at all. Maintained a high A all the way through to the end of my undergraduate. It just turned out that the month-long and semester-long projects sharply limited the scope of the careless mistakes I'd make that would, on real-life-sized projects, cascade into crippling architectural issues. So I just figured I needed to work harder (because "smart people don't work hard") and take better notes and pay more attention to the big picture. And I burned out catastrophically. Those problems all went away overnight when I finally managed to talk to a doctor about it. It was magical. I have so far not been able to identify any side effects rising above the noise floor.

So, based on the side effects and benefits of medication so far, yes, I actually really would have liked to have had it earlier. At least ten years earlier. I'd have spent exactly as much time studying - i.e. none - gotten back the 10% of my grade that I usually spent misreading the fucking question, been able to handle personal projects big enough that I'd have been able to get real practice with project management and software architecture, and gotten papers out of the research projects I was involved with during my undergraduate. I'd have been able to go to the doctor reliably and avoid the stress and wasted time I spent dealing with carelessly fucked-up paperwork. And that all would have compounded on itself to improve my life exactly the way the failures compounded the way it actually happened. If I'd had this shit ten years ago I'd probably have my fucking PhD right now and be working on getting tenure, which is what people were expecting when I was in second grade.

> It just turned out that the month-long and semester-long projects sharply limited the scope of the careless mistakes I'd make that would, on real-life-sized projects, cascade into crippling architectural issues.

Beyond any difficulties with controlling attention, I think this has a lot to do with lack of practice with large (and “real”) projects, ramping up in scope and scale slowly over the course of years. This is a big problem with the school curriculum/pedagogy, IMO.

Many people I know working in creative jobs (computer programming and otherwise) have various problems with large-scale project management, long-term problem solving strategies, etc., plenty of which have nothing to do with ADHD.

I don't think that's what OP was saying at all, though. I took his comment as saying that we often expect too much structure from kids at too young of an age, then diagnose the worst of them. For example, at age 7 I was still bursting with pent-up energy and often didn't want to sit still, especially if I was bored. My first grade teacher once taped me to my chair to try to get me to sit still during reading time (I was reading at a higher level, and "See Spot Run" bored me to tears). She and my kindergarten teacher probably could have pushed for an ADHD diagnosis, but they didn't because I think they realized that we often shove kids too young and expect them to adapt to a fairly rigid structure too quickly.

Now, I'm not saying that nobody has ADHD and that it's not a horrible problem for those who do. Sometimes, I really do wonder if I might have it, though I tend to think against it. But for those who truly do have ADHD, I understand that medicine is needed, and that the sooner we give it, the better off those students can learn. I just feel that OP was saying we test for it way too young, and expect way too much out of kids when testing for it.

> Many of the same kids would be just fine if their day consisted primarily of free play, especially outdoors.

There needs to be a balance between free play and structured learning, where the youngest students spend more time in free play than older students. The primary function of school is learning, and learning is often very structured time. Children need to be able to handle that type of environment.

I think the issue that GP is having is that we often expect this of them too young. We expect them to come in and be quiet and sit in focus at an age when they're bursting with pent-up energy, and then diagnose the worst of them as ADHD and give them a pill. Yes, we need to teach them to handle that type of environment, as that's (sadly) how the rest of their lives will be...But I think we need to do it a lot more gradually, or even a bit later, than we currently do.

>Children need to be able to handle that type of environment.

Why?

If their day consisted of outdoor free play, they wouldn't actually be learning - which is half the problem. They need to learn, and about every 5-10 years, the amount they need to know in order to function (in other words, how much the teacher needs to teach and test for) seems to be doubling. Then again, I wonder how different our world would be if I could just send the kids outside who didn't want to be in my classroom, let them have their "free play" time, and then be able to spend my focus & energy on a smaller and more focused group who know that there's an option - and make a deliberate choice to stay.

> If their day consisted of outdoor free play, they wouldn't actually be learning

Are you serious? You think that young children don’t learn from free play? What in the world is your definition of “learning”?

> how much the teacher needs to [..] test for

Oh I see. You mean “learning” as judged exclusively by standardized multiple-choice tests.

Well fine, it’s not exactly surprising that if we force children to spend 5+ hours per day sitting in rows in desks working independently filling out busywork worksheets or watching teachers solve similar trivial exercises on a whiteboard, they will be better at doing the same thing for arbitrary test points than someone who hasn’t spent any time practicing that, even if both kids think the test is a pointless waste of time.... but that doesn’t really indicate anything at all about children’s abilities more generally.

If we instead measured the kids’ balance, strength, running speed, hand-eye coordination, intuitive understanding of physics, ability to improvise mechanical devices from found objects, knowledge of local plants and animals, emotional self-understanding and self-control, negotiation and bargaining skills, social organization/leadership, .... we would find that the professional worksheet-fillers are years behind their playing peers.

Some of the most capable (even at book-smarts) people I ever met were absolutely horrid throughout school, but then did amazing things after. Others never went to school at all and still did amazing things. Others I know aced every test right up through college, and then had no idea what to do afterward, because they had never really been forced to think for themselves.

Getting children to be as successful as possible at multiple-choice tests at age 8 is not a good top priority for the education system.

Your comments here presume that there is an "actual underlying problem". But this study proves that isn't always the case.

I also think you're ignoring the extent to which a neurological difference has been medicalized here. Depression is truly debilitating in any context. Here ADHD is sometimes being diagnosed due to a poor fit between an artificial environment and and children who would have been seen as "normal" had they been born a week later. Is there actually a problem with those kids? Or is the problem with an industrial-age education system that expects kids to demonstrate obedience all day and drugs the ones who don't? That's far from the only way to educate children; maybe the problem is not the child's brain, but that we expect all children to fit a very specific mold.

Personally, I'm a September baby so was relatively young compared to my grade peers.

I got mostly A's in K-6. Once in 4th grade another student pitched a tiny fit about how I always got A's on spelling quizzes.

After that my grades started to decline. I was having trouble with the increasing demands of the work. Graduated high school with a 2.25 GPA or something like that.

In college I was diagnosed with ADD.

The industrial-age education system wasn't a problem for me, until it became a problem for me.

But it really isn't the problem, because ADD can prevent people from being able to focus on things they want to do of their own free will in their own time. Industrial-age education isn't an issue there.

So, being unable to maintain focus especially on the boring bits, they end up sucking at whatever it is, which gets depressing.

Just to be clear, I believe some people have disorders that affect attention. I also believe there's a larger group of people who are just cognitively different. They are fine in some circumstances, not in others.

As an example, I'll note that common characteristics of people with ADHD include hyperfocus [1] and higher creativity [2]. They are also more easily bored. Is this different? Yes. Is it bad? Certainly in the context of the standard educational experience. Do stimulants help? Sure, but they also help everybody cope with boring things. Almost every office in the world has a coffeepot. We have built a system that most people need stimulant drugs to function well. That some people need more or different ones than others to fit the system's needs is unsurprising. I'm just suspicious that the disease model fits it particularly well.

As an analogy, consider who can reach which cabinets. We just accept that there's a pretty wide normal variation in human height; some people can reach higher shelves than others. We also recognize that kids grow taller. If we started declaring kids below the median height had "Height Deficiency Disorder" and started giving them growth hormones because they couldn't reach the top shelves, that would be pretty sinister. Especially when that happened to the ones who were just younger in their grade, and therefore naturally shorter. Especially when it's possible to build cabinets differently, to provide assistive devices, and to help short kids learn how to deal.

So yes, we definitely don't want kids to fail. But I would like us to treat medication as a last resort, and to start being more accepting of neurodiversity.

[1] https://www.webmd.com/add-adhd/hyperfocus-flow

[2] https://www.psychologytoday.com/us/blog/here-there-and-every...

The spread in executive functioning and other attributes between ADHD sufferer and non- is WAY wider than the spread between tallest and shortest person.

I would be interested to see your data for that. But even so, so what? | There are plenty of human characteristics that have wider variation. Nobody's diagnosing people with European Skin Syndrome despite the way white people can't handle reasonable amounts of sun and are highly prone to cancer.

Also, it's an analogy, and not meant to be taken literally. It's just meant to give people a feel for what unnecessary medicalization might be like.

>> sometimes pills help people

Giving "pills" to a unruly school child might well help the teacher.

Whether it helps the child is much less clear.

Amphetamine, opiods, and steroids are catch-all drugs. They can cover up the symptoms of pretty much anything.

People are right to be skeptical when the message is: "we don't understand the problem well enough o cure it, but take these pills and it will get you through one day at a time."

That doesn't mean it's wrong. But skepticism is warranted and inaction is a good default.

We understand the problem well enough to know that frontal lobe damage can look a lot like ADHD and can be treated the same way.

From what I've read, increased development in the PFC is one of the effects of stimulants. They are prescribed for PFC brain injuries for a reason.

This sounds like "kids who can't read the white board should just sit closer or look harder". Yeah, some kids can't read the white board because they are sitting way far back or haven't figured out their letters yet, but some kids need glasses. The reason professionals make diagnoses instead of HN commenters is because they can tell the difference between "needs more phonics" and "can't see".

Teachers don't diagnose or prescribe.