Ritalin Gone Wrong

http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-add-drugs-dont-work-long-term.html

by cs702 • 14 years ago

200 154 14 years ago

kghose• 14 years ago

Though one could say "Another Nature vs Nurture"-er, this article is interesting to me from a "responsibility" point of view.

Our children are our responsibility. As tempting as it is to put the child in front of a TV, or pop it a pill, or (in the future I am involved in a small way in building) stimulate neurons in the brain to get some effect, there is a huge component of taking responsibility for actually nurturing a child: being near him/her, empathizing and simply supporting.

This article reminds us, we are responsible for the kids, by leading through example and by trying to understand and taking up the challenge of correcting wrong behaviors and supporting correct ones.

itmag• 14 years ago

I'd be interested in hearing what a (non-kooky) fringe scientist like Seth Roberts has to say on ADD.

It always seemed weird to me that huge amounts of people should be taking Speed on a daily basis. Has there been any research into treating ADD with stuff like low-carb diets, vitamin D, limiting EMF exposure, limiting videogames, fish oil, filtering chemicals out of drinking water? I'm just throwing those out there as hunches; I have no idea if they're scientifically valid.

akavi• 14 years ago

>filtering chemicals out of drinking water

I encourage you to give that a shot and report back on your results.

sebphfx• 14 years ago

it really is Speed. I'd be curious to see the percentage of the ADD drugs that are being crushed and snorted. As a kid, we used to snort Dexedrin and Ritalin and it's called the poor man's coke. You even get a heavier crash than bad coke. The same thing is happening with prescribed opiates. More people are taking them for other reasons than for the ones they were intended for. I already know that comment is going to go at the bottom of the page since I'm talking about experience and not scientific studies,but, it's my own experiments and empirical evidence.

jinushaun2• 14 years ago

I graduated with a degree in biochemistry hoping to get into the biotech/pharmaceutical industry, but was turned off by the emphasis on treaments instead of cures. Ritalin and Aderall seems analogous to taking pain killers to treat an open wound—masks the symptoms (pain) but doesn't address the cause (open wound).

With the explosion of ADD prescriptions, one has to wonder if our society/environment is causing this problem. Is it diet? HFCS? Modern parenting styles? The internet and information overload?

_delirium4• 14 years ago

My cautious guess in the specific context of academia (where I am) is that unreasonable expectations may be one factor (though probably not the only one). Academics calibrate their norms by a handful of famous people who have relatively rare cognitive styles, and due to academic competitiveness there's strong pressure to match that.

There are plenty of people who are objectively normal, in the sense of having traits that fall comfortably around the median of the population, who in this context feel that they're pathologically abnormal, because they're using very high baselines: if you calibrate "normal" by the 90th percentile for some trait, and you're 50th-percentile, it's tempting to conclude that what's holding you back from being at the top of your field is a medical problem that should be treated. And maybe it still should; I'm not inherently against taking drugs to mentally enhance people's performance above normal levels (nootropics, etc.), but imo that's a separate discussion that should be had with open eyes.

deno5• 14 years ago

> Ritalin and Aderall seems analogous to taking pain killers to treat an open wound—masks the symptoms (pain) but doesn't address the cause (open wound).

And how are you going to address the open wound? There’s no brain surgery for ADHD.

A better analogy is that of wearing glasses. Glasses don’t actually fix your eyesight, and you need them all the time, but they allow you to function normally. Medications used for ADHD treatment are exactly like that.

> With the explosion of ADD prescriptions

There’s an explosion of sensationalist reporting by general media. ADHD is still under-diagnosed in USA, and it’s even worse in Europe.

It’s exactly the same as the “explosion” of autism. No, the vaccines are not causing autism, just because there’s more data and a better awareness of the disorder.

mikeash2• 14 years ago

I find the juxtaposition of "non-kooky" and "limiting EMF exposure"/"filtering chemicals" to be really odd. A lot of these may well be interesting, but those two in particular just scream pure kook at me.

tokenadult2• 14 years ago

I was interested to see that the researcher who wrote the op-ed, a psychologist based at my alma mater, has participated in some of the research projects he reviews in the op-ed. As I read the comments here, I'll be collecting ideas for questions to ask the local researcher in person as I try to learn more about ADD. I was particularly interested to see that the op-ed criticized several earlier studies for their study designs.

http://norvig.com/experiment-design.html

I first became interested in what adult ADD treatments do after seeing a testimonial from an HN participant, a programmer, who said that his productivity increased dramatically after beginning ADD medication as an adult. I have since read parts of quite a few of the recent scholarly publications on ADD, especially those that focus on adult ADD, to try to wrap my mind around the trade-offs of medical treatment versus other approaches to symptom management. (I'm also still trying to make sense of just how ADD is defined, especially among adults who were not deemed to have ADD in childhood. The definitional issues are rather complicated.)

http://www.cdc.gov/ncbddd/adhd/diagnosis.html

http://www.nimh.nih.gov/health/publications/attention-defici...

http://www.mayoclinic.org/medical-edge-newspaper-2011/mar-18...

Another participant here has already commented that there may be other interventions to consider when grappling with problems of attention focus. What are the best sources on other interventions (diet, lifestyle, etc.)? What are the trade-offs of those? For the occupations most pursued by participants on Hacker News, do you find it helpful to seek ADD medication if you are found to have ADD symptoms? What do your loved ones and colleagues think about your performance on a before-and-after basis if you have tried treatment? On the whole, ADD seems to involve a minority of participants in any occupation, but perhaps a more significant minority among HN participants than among some other subsets of the human population. I'm still trying to get a reality check, and would like to learn more.

dlytle2• 14 years ago

I'm currently taking adult ADD meds (Adderall); it's a double edged sword, and I'd personally really prefer to find another method.

The primary problem is, during any sort of transition I would be pretty useless, and I can't afford to take that long being useless with my current job.

I went cold turkey from 25mg of Adderall XR daily, and for about a week and a half I was absolutely dead. I'd have a splitting headache due to dehydration, but I couldn't summon the energy to get off the couch and walk 12 feet to where I had bottles of water. I'm glad I went cold turkey rather than just tapering the dose, though, because tapering the dose would have taken months of feeling miserable, rather than 1.5 weeks of feeling like a dead man.

If you hear anything interesting from people about biofeedback/etc, long-term non-medicinal adult ADD treatments, could you toss me a mail at taloen@gmail.com? I'd really like to see other peoples' opinions on those routes, and I don't lurk enough on HN to be likely to see a submission about it.

(Just to clarify; yes, I'm back on the Adderall XR again, although at 5mg rather than 25 this time.)

ulisesrmzroche6• 14 years ago

I stopped on 56mg for two months and did not have any withdrawal symptoms. You may want to talk to your doctor about this, withdrawal like the one you experienced is not very common, I think.

qrybam• 14 years ago

Scary thought: Going cold turkey with coffee has had very similar effects on me (after 2 weeks of 1-2 cups a day; 2-4 shots/day).

I've also had a similar feeling of deadness when I stopped eating meat, dairy and anything with additives for 6 weeks. The first week or so I was completely useless - this could have also been due to me trying to feel my way through to a balanced diet.

So much of what we consume ends up having all sorts of unknown effects on us and the minute we stop consuming them we really feel it - it's easier to never stop.

One bonus of cutting certain stimulants out of my life has been that I've ended up feeling much better.

drumdance2• 14 years ago

I tried Adderall last year and had a similar reaction. I used it during the week but went off it on weekends. I only did it for two weeks and that was enough for me to know I didn't want it.

furyofantares• 14 years ago

I'd love to find another method as well. I am 31 and I've been on and off it for the last 6 years or so. More off than on, because I really don't like the effects it has on me, so I really only go on it when my life is in shambles.

One pattern I've noticed is that when I'm off it, I self-medicate with caffeine and energy drinks. It starts with an occasional Starbucks or Coke and before I know it I'm getting a venti latte with an extra shot every morning, then drinking 3-6 rockstars/redbulls/cokes throughout the day.

tocomment• 14 years ago

What do you mean by transition?

tripzilch• 14 years ago

I tried a few sessions of bio-feedback but quit because I got frustrated by it and not being worth the time and money.

During the intake the therapist described Ritalin as "poison". I should have probably gotten up and left right there. If you have the opinion that Ritalin is overprescribed, or that it should not be given to small children, that's all fine with me. But "poison" has a pretty clear definition, you'll find that whenever someone refers to a drug as "poison", you're dealing with pseudo-scientific quackery.

What made me quit was mostly that I couldn't find any correlation between the signals received from the electrodes and my own state of consciousness, be it more relaxed or more concentrated or alpha/beta waved, whatever.

When I watched the graphs on the monitor, I noticed a few things. There is a LOT of noise. If I'd clench my jaw, move a muscle in my neck, my ears, whatever, it'd cause an avalanche of noise, completely drowning out any possible brain signal. Ok so you sit still, you're meant to focus or relax anyhow. Except that muscles just seem to generate a whole lot more electrical signal than your brain, and every time I even blinked my eye there was a burst of noise (probably also because the eye muscle is relatively close to the electrodes). The software did nothing to filter out these noise-bursts, even though it'd have been trivial to make at least a basic attempt that would throw away the data during a burst so the other filters wouldn't trigger.

Ah, the other filters. Well, it quickly became clear I knew a lot more about DSP than this guy. He had no idea how his device operated, at least not how the signals were transformed into whatever was displayed on the screen. There's not really an excuse for this. Sure enough a surgeon might not know about the algorithms used to convert an MRI scan into a picture, but the radiologist does (at least, on some level), which is why we have radiologists.

So you know about these alpha/beta/theta/gamma brain waves right? They're at 12/10/7/3 Hz frequencies or something like that. Now I always had the idea that by this they meant some fundamental Eigen-frequency of signals in the brain, so you'd think to apply some auto-correlation to determine the base frequency and its harmonics. But instead he had a bunch of bandpass filters running concurrently being graphed through some ancient MS-DOS program with obvious leakage from one band to another and we were looking at the raw filtered signal, not even its energy and as I said there was no noise suppression.

I'd have loved to take that device home, write some code for it and see what it could detect though. Hell, even detecting muscle movements is already way cool :)

Anyway, no correspondence between my state of focus or relaxation.

Staring at a computer screen (with a game, usually one frequency band was used to control a game of some sort) for 1-2 hours per week, actively trying to relax or focus would definitely have a result of course.

Which is why I'm doing a universal yoga meditation class. Dunno if it helps with the ADD, but it can't hurt and it definitely has some other advantages (notably: posture and stress/tension). One thing I do notice, yoga works best if I haven't taken meds that day. You'd think it improves focus, but this yoga class is mainly being able to really feel your whole body and muscles should not be tense for that, but on meds I find I get way more fidgety and subconsciously re-tense every muscle I relax as my focus shifts to the next part of my body. Fortunately, noticing and being aware of such subtle effects in your body is exactly what the class it about :-)

rms7• 14 years ago

Modafanil works to cut Adderall withdrawal symptoms for most people. And Modafanil withdrawal is nothing more than being unusually tired, but not miserable.

Osiris• 14 years ago

I was also taking Adderall XR 25mg for about 2 years until I had to change doctors and the new doctor was concerned about my high resting heart rate so he gave 1 month of 10mg. After that was gone, I was pretty unproductive for about 2 months. I simply had a hard time concentrating, like I was in a haze.

I just restarted on Adderall (generic, 5mg x2 a day) and the side-effects are definitely difficult to deal with. I am able to hyper-focus but I also get irritable, daily headaches and exhaustion when it starts wearing off. I tend to take it one in the morning as I start work and perhaps once in the afternoon if I find that I need it, but I don't take it on weekends at all.

There's definitely something to be said for behavioral adjustment rather than medication. That's how my mom deals with it, but even so she's pretty scatter-brained.

jneen3• 14 years ago

I never took ADD meds as an adult, but what really enabled me to kick the habit in college was a sincere and dedicated meditation practice (in particular I took up passage meditation, but any sincere practice would have done the trick). Actually I just sort of forgot to take any for about a month and didn't notice! ADD made meditation really difficult and frustrating, but it's been really worth it.

thaumaturgy• 14 years ago

I have been off-and-on seriously tempted to find Adderall, but when I stop and think about why I want it, it's because my workload is severe and I don't feel like I'm being productive enough. Then I try to question whether or not I've got unreasonable expectations for how long I can sit in front of a computer and focus on a single task.

Over the last couple of years my diet has improved a lot: less meat, less sugar, almost no junk food, more nuts and fruits and vegetables, and at least a liter of water per day now. Before, it was a rare day that I drank even a glass of water -- I usually preferred chocolate milk or heavily sugared iced tea or something.

I also get a lot more exercise now and try to maintain a more regular sleep schedule.

At 33, I'm in the best shape of my life, and I've found that now when I do need to sit down and do work, I can do it for longer and with less frustration. When I get sick of sitting and focusing on a stupid little screen a couple of feet from my nose, I know it's time to get up and do something else.

So as I gradually develop more discipline in the rest of my life, I wonder if maybe that's all I really needed to begin with. People aren't that far removed from their hunter-gatherer days, and now we sit all day surrounded by walls, without sunshine, eating really poor diets -- maybe an inability to focus and concentrate all day is just our bodys' way of objecting to that rapid change.

"Eat better, get exercise, reduce distractions" isn't a very sexy answer though, when compared to, "take a pill and become awesome like that guy in Limitless."

CamperBob• 14 years ago

"Eat better, get exercise, reduce distractions" isn't a very sexy answer though, when compared to, "take a pill and become awesome like that guy in Limitless."

I've never understood these sorts of comments, although they appear reliably in almost every story on this subject. What in the world do diet, exercise, sleep, and clean living have to do with the subject of the story, which is the ethics and effectiveness (or lack thereof) of nootropic drug use?

If anything, having seen concrete beneficial effects from the dietary and lifestyle changes you've made to date, doesn't that make you even more curious about how far such effects can be pushed?

gtani2• 14 years ago

Your unsexy answer is pretty effective. When i need to produce a lot of code, i have green tea, earplugs that block ~ 30dB of ambient sound, a good ergonomic space for 2 laptops and monitors, plus: guitar and fretless bass for regular breaks, and.. shredded oat cereal. Don't laugh, it takes no time to prepare and doesn't have drastic insulin effects. I think the guitar breaks actually has biggest lift for concentration, memory and steady energy.

Stormbringer3• 14 years ago

I regularly give up caffeine for extended periods (months) and then get back on the wagon again for similar long periods of time.

Recently during one of the transitional periods I found that caffeine negatively impacts my ability to play chess. Which is to say that I have relatively well developed (for an amateur) intuition about what moves superficially look good, but at the level I play at, extended periods of concentration are required to actually play better.

Caffeine doesn't help me concentrate, it makes me more impatient, bored faster. So I'm more likely to jump at a move which at first blush looks good. Caffeine actually makes it harder to concentrate for extended periods of time. I know that isn't the conventional wisdom, but I am convinced that the conventional wisdom is pretty much exactly wrong in this regard.

In addition, I have read that caffeine take a long time to get out of the bloodstream (a 'half-life' of ~6 hours) so the effects of large amounts of caffeine during the day translate directly into poorer quality sleep or reduced quantities of sleep at night, which creates a vicious cycle, hence when I get back on the caffeine it quickly ramps up to the multiple cups per day levels.

pault• 14 years ago

Like many my age and younger, I was diagnosed with ADD as a child (I'm 32 now) and went through the entire gamut of meds (stimulants, tricyclics, SSRIs) before discovering that norepinephrine seems to be the culprit for me. I have a very difficult time coding when I'm off the meds (I can do it, it's just difficult to keep the data structures and control flow in my head). I took atomoxetine for several years and it worked wonders, but it caused severe side effects that I wasn't willing to put up with. I've since switched to buproprion, which isn't quite as effective, but otherwise doesn't give me any problems. The most general way I can describe the difference between being medicated and unmedicated is "sharp" and "dull", extremely so.

I have a friend that says if I can't do my job without medication, I'm in the wrong profession. He may be right, but I love working with computers, and I don't have that passion for anything else, so I'll keep taking the meds. I'm no longer interested in debating the ethics, since for me it really is the difference between high performance and average performance, and there is no reward for average.

munificent• 14 years ago

> I have a friend that says if I can't do my job without medication, I'm in the wrong profession.

I hate that line of reasoning. I couldn't do my job without glasses. Does that mean I'm in the wrong profession?

rms7• 14 years ago

I indisputably have adult ADD, though mostly avoid stimulant drugs (not really at all because I have a tendency to avoid drugs, but because I dislike the subjective state of most stimulants, including caffeine).

I spent about six weeks doing a massive amount of research on nutrition. http://www.medicineispersonal.com/contest/home I designed a diet designed to maximize nutrient absorption, similar to diets used to great effect in people with various auto-immune diseases. I'll publish my research eventually but for now I'm happy to share it with people that email me (fair warning -- the paper is 9500 words with 125 references and not exactly easy reading).

I've been on this diet for about two months now, and was hoping that it would help me with ADD -- and I lost ten pounds to get to the lower end of the healthy BMI range and definitely gained physical energy, but I didn't get any smarter or less ADD from diet.

So I think nutritional interventions are unlikely to do much for ADD in people not suffering from marked nutritional deficiencies or on crazy sugar-loaded diets. Among therapeutic inteventions, Cognitive Behavioral Therapy is pretty much the only technique with compelling evidence.

Keep in mind that adult ADD is mostly a condition of lowered productivity. Stimulant drugs increase productivity in basically all adults, ADD or not. Because of fears of neurotoxicity, I stick to Modafanil and use amphetamine sparingly when I need a stronger boost. This works with my rather charmed lifestyle, but I do plan on doing a venture funded startup eventually, and believe I'd be incapable of doing 50-60 hours a week as COO without stimulants.

Stormbringer3• 14 years ago

I think before you read too much into this:

"I first became interested in what adult ADD treatments do after seeing a testimonial from an HN participant, a programmer, who said that his productivity increased dramatically after beginning ADD medication as an adult."

You should note that (according to the article) those drugs for ADD contain amphetamines.

Is it really surprising that someone self-reports increased productivity after beginning a course of amphetamines?

Anyway, the take-home from the article is that in the long term the body adapts and there are no benefits to taking the drugs in the long term, and possible negative effects to be dealt with (not sure what symptoms of withdrawl from amphetamines is, but not likely to be pleasant).

You could probably experience just as much short-term benefit from taking up smoking or becoming an alcoholic.

greenyoda2• 14 years ago

Thanks for posting the link to Peter Norvig's wonderful paper, "Warning Signs in Experimental Design and Interpretation". Having this kind of basic statistical knowledge makes it possible to critically evaluate all types of scientific research. While it may be hard to gauge the significance of neuroscience research without being an expert in the field, you can easily weed out a lot of junk science if you can tell that an experimental design can't possibly deliver statistically valid results.

obtino• 14 years ago

One of the resources which psychartrists (and psychologists) use in the diagnosis of ADD/ADHD is by using the Diagnostic and Statistical Manual of Mental Disorders handbook (DSM).

http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manu...

juiceandjuice• 14 years ago

For the record, ADD doesn't really exist anymore. It's ADHD with subtypes inattentive, hyperactive, or combined inattentive and hyperactive.

I'm inattentive. About once a year I decide to try to go without medication for a month, but it's too hard. I've done mindfulness exercises, tried to focus on developing new habits, etc... but medication works best. A combination of concerta and wellbutrin works best for me, because I can take lower amounts of the stimulants and wellbutrin has less side effects for me. I was on adderall for a few years, but headaches + sleep stuff made it more annoying as time went by.

I got diagnosed when I was 20 by a family practitioner, when I decided I was having problems with focusing (physics major). after a few years of that I decided he was shit and I needed an official diagnosis and a psychiatrist to sort it all out, someone who knew about the disorder and medications. We tried Strattera, which worked awesome except for the "sexual side effects" which were too weird for me.

Friends can tell when I'm on or off of it. Colleagues can't, although I'm conscious of my decreased work.

jneen3• 14 years ago

I was diagnosed with ADD as a child, and have experienced firsthand the kind of dependencies these drugs can create. I wasn't able to stop taking Dexedrine (essentially the same as Ritalin) until halfway through my first semester of college, when I undertook a daily practice of meditation.

Now I've come to realize that "lack of attentiveness" is part of the human condition. We can make it worse by excessive stimulation and context-switching, but this unscientific idea of an "inbuilt" disability simply doesn't exist.

deno5• 14 years ago

If you can meditate, or sit still in one place without any stimulus for that matter, you’re quite lucky. It’s an impossible task for most people with ADHD.

> Now I've come to realize that "lack of attentiveness" is part of the human condition.

No. ADHD is a hereditary neurological disorder. One of the first things that you’ll see on Wikipedia’s page on ADHD is a PET scan comparing dopamine transporter availability in a healthy brain and one of a person diagnosed with ADHD.

In children, the biological differences are real, and can by no means be explained by “experience.” E.g.

http://www.msnbc.msn.com/id/21757514/ns/health-mental_health...

jneen3• 14 years ago

That's fair. Meditation is hard, and I don't claim to be particularly good at it. On the other hand, I would say it's an extremely difficult task for just about anyone.

The study the article you posted cites successfully correlates brain differences with AD(H)D diagnosis. Part of the argument in the original article, though (which I can verify in my own case at least), is that while the brain affects observed behavior, behavior also affects the brain. So it's a very real possibility that experience and learned behavior are causing both the observed behavior and the brain chemistry differences.

gruseom• 14 years ago

"To date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems".

jey• 14 years ago

Are there any long-term studies of these issues? I'd be surprised if there's actually enough good ones to draw conclusions.

adamjernst• 14 years ago

A great point. Our brains parse "no study has found any long-term benefit" as "studies have found no long-term benefit", which is not accurate.

Tichy• 14 years ago

Good point, but doesn't the article specifically mention one 8 year study where all effects were gone by the end of the 8 years?

_delirium4• 14 years ago

On a more basic level before even getting to treatment, imo it'd be useful to have more studies on what the distribution of some sort of trait called "attention" is in the population to begin with, perhaps in various common situations. That might provide some sort of baseline: if, for example, 90% of people have "abnormally low" attention by some measure in some situation, then the definition of "abnormal" is probably wrong. In that case, rather than concluding that 90% of people need to be treated for a disorder, it might make more sense to conclude that the alleged "normal" characteristics are actually quite rare, demanding a characteristic that <10% of humans naturally have. Of course, other numbers might lead to different conclusions.

Put differently, it feels like it'd be easier to have rigorous discussions about deviations from normal mental functioning if we first had a good, data-based picture of "normal mental functioning". I've looked but have had difficulty finding any such studies.

bermanoid• 14 years ago

I'm going to go against the grain here, and argue that "normal" is irrelevant - "desired" is the target here.

If people want themselves/their children to think/act a certain way, and this opinion is widespread, then it's completely valid to treat that as the target, even if 90% of the people in society need to be chemically modified to make them act that way.

Evolution isn't perfect, and at no point has it tried to optimize for happiness, it only goes for reproductive success, which we as individuals don't care too much about, at least in the short term. If there are interventions that we can impose that better optimize for happiness than letting us exist naturally would, we have no reason to avoid these interventions.

That said, I have no idea what the optimal desired mental function would look like...

_delirium4• 14 years ago

I have some sympathy for that argument, but I think we should still distinguish the cases and talk about them accurately. If the situation really is that 90% of people need some sort of intervention to reach the desired mental functioning, then we could just say that and argue for it openly; the pro-nootropics community makes those kinds of arguments, for example. I think when loaded terms like "abnormal" or "ill" or "treatment" are used, though, they're only really accurate if we're talking about pathological deviations from a species norm.

But actually my interest in what constitutes the "norm" is somewhat more basic; I think how human attention works is quite interesting as a subject of scientific study, and I wish there were more aggregate data on how it varies in different situations and across the population.

mynegation• 14 years ago

While I am not prepared to discuss specifics of Ritalin's effects, the article raises very important point: a lot of problems happening with children are due to the neglect on their parents' (or primary caregivers') side.

I've always wondered how you have to be licensed to drive any more or less complicated mechanism, but yet you can become responsible for things thousand times more complicated and important, like children, just like that.

Having children requires a lot of knowledge, but somehow our education system is not designed to prepare us to deal with that. How many parents read books on child psychology or development? The proper alignment of incentive could help here: e.g. having some kind of a test could be a prerequisite for getting children-related tax credits and benefits.

harryf• 14 years ago

> a lot of problems happening with children are due to the neglect on their parents' (or primary caregivers') side.

That nails the problem but I disagree strongly with your conclusion this is a problem of individual responsibility. Its a social problem which we have to solve as a society by understanding why parents are having problems giving enough attention to their kids. The problems here are far more fundamental and pervasive to blame any individual parents for "failing".

Great video on the topic here http://www.youtube.com/watch?v=_-KqeU8nzn4&feature=youtu...

oflannabhra• 14 years ago

I agree that children are incredibly complicated, and raising them properly requires knowledge, but I fail to see how the educational system and government regulation have any responsibility or authority in this domain.

trotsky2• 14 years ago

When Sroufe suggests the brain disorder known as ADHD may simply be the result of environment without providing a bit of supporting evidence, he ignores mountains of data that show strongly correlated multi-generational symptoms even when there was little or no contact. There is a reason science doesn't get presented on opinion pages. Trying to convince parents that it may not be a real disorder, or may not be developmental, or that drugs are ineffective does a serious disservice to the diagnosed. Stimulant drugs are unlikely to be the end all and be all for ADHD treatment, but they are currently the best we have and they've been shown again and again to provide significant benefit.

chimeracoder• 14 years ago

The same thing can be said about depression too - we don't really know why SSRIs work, but they generally work enough that we use them as a first-line treatment for depression. Like ADHD, depression is sometimes confused for being a product of the environment, when in both cases the environment is really just an exacerbating factor (clinical depression, unlike PTSD, cannot be caused by environment alone).

The problem with studying ADHD like this is that we generally agree that ADHD is over-diagnosed and over-prescribed, but then for evidence that ADHD exists as a medical condition, we look to the existing pool of people who are diagnosed or even taking medication to confirm that there is a difference between those who are diagnosed and those who aren't. 'm not saying that this means ADHD is a hoax - I agree with you that it's more than just the environment. It's just very difficult to construct definitions for mental conditions in particular, because there's usually no way to do a double-blind randomized experiment.

The problem is that ADHD and depression are both heterogeneous conditions - they're likely not single conditions themselves, but a bunch of somewhat related conditions that we're currently unable to distinguish between. The various hypotheses for what causes ADHD (and depression) may not be mutually exclusive.

That makes studies that much harder to conduct, because you have a mixed population, which makes identifying characteristic traits harder (and sometimes impossible, depending on the mixture). It also means that anecdotal evidence is that much more worthless, because what is true about one member in the population could be completely false for another.

And, in some cases, having a mixed distribution can give you the exact opposite results; see Simpson's Paradox: http://en.wikipedia.org/wiki/Simpsons_paradox

jdefr89• 14 years ago

I am currently on two medications. VyVanse for ADD and Anafranil for OCD. As far as effectiveness, yes the medication is helpful at the beginning. However, after being on it for two years the effect of the drugs wear off and you end up doubling your dose. That seems to be the pattern with all the medications I take, even those not concerned with ADD. Honestly I really improve my productivity through therapy related techniques; meditation, therapist, developing my focus muscle.

Strangely, I don't have attention problems when it comes to the things I have interest in such as coding and computer science.

watmough• 14 years ago

If it's not too personal, can you outline some of your OCD symptoms and behaviors?

hop2• 14 years ago

I have a real problem labeling 10 year olds that get bored and fidgety in boring situations with having a brain disorder and giving them speed.

Find me 10 successful entreprenuers and I bet I can show you 10 people who had a tough time sitting through unengaging lesson plans in school. Doesn't help with ballooning class sizes either.

drumdance2• 14 years ago

Possibly related: a surprisingly high percentage of entrepreneurs are also dyslexic.

wahnfrieden5• 14 years ago

Source?

nerfhammer4• 14 years ago

This armchair criticism might apply to the hyperactivity subtype but perhaps not as well to the inattention subtype.

hop2• 14 years ago

The general point I'm making is their personality should be embraced rather than drugged. I had an Adderal prescription for a month in college, its stronger than any other stimulant I've tried and it horrors me they give it to children.

The test they give for an ADHD diagnosis is a joke too. Do have trouble focusing in class? Ah yeah, most of engineering teachers aren't giving daily TED talks... :)

angstrom• 14 years ago

I wouldn't be surprised if there is a correlation between children's transition from asset to expense in the typical urban household.

As a child I would've been the perfect ADD candidate, but with plenty of stimulation in the form of work on my parent's farm, I winded up learning how to create outlets for my restless nature. There's nothing more boring or repetitive than driving a tractor around a very large field. My mind constantly wandered and in a few occasions led to damaged equipment because of it. Lesson learned and relearned. Another example would be pacing back and forth waiting to switch the milkers on the cows during the bi-daily 1-2 hr chores. Cleaning equipment, feeding, manure removal, stacking hay bales by hand. Repetitive, repetitive, repetitive, grueling.

School was fun by comparison. Even mundane lessons had their silver lining (at least it wasn't manual labor). And when I wasn't occupied with chores or school I found other stimulation; building a large purple martin bird house, flying model rockets, helping with mechanical repair, drawing, reading, shooting guns, exploring, painting ceramics, playing trumpet, and eventually, playing with our computer. The avenues of stimulation were not forced, but open. Most importantly: I could use the things I was learning in school to see how they had purpose, if not for my own satisfaction.

Why do these kids fidget and lack focus? In my non expert opinion it's because they lack both the perspective and a positive feedback loop to stimulate their own minds. It's not a disorder of the brain by any means, but a lack of purpose. Children reject the situations because they're contrived hoops with no meaning. The constant question in any child's mind is "HOW AM I GOING TO USE THIS?!" If they can't see the purpose of the lesson they haven't gained anything more than a useless set of facts.

kpennell3• 14 years ago

Great points...

bluemetal3• 14 years ago

That is a broken argument. Are you trying to suggest ADHD doesn't exist?

Not being able to sit still is only one of multiple symptoms (from only one of the two categories - inattentive and hyperactive) used to diagnose people with one of several different sub-types of ADHD. (ADHD-HI, ADHD-PI, ADHD-C)

You need a certain minimum of symptoms for diagnosis.

Right now I have a strong pain in my left shoulder, I'm sure I am not alone in this right now of all the people in the world. I bet some of your successful entrepreneurs have had shoulder pain before. When it turns out I am not having a heart attack, and that all those entrepreneurs were not having a heart attack, would you think it correct to suggest that heart attacks aren't real? That is pretty much what you said above.

And beyond that, you need more then just a certain number of symptoms for a diagnosis of a disorder like this. There must be negative effects to your disorder in multiple spheres of your life. (home, education, romantic)

Suggested reading for anyone who doubts the existence of ADHD: http://dl.dropbox.com/u/9991388/2200_7-barktran.pdf

sek8• 14 years ago

So Ritalin is just a usual mind boosting drug, it has rebound effects and people develop a tolerance.

Like cocaine, MDMA, ephedrine and meth. It differs in it's euphoric and adverse effects, but the positive influence is not permanent.

Not a single drug can help you in the long term, you have to develop the abilities yourself. These drugs have the opposite effect, because as long as you take them you don't evolve. The worst thing is when you get used taking this stuff. You give up faster and think you are unable to deal with it yourself, what leads very fast to an addiction.

So many of my fellow students are taking drugs now for learning, especially Ritalin (but also the other stuff i mentioned earlier). I tried Ritalin once and the results were impressive, but i always had a bad feeling about this. This article proves my concerns right, Ritalin is not without downsides.

tokenadult2• 14 years ago

because as long as you take them you don't evolve.

Homeostasis of the human body does make any intervention hard to keep long-lasting. I take it you mean "develop" (the word you used in the preceding sentence) for where you wrote "evolve," because of course individuals don't evolve (in the biological sense of the word) but rather populations do by changes in gene frequencies. The story of obesity seems to be that change is hard for human beings, period, whether the intervention is medical or a lifestyle intervention. If a person has a personal tendency that is truly a disorder for adaptation in current society, maybe nothing should be taken off the table for the person seeking help. But, yes, I agree with you that willpower-developed kinds of personal behavior changes are surely helpful for ADD and for other problems too, perhaps more possible if they are backed up by external helps of one kind or another.

sek8• 14 years ago

The word develop is the right one. It is the same translation in German, my mistake.

The big problem is that while you take it, it feels like it. To make the observation that this is not permanent, while influenced, is very difficult. The feeling is very subtle and not obvious like being drunk for example.

You are right, there are extreme forms who need medication. The article suggests, that the whole ADD existence is still not clear and i was diagnosed myself as a kid. I assume that just a little part of the people who take Ritalin really need and benefit from it.

natrius• 14 years ago

"Not a single drug can help you in the long term, you have to develop the abilities yourself."

What is your proof of this claim? As with most generalizations, I doubt there is one.

sek8• 14 years ago

Tell me which mind boosting drug does not wear off?

marshray4• 14 years ago

Would you advocate the use of cognitive or psych medication that had effects that were permanent? I don't think so.

So you're effectively arguing against the use of that entire class of medication in favor of "developing the abilities yourself".

Don't take this the wrong way but in my experience people who take this line of reasoning have never closely known anyone dealing with real issues in these areas who have actually been helped by medication, or they don't know about it (people are often reluctant to share their stories), or they're a Scientologist.

sek8• 14 years ago

When we talk about normal activities like studying and working, i think so. The ability to concentrate and motivating yourself is something you have to develop yourself. Ritalin is not the wonderdrug you take and become a perfect student.

If there is something like that, the perfect drug without side effects, i don't think you can prevent people from taking it. Even for caffeine you develop a tolerance very fast.

bluemetal3• 14 years ago

What do you mean by mind boosting? Do you mean that the effects of the drug when used by people with ADHD are no different then when used by an NT person, and that everyone is just being "boosted"? (if so, this is not correct, responses to these medications and the dosages required for certain effects differ between the two groups)

When you suggest that people need to "develop the abilities" themselves, do you mean to include ADHD people in this? It is believed that people with ADHD literally cannot develop such abilities. (actually, there appears to be about a 30% lag in their development of them .718yrs = 12.6yrs, .721yrs = 14.7yrs, .7*30yrs = 21yrs etc)

sek8• 14 years ago

The big problem is that there is no easy definition of what is happening. There are some words that describe the important undertone i call "boosting", they all have some euphoric impression too, but it declines after a while. These descriptions are somewhat like "ability to concentrate", "self-discipline", "motivation", "clarity". Some people say the difference is a lack of fears, or Mr Hyde is deactivated, who always manipulates you as a second personality who only seeks short term gratification.

Maybe it is easier defined by the complete opposite: There were tests with mice without dopamine production who starved next to food.

Maybe this is the real problem, we still don't know what we are really dealing with and we compare school grades to create some numbers.

Can you please elaborate on your numbers and who they are coming from and what they really mean?

I know some people here are easily offended, by saying there is no big difference between someone who has ADD and someone who hat not. But i am diagnosed myself and can't see a difference. We have a bigger problem here so maybe we are more entitled to take these. In the end, the problems are the same.

The main thing is, fucking everybody around me starts taking Ritalin, for the simple reason being a student. I have friend's who talk only about learning and convert into a Chinese stereotype.

CChristie• 14 years ago

Physical activity -> exhaustion = improved concentration. Practiced this in college and still to this day. Otherwise, I'm all over the place.

rkon2• 14 years ago

Parents should really take note of the studies and conclusions in this article. As someone diagnosed with ADHD who has tried numerous medications (Adderall regular and XR, Vyvanse, Strattera, Focalin, and Wellbutrin) I have to say I would never ever EVER allow a young child of mine to take any of them. I can't even fathom how confusing and damaging the side effects of these medications could be to the fragile psyche of a child -- anxiety, mood swings, depression, sleep loss, etc. I was diagnosed at the age of 23, so I knew my own personality well enough to tell when it was being altered by the medications, but how would a child know this? The answer is simple: they wouldn't, and in many cases they're prescribed additional medications (usually anti-depressants and/or anti-anxiety pills) to deal with it.

I cannot respect any parent who allows their minor child to take these types of psychotropic drugs in any but the most dire of situations. Reading ADHD forums was an absolutely horrifying experience for me: parents list the multiple drugs their children are taking in their signatures as if they're badges of honor.

After 2.5 years of trying various ADHD medications I gave up on them completely and have never looked back. Yes, most of them did have the benefits they promised, but the types of side effects they're capable of producing can absolutely wreak havoc on your emotional well being even in their most mild forms.

nerfhammer4• 14 years ago

You may have been more sensitive to the side effects than most.

rkon2• 14 years ago

I didn't personally experience all of those side effects, they just seem to be the most common based on dozens of other users of those medications I spoke with after beginning them myself. There are some other very common side effects I didn't mention as well, such as headaches/bouts of anger/crashing when the medication is wearing off each day, dehydration/drymouth, and heart palpitations or racing heartbeat.

The side effect that most annoyed me was actually loss of appetite, which is basically accepted as 'normal' when taking stimulants. Anxiety was probably a bigger issue with Adderall, though. I don't recall ever talking to someone who felt zero side effects from any these medications.

cullenking3• 14 years ago

To get through college, while working, I used adderall and ritalin on and off as needed. I was floored when I first got on it, my doctor tried me on the ritalin patch at the highest dose (32 mg I think). I dropped down and was still amazed with how hard hitting this stuff was. Granted, people have different skin and uptake I am sure, but I couldn't imagine giving a kid a patch which basically made me feel like I had a 12 hour cocaine high. Yes, I plowed through work I couldn't of done in twice the time, but I was HIGH. I was able to understand how I felt, but the 12 year old that gets the same dose wouldn't...Yet their parents might think it's a wonder drug, since that kid would most likely be able to finally do their homework in one sitting.

deno5• 14 years ago

The ‘high’ goes away after two weeks of continuous use, but the cognitive benefits persist. This is exactly why ADHD medications work long term.

> But in fact, the loss of appetite and sleeplessness in children first prescribed attention-deficit drugs do fade (…). They apparently develop a tolerance to the drug, and thus its efficacy disappears.

Those are side effects in the context of treating ADHD.

Here’s a great summary: http://www.reddit.com/r/ADD/comments/no6hp/would_anyone_be_i...

danneu• 14 years ago

I take a low dose of Vyvanse and I agree. Diagnosed in my 20s.

Always dreaded school. The 8-hour-day stagnant, unchallenging classroom model never compelled me. Maybe it's time to accept that if a kid isn't compelled by our education system we might have a systemic problem that can't be fixed by prescribing kids speed until they can make it through 8 hours without having a wayward thought.

A low dose of amphetamine helped me focus on my ambitions after I'd spent my entire life scavenging for freetime to chase them outside of school. But frankly, I couldn't tell you what came first: my "ADD" or my contempt for the education system.

greenyoda2• 14 years ago

I'm glad someone brought up the possibility that the problem is in an educational system which makes demands on children, such as sitting still for hours at a time, that evolution just didn't prepare us for. Unfortunately, it's a lot easier to "fix" the children than it is to fix the school system. And since pharmaceutical companies make huge profits from selling drugs to kids, there's a vested interest in the current approach.

kpennell3• 14 years ago

I was given a slew of ADD drugs from ages 8-16 and finally quit them cold turkey after I realized what they were doing to me. It was pulling me up and down throughout the day. I was high and awkward in the morning and depressed as hell come every afternoon. This experience ended up changing me in good ways but it was very painful at the time.

I just wrote about it on Quora. http://www.quora.com/Attention-Deficit-Disorder/What-does-it...

My mom regrets putting me on meds and felt unsure about it at the time, but it was all the rage in the 90s. I think a young person with focus problems would get a lot more out of meditation, yoga, and being outdoors that they would out of these drugs, but I don't have studies to back that claim.

I just hope we look back on what we're doing and shake our heads, wondering how we could be so stupid to put millions of kids on amphetamines. Just like how we look back and laugh that we used to give children a bit of mercury to play with (with bare hands) in science class in the 50s.

psaccounts2• 14 years ago

It is a shame that most people are unaware of the efficacy of Homeopathy to treat ADD, ADHD and autism-spectrum disorders. Do some research and you'll see how hundreds of thousands of people have been cured of these ailments using Homeopathy alone.

wahnfrieden5• 14 years ago

Do some research and you'll find homeopathy is bunk. There's no science behind it, studies have shown it completely ineffective, and besides, it's just clean water.

psaccounts2• 14 years ago

You are saying this out of the research you have done yourself, right? And yes, I have done the research and also have experienced it first hand -- something that Stanford doctors could not do (and an army of 3 different specializations nonetheless) was cured using Homeopathy. Is this placebo effect?

WalterSear• 14 years ago

This is a lie. Perhaps the poster is lying to themselves, but it is a lie nonetheless.

mikeash2• 14 years ago

The placebo effect can be a wonderful thing.

nn2• 14 years ago

the association of witch doctors recommends ... water!

Detrus2• 14 years ago

With the rampant abuse of market power by the drug companies with Ritalin and anti depressants, I wonder if homeopathy could be a helpful competitor. Magic water can't cause harm and takes some money away from you so you can't use it for something harmful.

I don't remember the names, but a whole generation of anti depressants was shown to be completely useless and harmful. The initial studies were fabricated and/or got into journals unethically. The various decade long studies on Ritalin also show it to be largely useless and harmful.

Homeopathy is offensive to people who respect science, but it's a noble lie in the current market conditions.

estevez2• 14 years ago

>The various decade long studies on Ritalin also show it to be largely useless and harmful.

Twenty seconds on Google Scholar would lead me to the opposite conclusion. Your source?

sek8• 14 years ago

This is why i love HN, this post is exactly where is has to be.

BasDirks• 14 years ago

I have taken Concerta for about 3 years and it helped a great deal in getting more organized. I periodically go without it, which is getting easier and easier with time (I guess because I have been able to structure life better). Eventually I will probably quit completely.

There is a danger in throwing pills at a common problem. But there is also a danger in dismissing medication as part of a solution. People for who Concerta/Ritalin didn't work often bash these drugs as dangerous or evil.

pizza• 14 years ago

Ritalin (methylphenidate) and Adderall (Dextroamphetamine / Levoamphetamine) are interesting and powerful nootropics (http://en.wikipedia.org/wiki/Nootropic). I haven't tried them yet, although I am looking forward to the day I do. However, they do have some serious negative aspects; they are addictive and come with a substantial 'crash'. This is where the racetams come in!

The racetam family consists of nootropics that enhance mainly memory recall, although I certainly feel there's an increase in ability to think of new ideas and convey them lucidly. They're not all that new (first developed in the 60s) and are widely regarded as non-toxic, in both the short and long term (sorry, don't know how to find the study. However, as anecdotal evidence, this guy did 80 GRAMS of piracetam in one sitting, which is 100x the regular dose http://www.drugs-forum.com/forum/showthread.php?t=153468).

The stimulation from piracetam, the racetam that is most commonly used, is sort of similar to caffeine stimulation but less pronounced; I have also never experienced a piracetam crash, even after nasal insufflation of a gram and a half. Piracetam also makes me much more productive, much more than caffeine ever did or probably will ever do, and I highly suggest it for anyone who is interested in nootropics!

georgieporgie• 14 years ago

I'm surprised I haven't seen more buzz about racetams on HN.

I recently started experimenting with Piracetam. It's too early to make a judgment, but I did seem to get a heck of a lot more done in the two weeks 'on' than in several weeks prior. I'm currently doing about 2g in the morning, and another 1.5g in the afternoon. I haven't directly noticed any effect, aside from perhaps a short period of mild dizziness one day.

vlad• 14 years ago

If I remember correctly, a recent article pointed out that prescriptions in every category of drugs have increased year over year at a similar or greater rate, and that prescriptions for ADHD and ADD have actually been increasing slower than expected compared to other categories of drugs. An article like this should qualify the magnitude this way.

Secondly, as companies release new drugs that can target specific conditions better or safer than ever, treat conditions that were not treatable before, it makes sense that doctors prescribe medicines more and more often every year, especially as patents on proven drugs expire and the medications become available as cheap generics.

Volpe2• 14 years ago

Why is this on HN?

Volpe2• 14 years ago

why the downvotes? its a link from mainstream news on something unrelated to tech... can someone explain?

tim_h4• 14 years ago

The site guidelines ( http://ycombinator.com/newsguidelines.html ) say "On-Topic: Anything that good hackers would find interesting." Judging by the comments on this thread, such is the case here.

cs702• 14 years ago

I submitted the link, so I should probably respond: IMHO this falls well inside the "What to Submit" paremeters specified on http://ycombinator.com/newsguidelines.html

tim_h4• 14 years ago

I was diagnosed with ADHD at age 18. At that point in my life I had developed pretty much a hatred for school, and had resolved to never go to college. Spending 8 hours/day at school was akin to torture for me. I found it to be mind-numbingly boring.

My doctor had me try various medications. Adderall was too intense. It got me high and gave me a tendency to focus too much on the wrong level of a problem (I would obsess over details). Worse, my body acclimated and I found that I needed a higher and higher dosage to have the same "benefit".

Everything turned around for me when I found out about a different medication from a friend - Dexadrine. My doctor never mentioned it to me but once I asked him about it he agreed to let me try it. Boy am I glad he did. To make a long story short, I finally went to college, graduated at the top of my class, then went on to Stanford to earn an advanced degree. Now I have a job that I love.

I've been on this medication for almost 10 years. I never acclimated to it (in the sense of needing a higher dosage for the same effect) and the side effects are very mild (slight loss of appetite, slightly harder to sleep).

Recently I decreased the dosage by almost 50%. I've found that over the years I've somehow learned how to concentrate better, and that therefore my need for the med has decreased. This makes me think that my brain has somehow changed for the better. Perhaps all the concentrating I did while on a higher dosage served as practice and that the benefits from all this practicing apply even without the medication. Maybe some day I'll be able to get off of it completely. But for now I still have a tough time concentrating without it.

jonhendry• 14 years ago

Remember: Real science and medicine don't happen in newspaper op-eds.

bocmaxima• 14 years ago

I've been using stimulants for almost five years (age 20 now). The last year or so I reached a point where like the article said — the effects of the drugs tapered off — and there was really nothing I could do about it. As a kid I exemplified the most extreme kind of inattention, behavioral, and regulatory problems that classify ADD, but once I began taking the meds I went through an equally extreme transformation, so I'm skeptical of any article that derides the use of stimulants. I'm also reminded of what the late Christopher Hitchens said in defense of his heavy drinking and smoking:

“Writing is what’s important to me, and anything that helps me do that—or enhances and prolongs and deepens and sometimes intensifies argument and conversation—is worth it to me.”

I recently met someone who has tourette's syndrome, which means he has increased production of dopamine. In other words — the inverse of ADD. The drugs he took induced a state of ADD that was identical to what I what I experienced sans-stimulants. It's crucial for those of us with the kind of dramatic impairment that comes with ADD to get by with as much help as possible from competent practitioners (of which there seems to be a very short supply of).

laserson• 14 years ago

Wow, 3 million "children". There are over 62 million children in the US. That means almost 5% of all kids are getting medicated...

http://www.wolframalpha.com/input/?i=US+population+under+age...

Alex3917• 14 years ago

It's worth noting though that three year olds aren't taking these drugs, so the actual rate is more like 9% of kids have ADHD, and a good percentage of those (60%?) are currently taking drugs for it.

vintagius• 14 years ago

What i never understood over the years was, why Ritalin was given to kids with ADD and ADHD.All though those two disorders are related,they do not have the same effect on a person.

People with ADD tend to be tooo calm and appear to be slow ,on the other hand those with ADHD (including me) tend to be too Hyper , our minds are at full speed all the time which affects concerntrating on things we do not enjoy.I found out that Ritalin works well for me by relaxing the pace of my thoughts ,which in turn allows me to focus on a BORING thing like a volumous book.

So now how can you give a person with ADD (Slow thoughts) a drug that will make them more slow and expect results.

My conclusion is that Ritalin works better for people who have ADHD then those with ADD,and the reason why results on the improvement that Ritalin has ,have varied time and again is because a drug that work for one group (ADHD) was also given to those (ADD) it does not work for.In such a situation results will never be consistant.

Ritalin Gone Wrong

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