I would definitely consider ADHD as a debilitating disability.

No we haven't, and ADHD is disabling for many people in a meaningful way. The criteria here is that a doctor says it is permanent and it "limits one or more aspects of their daily life".

It is also supposed to be a "severe" limitation, but I doubt someone with ADHD would be interrogated about this, everyone involved just wants more people to visit the parks.

I think the implication of the parent poster is that it's difficult to imagine why ADHD could put you at increased COVID risk to the point of needing Paxlovid. That makes no sense to me but I'm all ears as to the logic here.

Without looking it up, I can imagine the cognitive effects of Covid might be more severe for someone with ADHD. After looking it up, it seems there is some association between ADHD and worse outcomes: https://journals.sagepub.com/doi/full/10.1177/10870547211003....

It's also possible that ADHD makes it more difficult to scrupulously comply with self-quarantine measures, in which case it's a good public health decision to make Paxlovid available and reduce community spread. I'm not actually sure if Paxlovid reduces transmission though.

Thanks very much, that's the kind of medically appropriate implication I was looking for: "Conclusion: ADHD is associated with poorer outcomes in COVID-19 infection."

I'm sure that ADHD is comorbid with a variety of lifestyle and health problems that make COVID somewhat worse. But in general it does not directly affect health. Why not simply provide it to those with the comorbidities?

I consider community spread mostly a nonissue. We've known for many decades that if you can't get the replication rate below 1, the correlation between replication rate and how many get it is chaotic. We can't get the replication rate of COVID below 1, so there is little correlation between policies and outcomes. Obviously this does not apply if you are at risk or a caregiver of someone at risk. That's why saner countries than the USA (Germany is my favorite example) do not recommend vaccination against COVID for the general public.

> Why not simply provide it to those with the comorbidities?

I don't know, I would guess because they're harder to define and doctors generally diagnose conditions rather than individual symptoms or behaviors.

ADHD makes it more difficult to support yourself independently, live a "normal life" and keep a steady income - so for pretty much the same reasons as most of the other disabilities.

As a person with ADHD, I was about to argue that ADHD is not something that would, absent other health issues, qualify someone for something like Paxlovid.

But your argument completely 180'd me. I've got a lifetime of tools to deal with my ADHD, but me from 10 years ago absolutely would have gotten COVID and not taken it seriously (item 12435346 on the list of shit I'd not be tracking well), which is precisely the kind of additional risk Paxlovid was made for.

I heard on a podcast that ADHD can sometimes reduce life expectancy by 13 years. Compared to obesity, which reduces lifespan by 10 years, and type I diabetes, which reduces lifespan by 3-4 years, it's a real disability that needs to be taken much more seriously than it currently is, IMO.

Again, I see 0 relation between this and Paxlovid. There are about a million things that make it difficult to support yourself: being newly divorced is a huge hardship, as is being newly laid off, as is not having health insurance in the US (see today's stories about Mary Lou Retton needing to crowdfund for her medical care on GoFundMe).

Point being, if that's the bar, they should get rid of the nonsense requirement of needing a "disability" to get Paxlovid. Otherwise they should restrict it to disabilities that actually have a medically demonstrated increased risk of severe illness or death from COVID.

> There are about a million things that make it difficult to support yourself: being newly divorced is a huge hardship, as is being newly laid off, as is not having health insurance in the US (see today's stories about Mary Lou Retton needing to crowdfund for her medical care on GoFundMe).

Don't disagree with any of these also being very significant, personally I wouldn't mind if these folks also got the pax. But

a. these aren't considered "permanent" in the general sense (you can get rehired/remarried), and b. permanent disabilities are much "easier" for a govt to classify than to spend resources everytime someone needed assistance

And > Otherwise they should restrict it to disabilities that actually have a medically demonstrated increased risk of severe illness or death from COVID.

ADHD does have a medically increased risk of severe illness or death from COVID. Perhaps not "directly" like someone on immunosuppressants, but as someone w/ adhd and another chronic health condition (T1 diabetes), adhd makes it several times more difficult to handle my health (and T1D has life threatening complications within arm's reach of poor management).

As someone with ADHD I can't imagine that I would've made it to 25 without severely screwing up my T1D care - that requires pretty constant vigilance and, well, there's a reason I voluntarily don't drive.

I wonder if it's ADHD or just the side effects of continual stimulant usage that causes worst COVID outcomes. Stimulants can be hell on a lot of bodily system functions.

Stimulants at therapeutic (pharmaceutical) doses aren't as terrible on the body as one might expect. Especially when you compare it with something like cocaine (which does funky stuff to the heart/Calcium channels) or recreational doses (several times the avg/median prescribed dose). They can and often do have side effects etc, but Jeff blowing coke at a party is much more likely to have a problem.

I agree with you. But T1 diabetes is something which should suffice for Paxlovid.

BTW if you haven't checked out OpenAPS, I highly recommend it based on friends who have used it. It greatly reduces the self-discipline needed for T1 diabetes maintenance.

> OpenAPS

Thanks, I've been wanting to get on a pump forever. Hopefully it'll be sooner than later. I'm 99% sure I'll use a looping system (either Tandem's or one of the DIY ones), heard a lot of good stuff about them.

This is just an American with ADHD who emigrated to Canada speaking but... yea, why don't we lower the bar and remove that nonsense requirement. It'd be great if everyone who needed help could get it in a reasonable manner. Maybe you have severe mobility issues and need physical assistance showering and doing daily hygiene tasks - maybe you're a neurotypical person who just lost a family member, went through a rough divorce and was diagnosed with cancer all in the same week. It'd be great if there was social assistance to help you out - especially if you weren't shamed for using them.

But, specifically on the topic of Paxlovid, ADHD people tend to have less stable, shorter and poorer lives - there is a strong correlation between the illness and the need for financial assistance. ADHD people tend to also be less proactive about health issues and delay treatment more than normal people (because going to the doctor is hard and there are so many considerations) so perhaps the Paxlovid allowance is because people with ADHD are more likely to have more advanced COVID cases - I can't tell you why they made that decision but those are two pretty solid reasons to consider it.

Stubbing your toe makes it harder to walk up stairs, but we still build ramps and elevators for people in wheelchairs.

> Require close contact with those who may be infected, such as a caregiver or family member

> Have we as a society come to define disabilities so broadly that the term has basically become meaningless?

We’re getting close, but it’s okay. Expansion of the term has helped people and we’ll eventually come up with new common language to distinguish more and less catastrophic forms of disability.

I disagree - I think as a culture we're coming closer to realizing that everyone needs help sometime and that we should have social programs available to help with that. Some people need more access to those programs than other people and some people have specific needs that others don't - we should just help people in their time of need, make things more accessible, and remove the social shaming associated with it

Sure, except you’re not disagreeing. :)

If disability now means needing help, and help is something that everybody needs sometime, then disability really refers to everybody at some time.

And inasmuch as everybody should have the help they need, and statute already says that disabled people can get help, it works out well in practice. Everybody can claim that they’re disabled when they’re disabled and get the help they need. Sounds great!

But disabled used to mean something much more narrow and uncommon, and there’s still going to be need to find new language for that.

That is extremely difficult to provide a blanket term for - we're talking about such a wide spectrum of issues when we use the 90's definition of disabled. That would include people who are perfectly neurotypical but require physical assistance (i.e. someone with arthritis who needs ramps to change elevation at a reasonable speed), people who are neurodivergent but perfectly physically able and everyone inbetween. A lot of those folks just went unserved in the old system and struggled financially to keep themselves alive and fed while walking a much harder road than the rest of us.

I think a blanket term for disability isn't useful and it's much more productive to focus on forms of impairment - there's no real similarity in treatment and support between a person who was hit by a car and needs a wheelchair and someone otherwise normal looking who is prone to sudden violent outbursts due to a neurological disorder. And, unfortunately, one of those people is much more likely to be looked on with sympathy and the other shamed and feared - but both of them can live normal lives with proper care.

I believe more that we've grown to understand how debilitating ADHD can be and that is why it's considered a disability.

Consider how it affects people's life trajectory through school and work, the opportunities out of reach due to the condition. It's essentially a situational cognitive impairment, when I think about it that way it seems profoundly disabling.

I never felt disabled until I got a significant other who wasn't as familiar with my ADHD symptoms. When we get up to go do an errand I tend to execute my todo list very quickly thinking I will lose the opportunity. I'll do dishes, put in laundry, clear away trash, send emails, pay bills, schedule appointments, etc. All the things I should have been doing in the hours before we do the errand. It's become very clear to me how much this frustrates my partner while they're waiting for me by the door to get this stuff done. They can't get me out of the house sooner because I'll just say "just one more minute!" and "almost done..." over and over. I work from home, so my partner will get frustrated if I work past the end of my day. Computers/technology is the one area I can focus very well, so I might dig into something interesting for hours. Except then I've infringed on the time we have to be together (my partner).

When I was living with family they were used to this stuff, and just let me be if I was obsessed with something. They let me satisfy those last-minute compulsions where I procrastinated and was unable to execute on my todo list earlier. etc etc.

I thought I had light ADHD but it effects my relationship, friends, and work responsibilities so much. I hate that I do everything at the last minute, with only a suitable stress to make my thoughts order themselves. And it appears entirely un-ordered when I'm doing x-y-z quickly.

Why couldn't I do it all earlier?

I developed the habit of doing those things when I walk in the door, not when I walk out.

This also frustrates my wife, but I think less so than it would be to have the signal being an errand I'm already late for.

When I lived with family it felt normal. My family actually lied about my symptoms on a medical survey because my mom thought if I was diagnosed with AD?D I'd be unemployable somehow, like employers could get that in a background check?

Getting around other people made it more obvious I had some issues. Like, my partner and I will go on walks and they'll get annoyed if I point out an interesting animal or thing I'm seeing if they're in the middle of a topic. At work I always set reminders on my phone, sent emails to myself, and left stickies on my desktop. My supervisor pointed out he'd never seen someone do that as much as I do, and started requiring me to show up with a notepad in meetings. He'd tell me to do 2 things, and then have to ask me what the first thing I told him was as I left - then the notepad became necessary.

I worked to get onto an employee advocacy group at work and we do a lot of writing to identify systemic issues and propose solutions. I had 2 months to create a paper covering issues with hiring and on the last day - after I turned in the paper - I hit reply-all to add an additional thing that was critically important. Something I knew was an issue before I started the paper. For 2 months it was completely gone from my head. So I have whiteboards around my room, and I'm trying to move to using digital whiteboards to remember these things and organize them so I can even keep my supervisor and coworkers in the loop. "This is my MS Team Whiteboard for Monday stuff, buwhahaha"

I just remember being 25 and feeling like this didn't affect me so much. It still feels like I'm joking when I talk about it. ADD /sounds/ like a non-serious condition. But all these relationships have suffered because I'm forgetful and disorganized, and people are tired of my excuses. :-( I felt normal before.

2 days ago I had a big argument because my partner says I should be taking my medication. I usually don't take it on the weekends, because I shouldn't need to "focus" then, right? I hate that the meds for ADD are addictive, and sometimes it works when I need it - other times it kicks in a day later and it feels like a double-dose. That scares me.

People think disability as having no leg or being blind. If you ask any random gen-z, they will tell you they have ADHD. That's why ADHD as a disability lost its weight.

> People think disability as having no leg or being blind.

These are the "visible" disabilities. ADHD, amongst other conditions, are more invisible[1]. I have diabetes but "look" normal. I know a guy with epilepsy. They too, unsurprisingly, don't "appear" disabled. (I know this wasn't your main point but I think it's important for people to know.)

1 - https://en.wikipedia.org/wiki/Invisible_disability

Have they been diagnosed medically?

Because plenty of people say they are OCD too, but they don't mean the diagnosed condition. And it's quite different to "being tidy and needing things to be ordered" that the common vernacular makes it out to be.

Same as ADHD. Plenty of people who say they are "a bit ADD" mean something else.

Given how common it was (still is?) to abuse Adderall in college, I'm going to go out on a limb and say a lot of people have been "diagnosed" with ADHD, but that doesn't necessarily mean much.

My very strong belief is that a large fraction of those who are "medically diagnosed" do not actually have ADHD.

ADHD was originally a diagnosis of exclusion - lack of executive control not explainable by any other known condition. But you can lack executive control for a wide variety of reasons including depression, sleep deprivation, electrolyte imbalances, and so on. Often doctors don't look - they just shove you out the door with Adderall. The side effects of which include loss of appetite and insomnia - both of which can make symptoms worse in the long run!

If we're going to treat ADHD as the serious disorder that it can be, we should treat diagnosis and treatment as more than an opportunity to prescribe profitable drugs. But instead we have a combination of on the one hand not taking it seriously, and on the other treating it like something serious at the oddest of moments.

> That's why ADHD as a disability lost its weight.

ADHD as a disability was never respected, there was a 2 year time period post 2018 in which people sort of took it seriously but not really.

Pre-acceptance period we had "Is ADD real?" articles on the regular, now post-acceptance we have "Are ADHD sufferers faking it?" articles on the regular. Nothing substantial has changed for people with ADHD, the common man still does not try to understand.

Being American should be considered a disability.

Huh so i can get an ADHD diagnosis in 30 mins for cost of an office visit, and get a free lifetime pass to national parks? Pretty based

Sorta, in exactly the same way you can get an oxycodone prescription in 30 minutes for the cost of an office visit and flip it on the street for cash. What you're positing is just medical fraud. And, sure, it happens. But not for park passes.

Getting diagnosed with ADHD because you "can't focus" is comically easy. Millions of college kids, software engineers, investment bankers, and kitchen staff do it every year.

Per a quick google, only $9M adults in the US are even estimated to have ADHD, in total. Much less diagnosed, and certainly not per year. You're parroting something you imagined someone to have said.

In practice genuine clinical diagnoses aren't at all common. It's certainly not a "rare" disorder, but it's not remotely abused or abusable in the way you imagine.

According to research, 1 in 4 adults may be faking it[0]. Studies have also shown that it's easy to fake[1].

[0] https://www.nbcnews.com/health/health-news/adults-who-claim-...

[1] https://www.psychologytoday.com/intl/blog/mouse-man/201007/n...

Both of these sources are over ten years old and refer to diagnostic criteria defined in 2007, this is not the state of the world today.

Can you show any research indicating that it is not easy to fake with current diagnostic criteria?

Nope!

There's nothing published along those lines, given the criteria were updated in 2017 there's been plenty of time to test the prior methods again but either no one's tried or the results werent exciting enough to publish.

Which means that there is no particular reason to believe that it can't still be faked. Given the nature of the disorder, it is hard to see how it could be otherwise.

Given the rate at which prescriptions are being handed out, it is extremely unlikely that they are only giving prescriptions to people who actually have the disorder.

> Data from the analytics and research company IQVIA shows that the demand for Adderall has risen nearly 27% in recent years, with prescriptions jumping from 35.5 million in 2019 to 45 million last year.

Probably even higher now. That's nearly 15% of the population. Are stimulants like Adderall prescribed for conditions that aren't ADHD? Do ADHD diagnosis not include medication? My point was stimulants are being abused and are easily acquired (in the name of ADHD).

>My point was stimulants are being abused and are easily acquired (in the name of ADHD).

You say this in such a matter of fact way. Doctors regularly gate-keep people with ADHD from a diagnosis because of drug seekers. You are speaking like a person with no experiences in the subject, and considering your original post we know you are not arguing in good faith here at all.

You are dead wrong.

It is estimated that around 9 million adults have ADHD.

https://www.forbes.com/health/mind/adhd-statistics/

But during COVID, rules were loosened about being able to diagnose ADHD by telehealth. The result was on the order of 2 million new prescriptions per year.

https://spanberger.house.gov/posts/spanberger-puts-more-pres...

It is also true that there are people being kept from a diagnosis because of drug seekers. But that just means that the drug seekers have to look around until they find a compliant doctor.

But hey. When I pick up my son's medication, I now have to show my driver's license. So at least we're catching the ones who shop around, find 5 compliant doctors, and then sell the extras on the black market!

(My son doesn't need medication picked up very often. Unfortunately for him, he can't tolerate the side effects of more than sporadic use. But he would struggle to get through major exams without it.)

What you are saying does not match my and many other peoples reality. I personally have been denied a diagnosis even tho I have had done 3 previous assessments. This was even when I changed back to the same provider I had previously after a move. It seems every time I change insurance providers the new one does not believe that I am anything but a drug seeking addict. This is still the narrative for many people with ADHD. I am sorry that as a parent this is an aspect you dont see, but your kid will need to deal with it and many other struggles that you will never experience first hand.

I'm sorry that you are struggling with the concept of objective reality.

The statistics that I quoted are real. This isn't a question of matching your perception of reality. It is a question of what is actually true.

The number of people prescribed ADHD medications is several times the estimated number of people with ADHD. I isn't hard to find people with questionable ADHD diagnoses. I already said that there are people with real diagnoses who struggle to get diagnosed properly. I'm sorry that you are one of them. My daughter happens to be another.

Oh, and here's another point from reality. ADHD is genetic. My son got it from me. I am also likely where he got his inability to tolerate regular use of Adderall. So the next time you find yourself struggling to get a prescription, reflect on how you are getting to temporarily experience a bit of the struggles that I live with.

Maybe that thought will help you to not jump to conclusions in the future.

I was not gonna reply but I got kind of curious. How often does this statistics argument work for ya in general? I was wondering how many people turn around and go "wow you are right!"

This particular one? It is the first time I made it.

Statistical arguments in general? I get a pretty good response. But there is a selection bias. I rarely bother interacting again with anyone who can't be convinced by data when they encounter it. (And conversely, I try to be convinced by data when I encounter it.)

Unclear, your doctor would have to state that your ADHD is a permanent disability "that severely limits one or more major life activities." I'm not sure they'd be willing to do that after one 30 minute visit.

If you as an individual applied for this with a 30-minute ADHD diagnosis they might still give you the pass, because what's the point in arguing with you, but if a ton of people followed your lead then they'd probably start enforcing that criteria.

The Paxlovid.com website is from the for profit company Pfizer, which makes Paxlovid, so yes, they'll list every kind of disability that could conceivably be a reason to take paxlovid and make them money.

But yeah ADHD can count as a disability, in some people. That's based not what you have, but if what you have substantially limits at least one major life activity.

While they publish that list, they did not come up with it. That list is from the emergency use authorization granted by the FDA.

You're free to guess whether the FDA is basing that on science, politics, or corruption. I've seen sufficient evidence that they do all three that I don't have a strong opinion. (In this case, I don't think that the science is there.)

At the very least, we should be aware of potentially perverse incentives. The more we reward disability, the more incentive there is to get yourself declared as disabled.

Hopefully it will be an equal amount of incentive for people with undiagnosed disabilities to get diagnosed and receive treatment or support. Even if just to be productive members of society for longer!

> Have we as a society come to define disabilities so broadly that the term has basically become meaningless?

I would say so. There ought to be a distinction between losing your legs and having ADHD. Most people with ADHD don't even know they have it. And it's also incredibly easy to fake.

There is a difference one is only physical and the other is cognitive.

As long as we have qualified doctors diagnose disabilities, I‘m quite sure the actual amount of faking or fraud will be negligible.

To take another example, schizophrenia is in a whole different league than ADHD and arguably worse, or on par with, losing one's legs.

> As long as we have qualified doctors diagnose disabilities, I‘m quite sure the actual amount of faking or fraud will be negligible.

There is a ton of people who get prescribed Adderall for its cognitive enhancement properties. It's incredibly easy to get diagnosed[0].

[0] https://www.psychologytoday.com/intl/blog/mouse-man/201007/n...

"there were a ton of people who did" you mean, this source is over a decade old and the diagnostic criteria have been updated since

Still an issue today.

> 55% were classified by the SAMS as likely to be malingering or exaggerating their symptoms.

https://www.tandfonline.com/doi/abs/10.1080/10550887.2020.17... (2020)

I assume you have access to the study text, what does "likely" equate to here?

Based on my experiences with the system, I'm quite sure that the actual amount of faking and fraud is extreme.

In other news, we have a national Adderall shortage because it was widely prescribed to kids whose problem was being unable to concentrate during lockdown due to stress and depression. As a result, by default teenagers lose their diagnosis when they graduate. I learned this when my son's psychiatrist had to give him very explicit instructions about how to document his disability so that the diagnosis he received in grade 1 will follow him into his adult life without having to prove it again.

> In other news, we have a national Adderall shortage because it was widely prescribed to kids whose problem was being unable to concentrate during lockdown due to stress and depression.

This is an exceptionally cynical take on the situation, one that tugs the rage strings a little too neatly for me to think this is an accurate reflection of reality.

Drug companies have said it's part caused by increased demand but supply has also been affected by unpublished limitations on handling controlled substances, instituted by the federal government in response to the opiate crisis.

I'm reporting on what my son's psychiatrist told us at the same time as she wrote my son's final prescription as a minor. She knew about it because she was a child psychiatrist in a system where that policy change was made.

She also told us that, BECAUSE that policy change had been made, it was no longer automatic to have a childhood diagnosis follow you into adulthood. She then walked us through the documentation that we needed to get so that my son's long-standing diagnosis actually would transfer into adulthood.

I wound up having to fill that prescription twice. Both times I personally experienced the shortage.

You might be right that there are factors other than increased demand. But demand definitely has increased. And I have no reason to doubt the psychiatrist.

> As a result, by default teenagers lose their diagnosis when they graduate.

I believe you misunderstood what happens and why the coaching was necessary. The laws governing children in K-12 schools are different from those governing adults.

Children are covered under the IDEA (Individuals with Disabilities Education Act).

Adults are under the ADA (Americans with Disabilities Act).

Lots of colleges document the differences. Bryn Mawr's page looks good. [1]

[1]: https://www.brynmawr.edu/inside/offices-services/access-serv...

She covered both.

My son needed to provide specific documentation from his school to his university if he wanted the possibility of accommodations.

Separately she walked through what my son would need to do to get an adult diagnosis that would let him continue to be prescribed Adderall.

ADHD can be debilitating when severe.

It's a truly awful condition that is not the "can't concentrate need to play games all day!" Condition the 00's characterised it as.