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Re:Doctor: ADHD, as currently defined, does not exist by JohnBooty on Monday March 17, 2014 @02:09PM (#7416864)
This article is so potentially harmful, even if it's more nuanced than the hyperbolic "ADHD Doesn't Exist" title would suggest.

The reality is that -- whatever the underlying cause -- a lot of people struggle with attention span issues, and that these issues cause a lot of pain and unfulfilled potential.

Even if ADHD medications are overprescribed Band-Aids, people benefit from them. We should try and find better diagnoses and treatments, but it makes no sense to blast people by telling them their condition "doesn't exist."

If I have one complaint about the way we treat ADHD it's a lack of education for patients. The medication is only one part of the solution and in my personal experience it's nowhere near the biggest piece. Diet, environment, sleep, and exercise are just as crucial... but these are things I figured out on my own, not anything my doctors mentioned.

  Firstly, addiction to stimulant medication is not 
  rare; it is common. The drugs’ addictive qualities 
  are obvious. We only need to observe the many patients
  who are forced to periodically increase their dosage if   
  they want to concentrate. 
This true but disingenuous at best because it omits perspective in a way that borders on maliciousness. Adderall causes only a very mild dependence according to all studies I've ever read. The FDA and my personal experiences agree. I've discontinued my Adderall on a number of occasions (by responsibly tapering it down to 0mg over several days) and it was no problem.

To compare it to something most of us are familiar with: I found Adderall much easier to discontinue than caffeine, a thing I've never been able to quit. (I've never smoked, so I can't compare with nicotine)

And to all those who say ADHD is a matter of "willpower..."

Maybe. For some.

I always told myself that too. I was born in 1976 so I went through school here in the USA right before they started diagnosing ADHD left and right and I was labeled a procrastinator instead. I never even really heard of ADHD until I was out of school.

After four years in college, which were a mix of promise and opportunities torpedoed by procrastination, I worked 10, 12, 14-hour days to finish work that I was more than talented enough to finish in 5 or 6 hours. My happiness suffered, health suffered, and relationships died.

Then I finally admitted that maybe it was a little more than a willpower issue. If it a matter of lacking willpower, why was I at the damn office trying to work long after everybody else had left? Whatever the hell my problem was, it wasn't work ethic.

So I sought treatment... at the age of 32. And while medication was only an imperfect yet valuable part of the solution, my life has been on track again for a number of years.

Re:Doctor: ADHD, as currently defined, does not exist by chimeracoder on Monday March 17, 2014 @02:39PM (#7417094)
> After four years in college, which were a mix of promise and opportunities torpedoed by procrastination, I worked 10, 12, 14-hour days to finish work that I was more than talented enough to finish in 5 or 6 hours. My happiness suffered, health suffered, and relationships died.

> Then I finally admitted that maybe it was a little more than a willpower issue. If it a matter of lacking willpower, why was I at the damn office trying to work long after everybody else had left? Whatever the hell my problem was, it wasn't work ethic.

Thank you. These two paragraphs are a perfect counterpoint to the uninformed claims I hear about ADHD all the time, so I'll probably mention them the next time I hear people claim that ADHD 'doesn't exist'.

I think the only real problem is that ADHD has always been improperly named[0]. The actual condition itself has very little to do with attention. The condition is named not after the cause, but after a symptom - and worse, after a symptom that is not even characteristic of the condition. Not all people with ADHD actually exhibit attention issues as their primary symptom, or even at all.

It's like referring to depression as "Excessive sleep disorder". Well, sure, excessive sleep is oftentimes a symptom of depression. But taking stimulants won't (necessarily) help, and trying to force people to "just wake up" (or, more commonly, "just be happy!") isn't a solution.

It's no longer socially acceptable to tell dyslexic people that their condition doesn't exist and that they are "dumb". So why is it socially acceptable to tell people with ADHD that their condition doesn't exist and that they're "just lazy"?

[0] Previously it was called ADD, and before that it was oftentimes classified as auditory processing disorders, etc.

Re:Doctor: ADHD, as currently defined, does not exist by visarga on Monday March 17, 2014 @03:21PM (#7417413)
I don't like that it's classified as a disorder. It's a different style of cognitive activity, with its advantages and disadvantages.
Re:Doctor: ADHD, as currently defined, does not exist by ajcarpy2005 on Monday March 17, 2014 @04:29PM (#7417883)
Sorry but that sounds like an after-the-fact rationalization rather than a sensible statement, especially given the piles of evidence that inflammation causes ADHD. I mean, sure, a chronic infection can teach you something but that doesn't mean we shouldn't fix it.
Re:Doctor: ADHD, as currently defined, does not exist by ahknight on Monday March 17, 2014 @04:24PM (#7417847)
Re:Doctor: ADHD, as currently defined, does not exist by exelius on Monday March 17, 2014 @04:48PM (#7417991)
It's not a "gift" or an "advantage", but it's not necessarily a disadvantage either IF the individual learns the proper coping strategies and can structure their work/life in a way that can make the ADHD less of a liability. It takes hard work.
Re:Doctor: ADHD, as currently defined, does not exist by jasonlotito on Monday March 17, 2014 @05:06PM (#7418094)
Learning to overcome disadvantages doesn't cease to make them disadvantages.
Re:Doctor: ADHD, as currently defined, does not exist by exelius on Monday March 17, 2014 @05:32PM (#7418247)
Ok, well how about this: I don't ever remember what happens in meetings. Because of this, I learned to take really good notes. As a result of my coping strategy, I always have a distinct advantage over people who don't have ADHD. I can look at my notes from 6 months ago and tell you what we talked about in a meeting.

I don't really think of it as a "disadvantage" because it's really just about knowing your personal limitations. One of mine is that I can't remember shit. Some people struggle with complex math problems (which I would say is a bigger weakness than memory issues which are easily solved with an iPhone and a notebook.) It doesn't have to be a weakness if you manage it.

Re:Doctor: ADHD, as currently defined, does not exist by flagg on Monday March 17, 2014 @08:15PM (#7419069)
Not being able to keep a complex math problem in ones head would be a memory problem as well, would it not... before my age 34 diagnosis - forget math all together... my working memory was abysmal; now I am completing 2nd year IT: ComSci. I have a chance, thanks to that "demon" stimulant medication, and a environment, where I am not told I am "lazy" any more. This article, while seemingly accurate, leaves out the obvious rare case of actual ADHD.
Re:Doctor: ADHD, as currently defined, does not exist by darkarmani on Monday March 17, 2014 @03:43PM (#7417560)
> I don't like that it's classified as a disorder. It's a different style of cognitive activity, with its advantages and disadvantages.

I'm sure the same can be said about all of the disorders like depression or anything else.

Re:Doctor: ADHD, as currently defined, does not exist by spacedmountain on Monday March 17, 2014 @03:53PM (#7417628)
What are the advantages?
Re:Doctor: ADHD, as currently defined, does not exist by exelius on Monday March 17, 2014 @04:39PM (#7417950)
People with ADHD tend to be very fast thinkers -- indeed this is part of the "problem" because while we're having a conversation with someone, we've thought through every consequence of what you just said before you finish your sentence. Because of this, we tend to get to "outside the box" type solutions much more quickly than others because we can effectively execute parallel tasks in our minds and come up with an answer to a complex problem quickly. The issue then comes in translating the issue in a way that can be communicated with others; so much so that when someone with severe ADHD seems to be very pensive in thought, they're likely just trying to work through how to verbalize what they've been thinking since before you finished talking.

Another hallmark of ADHD is actually the ability to "hyperfocus", which is almost an autistic-like quality. If I'm working on something I'm intensely interested in, I can work on it all day long and not notice that I forgot to eat both lunch and dinner. This happens whether stimulants are involved or not. It comes off as a lack of attention because, well, you ignore everything else unconsciously. When "hyperfocus" happens, you can lose tracks of large periods of time (we're talking 6 hours go by and it legitimately feels like 15 minutes.)

I do agree that it's not so much a "disorder" as it is just a different way of functioning. It's advantageous in some lines of work (a lot of software developers tend to be ADHD because of the hyperfocus) and disadvantageous in others. There are coping strategies, but it's no different than the types of things non-ADHD people have to learn how to do -- the strategies just end up being a little different and focused more on reminding us to do things.

Re:Doctor: ADHD, as currently defined, does not exist by zeidrich on Monday March 17, 2014 @05:01PM (#7418062)
Disorder is maybe a harsh word, but my issue is that it runs counter to how I want to act.

I want to do x, but I don't do it. It's really hard to explain to someone who doesn't feel the same way. It's not just a procrastination, it's a complete inability to adhere to a rational set of priorities.

For most people task avoidance is due to stress or fear. For me it was simply that it disappeared from my head while I did something else less important. Then later I realized that I didn't do what I wanted to, and tried to understand why.

Parts of the day would disappear into nothing. I wasn't avoiding work, or even procrastinating as many people would view it, I was just unable to see that mental priority list for a time.

Then there's the periods of seeing that mental priority list, but being unable to commit to any single task to the extent that nothing gets done. If there's giant pressure or stress behind something, it could force me to act, but otherwise nothing.

"Hyperfocus" is kind of true in that when you unhinge from that mental priority list you stop feeling the distractions, but the problem is you don't exactly get to choose what you want to focus on. The other problem is, that condition only lasts for a while and then you're left listless and useless. So sure, you can spend a few hours writing responses up on HN instead of working, process all that dopamine superfast, and then sit around trying to remember what you were trying to do when you sat down at your computer in the first place, until some crisis pushes you to action.

You talk about it like it's great, but I think you're misrepresenting it. It doesn't make you an incredibly quick thinker, you don't necessarily "think through every consequence of what you just said before you finish your sentence" what is more realistic is we think through some things unrelated to what was just said, sometimes this might lead to an alternate line of reasoning, a "thinking outside the box". Sometimes it just means you have no idea of what was actually just said because you were thinking about whether when they said they had been working all last night that they maybe got Pizza when they were working last night, and whether they liked anchovies on their pizza because your Dad used to put anchovies on his pizza and you never really liked them. You know, they were so salty, and the little bones got stuck in your teeth. But it's kind of cool that you can eat those little fish almost whole, unlike Tuna, which while it comes in tiny little cans is actually a pretty big fish.

Re:Doctor: ADHD, as currently defined, does not exist by JohnBooty on Monday March 17, 2014 @05:34PM (#7418252)

  Then there's the periods of seeing that mental priority list,  
  but being unable to commit to any single task to the extent that 
  nothing gets done. If there's giant pressure or stress behind 
  something, it could force me to act, but otherwise nothing.

  "Hyperfocus" is kind of true in that when you unhinge from that 
  mental priority list you stop feeling the distractions, but the 
  problem is you don't exactly get to choose what you want to 
  focus on. 
Get out of my brain! Yeah. This! Eerily accurate description of how I feel a lot of the time.

  It [ADHD] doesn't make you an incredibly quick thinker, you 
  don't necessarily "think through every consequence of what you 
  just said before you finish your sentence" what is more 
  realistic is we think through some things unrelated to what was 
  just said, sometimes this might lead to an alternate line of 
  reasoning, a "thinking outside the box".
Yeah, I agree with this. I think that people with high intelligence and ADHD often conflate the effects of one with the effects of the other.

Being smart makes you think ahead; having ADHD makes you think sideways. Together, they can be a real doozy, huh?

Re:Doctor: ADHD, as currently defined, does not exist by sizzle on Monday March 17, 2014 @07:20PM (#7418799)
wow you articulated this really well, I'm going to start explaining it like this to people. thank you
Re:Doctor: ADHD, as currently defined, does not exist by bad_user on Monday March 17, 2014 @04:59PM (#7418056)
Are you sure that "hyperfocus" is a symptom of ADHD?

I'm a developer, depending on how well rested I am I can go into that zone for 12 hours, sure, but I've always been like that since I was a child and if I want I can focus on subjects that don't bring me pleasure at all, it's all a matter of determination (edit: for me).

Observing children at my wife's kindergarten that allegedly have ADHD, it's quite the opposite of being able to hyperfocus. Such children can't focus for 5 minutes on a single thing. Like, if you ask them to draw something, or to play a game, or if you read them a story or whatever, there are children that once past the 5 or 10 minutes mark lose their focus completely and shift their attention to something else, being a constant struggle to win back their attention.

Or maybe these are in fact 2 different disorders? It does take motivation on my part to focus on things that I don't like. Plus I think doctors are too quick to prescribe medication to children, which is my only problem with an ADHD diagnostic - as focus is also a matter of training (i.e. the interest for hearing stories or drawing stuff doesn't develop overnight) and parents, from lack of time, prefer to succumb to giving their children drugs instead of reflecting on their interactions at home.

So you know, I've got a mixed feeling about this - on one hand I've seen children and even grown men that can't focus on anything at all, so I'm sure ADHD is real, on the other hand it's often misdiagnosed and those drugs may in fact do more harm than good in many cases.

Re:Doctor: ADHD, as currently defined, does not exist by darkarmani on Monday March 17, 2014 @05:30PM (#7418238)
> Are you sure that "hyperfocus" is a symptom of ADHD?

Yes. The name is a misnomer. It's a kind of executive function disorder. The ability to prioritize and focus at will on what is needed. Hyperfocus means that other things that might need to be a priority are being dropped. Hyperfocus is only good when it is on the right things.

> it's all a matter of determination.

That's good for you, but what about the people that can't no matter what level of determination? Determination isn't a solution to erectile disfunction so why is it a solution to adhd?

> on the other hand it's often misdiagnosed and those drugs may in fact do more harm than good in many cases.

Isn't that true in almost all treatments? In how many cases have medication caused more harm than good?

Re:Doctor: ADHD, as currently defined, does not exist by bad_user on Monday March 17, 2014 @06:14PM (#7418496)
So I wasn't saying that it's a matter of determination for people with real problems and wasn't in no way proposing it as a solution.

I was trying to suggest that there can't be a one size fits all - some people are fat because they practice impulsive eating at midnight and/or when upset and some people are fat because their metabolism is seriously malfunctioning (e.g. people with diabetes or a predisposition to diabetes). Can you agree that we've got at least these 2 categories? Can you see how these 2 categories require different types of treatment?

In regards to treatments sometimes doing more harm than good and my problem with an ADHD diagnosis from my experience in talking with people diagnosed as such is that the diagnosis itself is often without any hint to the root cause, being often about the symptoms. For example a magnesium deficit can lead to ADHD symptoms. If a person with a magnesium deficit takes drugs that don't treat this deficit, it's easy to see how the treatment can do harm.

Re:Doctor: ADHD, as currently defined, does not exist by exelius on Monday March 17, 2014 @05:24PM (#7418197)
Well, trying to diagnose ADHD in a 5 year old is witchcraft at best -- kids at that age just naturally have no attention span. It's not ADHD when you're 5, it's being a kid. I was diagnosed young, and let me tell you: the meds are no fun for the kid. You're amped up on pills all day then when you come home you're a zombie. It likely results in a lot of depression issues for kids who don't really understand what's going on.

When unmedicated, an adult with ADHD literally cannot focus on a subject that is uninteresting. You try, then OOH SHINY. You can try cutting out distractions, great! You get 5 minutes of work done then you have to pee. Then you notice a magazine on the table. Then 3 hours of this later, you remember that you originally had a task you were trying to complete.

It goes beyond simple procrastination: short term memory is a real issue in general, especially about doing things. It doesn't matter how hard you need to focus, you'll constantly be distracted, and when you get distracted, you forget what you were originally supposed to be doing. Likewise, you may then hyperfocus on something that is interesting to you and end up playing around with an Arduino for 4 hours without realizing it. You know how you have a nagging feeling you were supposed to do something? That's pretty much life for an adult with ADHD. A constant feeling that you're forgetting to do something. But you can't remember what it is.

It's hard to explain the difference between ADHD "hyperfocus" and just being "in the zone"; but I'd have to say it's the in-the-moment perception of how time passes. Most people when they're "in the zone" make a conscious decision to stay there: with ADHD it's almost an accidental thing where you enter a trance and only leave it when your task is done or when someone smacks you across the face.

Re:Doctor: ADHD, as currently defined, does not exist by JohnBooty on Monday March 17, 2014 @05:28PM (#7418218)
A typical ADHD complaint is that the "hyperfocus" happens but the problem is that you can't choose what you want to focus on.

  Or maybe these are in fact 2 different disorders?
Sure. Even with our woefully incomplete understanding of things, there have been recognized subtypes of ADHD for quite some time, as well as recognition that there are a great many things (situational depression, clinical depression, etc) that can affect one's focus.

And yes, diagnosing little kids with ADHD and giving them medication sounds horrifying to me.

Re:Doctor: ADHD, as currently defined, does not exist by watwut on Monday March 17, 2014 @05:17PM (#7418157)
Six years old when they start school are expected to focus for 10-15 minutes. Kindergartner loosing attention after 5-10 minutes sounds to be exactly where he is supposed to be.
Re:Doctor: ADHD, as currently defined, does not exist by bad_user on Monday March 17, 2014 @06:44PM (#7418619)
Yes, that's my opinion as well, but there is a lot of variation in the same age group. That number was pulled out of my ass btw, I only observed the differences while being there as a volunteer for various activities and from my wife's stories. And because of this variation, I think people are too eager to diagnose children with ADHD. And this is also a pity, since there may in fact be children with real problems that can't be separated well from children that are simply being children.
Re:Doctor: ADHD, as currently defined, does not exist by JohnBooty on Monday March 17, 2014 @04:13PM (#7417771)
It's hard to generalize, but when paired with intelligence and so forth, ADHD symptoms like restlessness, curiosity, "not fitting in" etc. can work as positives.

It's often been said that these can be beneficial traits in entrepreneurs.

Re:Doctor: ADHD, as currently defined, does not exist by ahknight on Monday March 17, 2014 @04:28PM (#7417877)
> when paired with

No. The other traits are themselves beneficial. Do not confuse their success in spite of their ADHD with success because of their ADHD.

Re:Doctor: ADHD, as currently defined, does not exist by darkarmani on Monday March 17, 2014 @03:44PM (#7417566)
> I think the only real problem is that ADHD has always been improperly named[0]. The actual condition itself has very little to do with attention.

I think it should be called "executive function disorder."

Re:Doctor: ADHD, as currently defined, does not exist by ahknight on Monday March 17, 2014 @04:30PM (#7417890)
Too broad; Asperger's is also considered an EF disorder. While there are many similarities (people in support groups for either tend to call the other "cousins") they are very different in presentation.

Yes, it is an EF disorder, but one of many on the spectrum of EF disorders. That said, I can think of no better name at the moment.

Re:Doctor: ADHD, as currently defined, does not exist by siphor on Monday March 17, 2014 @03:23PM (#7417433)
To play devils advocate, I think its possible that ADHD as a title is more harmful. Letting people fall into a self-fulfilling prophecy that may or may not have occurred otherwise.

You say you were more than talented enough to finish said work in 5-6 hours but couldn't. To me that sounds like you thoroughly did not enjoy it and thus got distracted and 'procrastinated'. Why did you choose to work in an office if it was making you so unhappy?

It sounds like the drugs helped you live your life in an office setting, and is helping you get your life on that specific track.

I personally think there are a lot of societal pressures that makes one feel forced into a situation where they do not thrive.

But everyone around says that `you` have a specific problem. Why can't it be the other way around, everyone else doesn't fit to you?

These drugs seem to work great to make you live like everyone else. But why is that good? More boldly, why are the ADHD symptoms bad? Some of the most successful people probably exhibit these symptoms.

Re:Doctor: ADHD, as currently defined, does not exist by JohnBooty on Monday March 17, 2014 @04:46PM (#7417984)
I don't feel that Adderall even remotely makes me "like everybody else" - I feel it has some benefits toward reducing a specific difficulty I have and that those benefits outweigh the minor downsides.

  To me that sounds like you thoroughly did not enjoy it and thus 
  got distracted and 'procrastinated'. Why did you choose to work 
  in an office if it was making you so unhappy?
I certainly don't blame you for making this assumption, since I didn't flesh out my (not terribly interesting) story. And I also agree that there are a lot of upsides that come with ADHD, though of course it's hard to tell which positive personality traits are /due/ to ADHD and which are coincidental.

However, the truth is that I actually tried starting my own business I was passionate about /before/ even considering an ADHD diagnosis!

Just like you said, I decided my inability to focus in an office environment was due to a lack of motivation. (And that was partially true, it turned out, but wasn't the whole story)

So I started my own business. Now, at the time, I didn't think about ADHD very much at all but my opinion of it was that it was a thing they over-diagnosed in kids so they could sell a bunch of pills and basically make excuses for boring teachers and ineffective parenting.

After a couple of years creating the business it was pretty clear I was hitting the limits of my ability to focus even when doing "the fun stuff" like writing code for a thing I was passionate about. And don't forget that running a business also requires a lot of deadly boring stuff too - taxes, regulations, paperwork, etc.

It was at that point I started looking at a lot of things and decided maybe exploring the ADHD thing made sense after all.

Re:Doctor: ADHD, as currently defined, does not exist by spacedmountain on Monday March 17, 2014 @04:13PM (#7417767)
I've found the opposite. About 6 months ago, I began to suspect I had ADHD. I went for help, and was diagnosed about a month ago. I haven't used it as an excuse, on the contrary I am now able to understand and catch my symptoms in the framework of the disorder. Maybe an analogy is trying to run while having different length legs. Once you realise this reality, you are able to understand, compensate, and adjust.

I do think there is a component of ADHD treatment that is trying to 'fit in' to a society that doesn't think the same way the person with ADHD does. But there are big impacts on people's lives independent of society. And its not easy to always be "different", disruptive, and/or inattentive to people around you.

Re:Doctor: ADHD, as currently defined, does not exist by JohnBooty on Monday March 17, 2014 @05:48PM (#7418338)
I feel the same way. And congratulations on your progress!
Re:Doctor: ADHD, as currently defined, does not exist by jasonlotito on Monday March 17, 2014 @05:14PM (#7418143)
You're asking a lot of loaded questions. These drugs allow me to do what I want to do. Why isn't that good?

People who try to claim that ADHD symptoms are good are probably people who aren't diagnosed with ADHD (and let's not get started with OCD).

Re:Doctor: ADHD, as currently defined, does not exist by djyaz1200 on Monday March 17, 2014 @02:29PM (#7417003)
I agree the article is potentially harmful. The paradox is that people who DO NOT have ADHD easily get hooked on meds but people who DO have ADHD hate taking meds. Saying ADHD doesn't exist is cruel and shows how badly it's misunderstood. The newer drugs that have countermeasures that prevent snorting/abusing should change the debate. Older meds that can be easily abused should be taken off the market. Then let's see who wants to abuse them? Anyone with any proximity to ADHD kids knows getting them to take their meds is a chore, they enjoy just being themselves and perhaps the bigger questions is WHY DO WE HAVE TO MEDICATE PEOPLE TO MAKE ENGAGE IN AN EDUCATION SYSTEM THAT SUCKS?! EH? I'm proud I don't sit still and do what I'm told, I don't think that's an illnes... so in that sense they are right ADHD doesn't exist! (steps down from soapbox, exit stage right) :)
Re:Doctor: ADHD, as currently defined, does not exist by MBCook on Monday March 17, 2014 @04:14PM (#7417774)
> Saying ADHD doesn't exist is cruel and shows how badly it's misunderstood.

I didn't get that from the article at all.

He's not saying people don't have problems, he's saying the label ADHD is doing a disservice. It's not a condition, it's a symptom.

If we had a label called "breathing problems" and just lumped all lung-related stuff in there, it would be problematic too. That doesn't mean no one has lung problems, it means we need more narrow diagnosis such as pneumonia, cancer, cystic fibrosis, bronchitis, asthma, etc.

The article is completely right. Any disorder that fits 90%+ of the population is too broad. Either it needs to be split into multiple disorders or the criteria need to be tightened.

This is a categorization article, not a "there's no such thing as ADHD they're all faking it, work harder slackers" article.

Re:Doctor: ADHD, as currently defined, does not exist by exelius on Monday March 17, 2014 @04:45PM (#7417977)
I won't dispute that the definition of ADHD as it exists in clinical guidelines is entirely too broad. I do think that there is a "condition" that exists in a smaller subset of the population that is described by the guidelines of ADHD, and it's not a sleep disorder or anything like that (in fact, my ADHD is far worse if I sleep too much.)

But the article is potentially harmful because it discounts this population and pretends that there's nothing there. The author says "there is no such thing as ADHD" without allowing for the possibility that there actually is, but it's far too broadly applied and needs to be tightened up.

Re:Doctor: ADHD, as currently defined, does not exist by JimboOmega on Monday March 17, 2014 @02:33PM (#7417040)
I think you're wrong there - ADHD is generally associated with a higher risk of abusing drugs than for people without the condition. (And myriad other conditions, including getting in car accidents).

And as someone with ADHD I never hated taking the medication. It was, like for the OP, a great experience that let me do a lot of things I didn't think I was capable of doing.

I do hate taking too much of the medication, granted. Accidentally doubling my dose is always something that I really regret.

Re:Doctor: ADHD, as currently defined, does not exist by stan_rogers on Monday March 17, 2014 @04:53PM (#7418030)
There's a little hole in your argument. You've lumped "meds" in with "drugs". And sure, they fit into the broader category. But let us, for the sake of argument, say that "meds" is a term generally used for substances that effectively treat a problem/condition, while "drugs" (at least as it seems to be used here) is a much more general term.

People will self-medicate when they can, and they will use anything that reduces the symptoms they perceive as problematic even when those substances have detrimental effects elsewhere in their lives. Taking into account only correlation, there are abnormally high numbers of people with chronic depression or dysthymia among alcoholics and those addicted to other CNS depressants (like barbiturates), of people with bipolar disorder among cocaine addicts, and of schizophrenics among people who even the most pro-weed activists would say use an, um, immoderate amount of hallucinogens.

So it is unsurprising that people who have something like ADHD (for want of a better label) may find relief for the symptoms they feel in some substance that at least gives them the perception that the problem is ameliorated (whether or not it actually helps functioning). And since the problem reduction is imperfect or short-lived, there is apt to be a bit of overuse or compensation for diminishing returns (rather like the "sunk cost" phenomenon). There is nothing to suggest that medications that actually work tend to be abused among that population (accidental missing or doubling notwithstanding - I do that with my Parkinson's meds occasionally, and it ain't fun when I do).

As a long-time recovered addict, I have no trouble saying this: the biggest problems with medications that you actually need is that they only do what they're supposed to do. (Post-surgery morphine was a complete bust, and it went away before I could rely on it for anything but high-level pain.)

Re:Doctor: ADHD, as currently defined, does not exist by zeidrich on Monday March 17, 2014 @04:44PM (#7417970)
If ADD/ADHD is a matter of willpower, then maybe that is true, but willpower is a neurological resource. Exercising willpower diminishes that resource, you can see that in studied conditions like decision fatigue.

If some people have too little of this resource to function in a normal capacity, why then should people argue against a drug that helps buoy this resource.

If doctors found a better way to treat the condition, neurogenesis or something, then fine, do that instead. But right now, we're in a position where some people, whether through genetics, traumatic stress, brain damage, or just diverse brain chemistry, don't function as well as others. We also have medication that can keep that "willpower" hanging around in your nucleus accumbens.

What bothers me is the pseudo-scientific idea of a mystical "Willpower" that just manifests itself in "good" or "strong" people, as though there's a moral component. It's like running a race with one leg, and being told "Stop using a prosthetic! Just use 2 legs! Everyone else is!"

Re:Doctor: ADHD, as currently defined, does not exist by JohnBooty on Monday March 17, 2014 @05:42PM (#7418306)
Amen. It's funny how as a society we've come to accept certain mental issues as things rooted in brain chemistry and others are still "willpower" issues; issues of personal quality.

I think that at this point, nearly everybody in the civilized world accepts dyslexia as a neurological thing and not a issue of "willpower" or low intelligence. It wasn't always that way, though - that's a pretty recent development.

I hope we can see (and contribute to) ADHD getting there in our lifetimes.

Re:Doctor: ADHD, as currently defined, does not exist by JimboOmega on Monday March 17, 2014 @02:31PM (#7417018)
So I agree this article is kind of a mess, the title misleading. This is the nature of ADHD. It's a magnet for people wanting to cry "overdiagnosed"!

However, tolerance is a big question. Taking an ADHD medicine for the first week or so after not taking any for months prior is a pretty profound experience. But that tapers off. And leaves one to wonder... is my condition still improved?

I have seen very few studies (though the ones I saw were positive, indicating positive effects even a year out). I've heard of doctors prescribing drug holidays to minimize tolerance (and also heard this was no longer current practice from an expert in the field).

It's an area I'm always somewhat concerned about. I've read anecdotal stories suggesting that one becomes tolerant and experiences less of certain effects (such as appetite loss, and the 'buzz' feeling) but not others (such as attention span).

I will say that as physical effects go dependence is not an issue. But it is for mental ones - without the medication I'm just exceptionally tired and hungry, and almost entirely useless for anything that requires focus.

Re:Doctor: ADHD, as currently defined, does not exist by JohnBooty on Monday March 17, 2014 @04:25PM (#7417861)

  > I've heard of doctors prescribing drug holidays to 
  > minimize tolerance (and also heard this was no longer current 
  > practice from an expert in the field).
When you say "drug holiday" do you mean temporarily reducing your dosage, or temporarily stopping the medication entirely?

I can't speak for current practice in general, but I've had a couple of doctors and a nurse practitioner recommend tapering down my dose a bit on days when it's possible (ie, days off from work, etc) in the last few years.

I don't know if everybody would respond this way, but a lot of feel doing that helps stop tolerance/dosage creep, which was definitely a thing I experienced in the beginning. After some experimentation it seems like the way to go for me. I've been steady at a prescription of 15mg/day for a few years. Some days I take ~10mg and some days I take ~20mg.

Re:Doctor: ADHD, as currently defined, does not exist by trillium on Monday March 17, 2014 @03:22PM (#7417420)
I've written a book on ADHD (Adult ADHD: What You Need to Know). I specifically looked into the tolerance questions. The doctors I found who are experts in the field and have treated a very large amount of patients say developing tolerance is unusual.

*Minor edit

Re:Doctor: ADHD, as currently defined, does not exist by darkarmani on Tuesday March 18, 2014 @01:41PM (#7423544)
Thanks for writing a book. I haven't read your book, but I've found Delivered from Distraction to be a godsend. You can't help but read that book and either feel comfort for yourself or a better understanding of someone else who you just realized has ADD.

http://www.amazon.com/Delivered-Distraction-John-J-Ratey-ebo...

Re:Doctor: ADHD, as currently defined, does not exist by JimboOmega on Monday March 17, 2014 @03:49PM (#7417599)
What in unusual? Any sort of tolerance?
Re:Doctor: ADHD, as currently defined, does not exist by trillium on Monday March 17, 2014 @03:57PM (#7417656)
Edited to make more clear, thanks!
Re:Doctor: ADHD, as currently defined, does not exist by DanielBMarkham on Monday March 17, 2014 @02:50PM (#7417180)
So I'm with you. I also suffer from attention span issues. It's been a terrible thing to have to live with at times.

But I have to ask an honest question: do you have a deficiency for which you need treatment? Or do you have a personality type which might make you unsuited for certain types of work? Or -- more likely -- do you have a tendency for a type of personality attribute expression which varies depending on various external stimuli?

I think it's perfectly fine that something like ADHD is a naturally-occurring personality trait and/or state of mind for which we might need medication to overcome. At the same time, I'm not too happy with characterizing it as a disease or dysfunction. I think we are taking people who are acting in a completely normal fashion and telling them something is broken about them. That ain't right.

In other words, you both might be right. It's not an either-or situation. As we continue to develop our knowledge of the brain, it's a terrible mistake to create some artificial "perfect" personality and mind that any deviation from is a disease. Very. Bad.

Re:Doctor: ADHD, as currently defined, does not exist by JoeAltmaier on Monday March 17, 2014 @03:25PM (#7417441)
Why is it ok, if its 'natural' or a native trait? My eyes are bad; should I go around without glasses to prove some ethical point?

No, ADHD exists, my family exhibits it (3 generations now and counting), and it can be harnessed, treated or ignored with wildly differing outcomes.

Harnessing and treating it are vastly preferable to ignoring it.

Re:Doctor: ADHD, as currently defined, does not exist by jaggederest on Monday March 17, 2014 @03:08PM (#7417304)
I would argue that the vast majority of people diagnosed with ADHD don't fit the DSM V criteria for a disorder. They're experiencing "an expectable response to common stressors", and probably not "reflecting an underlying psychobiological dysfunction" - they're human, humans are often distracted, this is not a disease until it gets to the level where it absolutely begins to destroy your life, and even then it's probably reflective of something else going on rather than a primary disease.

The key to anything as a disorder in the DSM is that it:

Features

A a behavioral or psychological syndrome or pattern that occurs in an individual

B the consequences of which are clinically significant distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning)

C must not be merely an expectable response to common stressors and losses (for example, the loss of a loved one) or a culturally sanctioned response to a particular event (for example, trance states in religious rituals)

D that reflects an underlying psychobiological dysfunction

E that is not solely a result of social deviance or conflicts with society

F that has diagnostic validity using one or more sets of diagnostic validators (e.g., prognostic significance, psychobiological disruption, response to treatment)

G that has clinical utility (for example, contributes to better conceptualization of diagnoses, or to better assessment and treatment)

Other Considerations

H no definition perfectly specifies precise boundaries for the concept of either “medical disorder” or “mental/psychiatric disorder”

I diagnostic validators and clinical utility should help differentiate a disorder from diagnostic “nearest neighbors”

J when considering whether to add a psychiatric condition to the nomenclature, or delete a psychiatric condition from the nomenclature, potential benefits (for example, provide better patient care, stimulate new research) should outweigh potential harms (for example, hurt particular individuals, be subject to misuse)

Re:Doctor: ADHD, as currently defined, does not exist by JohnBooty on Monday March 17, 2014 @05:18PM (#7418166)

  But I have to ask an honest question: do you have a deficiency for which
  you need treatment? Or do you have a personality type which might make 
  you unsuited for certain types of work? Or -- more likely -- do you have 
  a tendency for a type of personality attribute expression which varies 
  depending on various external stimuli?

  I think it's perfectly fine that something like ADHD is a naturally-
  occurring personality trait and/or state of mind for which we might need 
  medication to overcome. At the same time, I'm not too happy with 
  characterizing it as a disease or dysfunction. I think we are taking 
  people who are acting in a completely normal fashion and telling them 
  something is broken about them. That ain't right.
I love the way you put this, and I agree with a lot of what you said. BUT I also don't think what you say is incompatible with treating focus issues as a problem that can be helped by medication.

For me, learning about ADHD was very liberating!

It wasn't a diagnosis that told me I was fundamentally broken as a person; it was exactly the opposite.

I had a lot of love and support growing up in the 80s and early 90s, don't get me wrong. But I also got a lot of negative reinforcement and had come to think of myself (as a certain book title suggests) as "lazy, stupid, or crazy" (ok - maybe just lazy or crazy) when it came to focus and procrastination issues. I never even considered ADD/ADHD because as far as I knew, it was a label for hyperactive kids and I was never hyperactive.

Those are very broad terms, you know? I really felt like there was fundamental shit wrong with me. I grew up believing in hard work but had the hardest time doing homework and taxes and things I didn't want to do.

So learning about and eventually being diagnosed with ADHD really helped the way I feel about myself. Instead of feeling broken on some fundamental level, I came to feel like I had a pretty specific thing to deal with; one that could be helped by medication and proper sleep/diet/environment/exercise.

Edit: I also want to address this one specific thing you said:

  Or do you have a personality type which might make you unsuited 
  for certain types of work?
I can't think of a single line of work that doesn't benefit from an increased ability to focus.

Even entrepreneurs, who are often famously ADHD (or ADHD-like, anyway) in their restlessness and curiosity, need to focus on the mundane stuff sometimes.

And it's not like medication erases those positive ADHD traits either. The fact is that stimulants leave your body pretty quickly, and with something like your Adderall dosage from day to day. If you're responsible and take a little bit less on the days you don't need it, you can take a little more on the days when you need it more. You can tailor the effects a bit depending on your needs on a particular day.

(Note: The medication is far from perfect; it's not for everybody and is not a cure-all. Biologically, stimulants are a very crude way to address one's focus. In my experience, proper sleep/diet/exercise/environment are more important than any medication I've tried.)

Re:Doctor: ADHD, as currently defined, does not exist by DanielBMarkham on Monday March 17, 2014 @06:58PM (#7418696)
I agree. It's the stigma that I'm talking about. Medicating yourself to adjust your ability to focus in order to perform your job? Like I said, count me in for that.

As a society we're going to have to accept that people are different, and that people may need various medications to adjust their performance capabilities to do various things. That doesn't make these people broken! Simply because you are taking some chemical to do X doesn't mean that you are disabled.

This is going to be a big leap for society. Up until now it's all been "If you need drugs, it must be because there's something wrong with you!" Well, not really. We're all "broken" in various degrees....

Re:Doctor: ADHD, as currently defined, does not exist by JohnBooty on Tuesday March 18, 2014 @05:00AM (#7420859)
Yeah. The stigma is a terrible thing, possibly the worst thing about it.

I never, ever mention ADHD in a workplace[1]. Too many misconceptions, and too many people willing to assume that you're trying to make "excuses."

If I have a specific need, such as having a quiet work area for concentration's sake, I don't ever shy away from making my case for it. But I never present it in the context of "having ADHD."

[1] Although perhaps future employers will Google me and see this discussion. :)

Re:Doctor: ADHD, as currently defined, does not exist by jptman on Monday March 17, 2014 @02:30PM (#7417014)
I think the article is trying to say that ADHD is an umbrella term used for a range of symptoms, rather than 1 disorder. I can imagine this being true for at least some of the cases, but it didn't provide much in the way of evidence. Although it does have a sensationalist headline, it's asking for a better look at ADHD rather than saying it should be ignored.
Re:Doctor: ADHD, as currently defined, does not exist by skywhopper on Monday March 17, 2014 @03:08PM (#7417307)
If you do any reading on ADHD, I think you'll find that everyone who knows anything about it would agree with this. ADHD is defined as a collection of related symptoms, with the full admission by everyone involved in the definition that the causes are varied, that most of the symptoms are exhibited by everyone to some degree, and that effective treatments likewise vary greatly.

In other words, ADHD is no different than any other mental disorder, except that the drugs have effects people like, even if nothing's wrong with them.

Re:Doctor: ADHD, as currently defined, does not exist by MBCook on Monday March 17, 2014 @04:17PM (#7417791)
But isn't that a problem? Shouldn't we try to split ADHD up into smaller more specific disorders so that we can better study/treat it?

If lumped all together, that seems to only help cause over-diagnosis (because the symptom list is so large) and makes it harder to study (because two very different conditions may be manifesting in very similar ways).

Re:Doctor: ADHD, as currently defined, does not exist by spacedmountain on Monday March 17, 2014 @04:29PM (#7417881)
Actually, it is split. There are three types of ADHD - predominantly hyperactive-impulsive (PH), predominantly inattentive (PI), and combined (C). There is also Sluggish Cognitive Tempo, which seems to be related to ADHD-PI, but there is less research on it.

Additionally, people who may seem to have ADHD may in fact have OCD, anxiety, depression, or other disorders. And vice versa. Or they may have a combination of one or more of these with ADHD.

Re:Doctor: ADHD, as currently defined, does not exist by MBCook on Monday March 17, 2014 @04:31PM (#7417893)
I was not aware of that.

As someone outside all of this (I've never had to deal with it, so I only have a passing familiarity) it sounds like the term ADHD needs to be removed from use as it's only causing more confusion. The various facets should have their own name.

Re:Doctor: ADHD, as currently defined, does not exist by 300bps on Monday March 17, 2014 @05:15PM (#7418148)
So I sought treatment... at the age of 32.

Hi John, I'm curious if you tried any of the following before trying medication:

1. No TV

2. No Video Games

3. No Internet aggregators (slashdot / digg / reddit/ hn / etc)

4. Meditation

I am a colossal procrastinator and frequently unfocused person that had a much less successful academic career than you due to that. So far I've been going through periods of trying the above, thinking that medication is an absolute last resort. So far I haven't had to go there but I'm curious as to what things you may have tried before going to medicine?

Re:Doctor: ADHD, as currently defined, does not exist by eruditely on Monday March 17, 2014 @05:24PM (#7418196)
You obviously do not understand how this even works. With my kind of ADHD. Okay here set a remminder to do this, except with your reminder, you forget to remember the reminder.

"Remind yourself! But I forget to remember!" It just doesn't work in the space planning/organizational structure that normal people use to cope with their problems, and their stupid fucking instructional ways to suggest otherwise just give other people with armchair opinions more safe-guard to continuously allow people to have shit opinions.

People with ADD, are much more likely to engage in drug abuse, criminal behavior, and under-perform. It is a societal COST to not help them out.

Re:Doctor: ADHD, as currently defined, does not exist by Houshalter on Tuesday March 18, 2014 @08:05AM (#7421383)
Well my anecdote: Before technology, I procrastinated just as much, by spending many hours walking outside. I can't say technology improved things, but it's certainly not the root cause. Can't say I tried meditation, it seems like pseudoscience. I haven't tried medication yet either, but I'd really like to.
Re:Doctor: ADHD, as currently defined, does not exist by eruditely on Monday March 17, 2014 @05:14PM (#7418139)
Thank you. Every time I set down my wallet, keys, phone, and pocket equipment and whenever it's time to pick everything up. I lose everything. I have lost my wallet + cash roughly 6-9 times this year so far and probably like 4k cash.

I always miss deadlines and forget everything, I was diagnosed with ADHD with a child, but went along with the narrative that I was just lazy, or didn't have discipline, or was just an underachiever(even though everyone would insist I was very smart), some of my friends when I graduated high school going to MIT/Princeton told me. "Dude, cmon you should be here with us, what's going on?".

So I resolved many times so far to try harder and that I was just lazy, and gained many times extreme inspiration, inspiration that almost all in my life say they've personally never experienced, but always I would lose my path. I would just, forget... then one day on the bottom of depression and people around me picking up on my anxiety issues, people around me kept picking up on observations of me and recommended I try to get professional help.

I know now I actually have this fucking thing, and that for me it's so bad that even if I know that some task is due that will cause me impending doom in a matter of a few days on even 3 hrs. I will always just get distracted, or forget some deadline. Over, and fucking over again, but if I actually remember to take this stupid fucking medication that i'm given. My life is normal again and I can actually achieve the performance my peers/teachers/community has always expected of me.

Through fucking countless suffering and being told i'm a lazy piece of shit, dumbass kid is always late to class even though I arrived to school early because I got distracted. I found that i'm not always like that. I have PLENTY of emotional baggage, and my personal life is 40x crazier than what i'm allowed to post here(Friends in prison in recent years).

But this DISORDER, however ill-specified it is or what everyone's fucking problem it is. Taking my medication daily or SOMETHING will help me achieve. So when I'm not distracted i don't crash into the fucking car in front of me or the side pavement of the freeway to check my phone impulsively over and over again.

Lol. You people have no fucking idea what you do to me with your armchair bullshit opinions, and you have NO idea how much it's hurt me over the years. I can't tell you how many times I haven't had the attention spamn to notice my tire is flat or THIS, OR THAT. Is happening. Some times, I just get distracted by whatever activity that I forget to eat for like 2-3 days straight, and thus at 5'7 am roughly 100~ish pounds.

Re:Doctor: ADHD, as currently defined, does not exist by darkarmani on Tuesday March 18, 2014 @01:42PM (#7423557)
The book below is pretty awesome. The other wrote two different books: Driven to distraction and delivered from distraction.

http://www.amazon.com/Delivered-Distraction-John-J-Ratey-ebo...

Re:Doctor: ADHD, as currently defined, does not exist by NextUserName on Monday March 17, 2014 @06:22PM (#7418525)
For every one of you who takes the meds route, there are others who change careers, jobs, or learn exercises and methods to stay on task better. This has been the traditional way to deal with these problems.

I am not saying that I would not do any different if I were in your shoes, but changing your career to match your brain sure sounds more natural, and that is usually a good thing.

It is sad how science and technology has made normal people have a medical condition. A couple of hundred years ago you would have been a farmer rather than a banker. Now you are on mind altering drugs the rest of your life.

Re:Doctor: ADHD, as currently defined, does not exist by runawaybottle on Monday March 17, 2014 @07:53PM (#7418959)
Lets just be really clear about one thing, focus related drugs have been pretty common in academia and highly intellectual professions for decades now. Similarly, drugs like Ritalin are legal in Israel and can be had by anyone if they just get a script from a doc (no need for a diagnosis). In the long run I think we as a society need to grow up about this stuff, as use of some of these meds in moderation is fine either for light occasional use by those without severe focus issues, or prescription based moderate use by those that have ADHD.

Instead of sitting around and writing articles about 'omg millions of college kids and high intellectual work professionals take drugs, holy shit no one has ever taken drugs to create things before!', we just need to get real and be responsible about the reality. Don't stigmatize it, and allow people to responsibly explore the option with their doctors and see what works. Now if you disagree with this approach, you must argue that the health effects of moderate use is too severe, or the medication gives people an unfair advantage.

As far as changing careers, sure, that's an option an individual can explore. If they feel like they can deal with life acceptably with some medication, what's wrong with that? Are they assholes now? Frauds? Phillip K Dick was a anphetamine abuser (which no one advocates), but incredible writer. I would never dare suggest someone limit their potential if there are options they can reasonably try.

Re:Doctor: ADHD, as currently defined, does not exist by NextUserName on Friday March 21, 2014 @02:39PM (#7443945)
>Phillip K Dick was a anphetamine abuser (which no one advocates), but incredible writer. I would never dare suggest someone limit their potential if there are options they can reasonably try.

This is very telling and I believe that it defines pretty clearly the rift between our convictions on this.

In the near future, we will have the ability to augment our brains via drugs and implants to make us many more times smarter and more productive. We are starting down this path already. Where does our humanity end up after all of this. There will certainly be a tradeoff.

I believe the present and future of humanity is better off letting us reason with out own natural brains vs enhanced/inhibited (enhanced/inhibited always go together because there is always a tradeoff, even if eventually the only side effect is an imbalance of abilities). I am not saying that I never condone the use of ADHD drugs and Antidepressants, but when they are handed out like candy - I see that as being a problem. Clearly you do not, but that is the difference between us.

Re:Doctor: ADHD, as currently defined, does not exist by Houshalter on Tuesday March 18, 2014 @08:09AM (#7421392)
A couple hundred years ago I would have been essentially blind because a lack of these "unnatural" glasses. There's a good chance I'd be dead because of "unnatural" vaccines and antibiotics.

No, technology hasn't made normal people have a medical condition. We already had a medical condition. Science and technology allows us to understand that, and to improve our lives beyond just "give up and get another job".

Re:Doctor: ADHD, as currently defined, does not exist by NextUserName on Tuesday March 18, 2014 @08:27PM (#7426071)
You have to draw a line somewhere don't you? otherwise we've eventually got Gattica.

Does wearing glasses modify the logical center of your brain like Ritalin? How about we start genetically engineering humans to be smarter, stronger, etc. How about we give all short kids hormones so they can be as tall as the rest of their classmates, it's only fair after all. Vaccines do something that nature also does, it is just in a more controlled way, antibiotics are used to save lives so they have a different consideration, again though the thing that I want to underline is that altering the brain's chemistry and behavior is bad.

Some things like modern agriculture seem like good ideas at some level. Tons of food can be achieved cheaply, but it has side effects of pollution and toxins/antibiotics ending up in our bodies, the cycle of life and our ecosystem is damaged. The same with factories. They can produce amazing amounts of goods, but they can also destroy the earth.

Systematically altering thoughts and minds because they don't fit into office jobs well is something that will end up with consequences (it already is starting too).

Re:Doctor: ADHD, as currently defined, does not exist by Houshalter on Wednesday March 19, 2014 @12:06AM (#7426760)
One, who the hell cares? Just because something is natural doesn't make it good. If you want natural, go live in a cave and risk dying whenever you get a cut or a tooth infection. There's nothing wrong with improving things.

Two, again, it's a real condition that seriously affects quality of life. Your argument is about as reasonable as telling crippled people they shouldn't have wheel chairs, or depressed people they shouldn't take anti-depressants, or otherwise blind people have glasses, etc. It's absurd and offensive.