Researchers are questioning if ADHD should be seen as a disorder

https://www.economist.com/science-and-technology/2024/10/30/researchers-are-questioning-if-adhd-should-be-seen-as-a-disorder

by uxhacker • 2 years ago

29 39 2 years ago

economist.com

gregjor• 2 years ago

https://archive.is/2024.10.30-182635/https://www.economist.c...

rodgerd• 2 years ago

"Researchers would like to take treatments away from disabled people and tell them to just crack on with it"

adolph3• 2 years ago

Since the 1990s the first line treatment has been microdosing meth, not crack.

[I]n late 1984 and 1985; this rapid increase in use and availability was named the "crack epidemic", which began to wane in the 1990s. The use of another highly addictive stimulant drug, crystal meth, ballooned between 1994 and 2004.

https://en.m.wikipedia.org/wiki/Crack_cocaine

grammarxcore2• 2 years ago

The comment said “crack on with it” not “take crack for it.” “Crack on” is an idiom more associated with British English than American English.

https://dictionary.cambridge.org/us/dictionary/english/crack...

smolder2• 2 years ago

While I feel people who benefit from treatment (even those who are yet untreated,) shouldn't be denied treatments that are a clear positive contribution to quality of life, I tend to agree that it's not a disorder of the individual but a normal response to the disorder imposed by society as it operates now. The attention economy impairs attention spans.

TomK324• 2 years ago

ADHD can be found not by name but by symptoms and descriptions of patients over at least the last two centuries. Don't blame it on modern technology.

smolder2• 2 years ago

Sure, I don't doubt that. But it also seems to me that those symptoms are exacerbated by the kind of sensory overload that is enabled with modern technology. So I also think it's more common and more severe in terms of impact.

djmips• 2 years ago

It sure feels like everyone is ADHD but I'd also assume there are the outliers where it's debilitating.

cyberax• 2 years ago

The article literally is the opposite of the headline...

dr_dshiv• 2 years ago

It’s the best disease, I tell my kids.

Btw, long term heart issues are more positive for those prescribed amphetamines than those with adhd but unprescribed. Phew.

But we are different.

fao_• 2 years ago

That's great!

ADHD makes me utterly incapable of holding a job down, creating a CV, or even "performing being disabled properly" because to "perform being disabled" you have to do things like regularly travel to the job center, do lots of phone calls and scheduling with medical professionals, actually going through the "disability application" process (which requires going to court when they inevitably refuse you), etc. There's a laundry list of medical issues I've been putting off for- literally years now- and only half of those got solved when one of my friends stepped in and acted as a carer. The rest seem intractable at the moment.

The last psych I saw for ADHD ignored my two prior failures at holding a job down, my inability to properly access healthcare, my inability to sit down and read a god-damned book or study at something for more than an hour, and wanted more salient evidence. Namely, she wanted me to acquire another job (I'm not quite sure how, because despite my skill and very large breadth of knowledge (acquired back when I could focus on things — I suspect stress has had an impact on this), I have two large gaps on my CV and less than 2 years combined in a position) and fail at it before providing treatment. To me, right now, in the current status of the hiring economy, that's basically an insurmountable task where there's no guarantee that if I do those things, that I will actually be prescribed treatment. Which is a hell of a situation to leave someone in, especially when my symptoms match up exactly with people I know who have ADHD (I've literally pointed at people with my symptoms and gone "sounds like ADHD buddy", and they've been prescribed, lmao), and the solution to all of this is a non-stimulant like guanfacine, or literally just "adderall". The doses are small enough that when it's working well it doesn't feel like you're on anything, which is very hardly comparable to me downing so much caffeine at my first job to function that I ended up having panic attacks in meetings.

So like — what, do I pay 3k on a private psych that might say the same damn thing? Do I struggle uphill forever until I can finally "perform adhd" enough for them to see me and believe that I'm not just trying to find a way to sell pills? What are my options here supposed to be that aren't "get ground up by a system that doesn't want me around"? It makes me wonder why I bothered putting my life on pause for (honestly much longer than,) two years for the appointment in the first place.

Articles like this leave me in a position of — ok, but who is this point of view helping. Almost anyone I know with a mental health disorder that has actually managed to create a stable life for themselves has said medication was the key — that yes, over the long term, the solution was to reframe and reorganize their environment, acquire stability, etc. but that they wouldn't have achieved any of that without medication and therapy to provide the tools and stability necessary to do that from. I know people, and I myself personally, have gone to heath services seeking support for mental health issues with, e.g. depression[1], and been presented with — not even social options (group therapy) — but mindfulness therapy[2]. I genuinely wonder how many people are driven to suicide by a system that takes years of work to basically battle them into giving you a solution to something, and that provides approaches that leave people putting in a lot of work and feeling utterly uncared for.

Increasingly, the health systems that people rely on do not want to give those initial tools — and while there are a number of very good reasons for this, it drives people to unsafe alternatives. I very literally know someone in another country who buys black market amphetamines and purifies them into ADHD treatment, simply because the alternative is "no treatment" or shelling out 300 bucks a month. Drugs are a huge risk for people with ADHD, I wonder how many people are out there doing cocaine or street meth to function when they could be taking drugs at low dosages dispensed by a doctor with medical training all with a level of certainty that trace elements present are not going to completely rot your brain.

I'm not quite sure how to finish this, since the graphomania has kind of left me. 50/50 chance on whether i can focus long enough to read the comments! lmao

[1]: Before I discovered that my depression is entirely because of how fucking hopeless my circumstances feel like.

[2]: Mindfulness therapy can be very effective, I've used it on myself. But it requires a better presentation than the website's "wish yourself better with the power of your mind!", it should absolutely not be a first-line approach of therapy, and especially not for depression. If I hadn't had personal experience with it it probably would have taken many months with a therapist for me to be convinced that it's a thing that works, quite frankly. What I'm trying to say is that most people are not as open minded as I am towards mindfulness as a Thing, and it felt like a slap in the face to me. It was almost as bad as me waiting 8 months for speech therapy and getting a letter that boils down to "Sorry! The best we can do is these recorded zoom links, 30 minutes each, one of which is a dead link!"

dqv• 2 years ago

Articles like this leave me in a position of — ok, but who is this point of view helping.

To me, this point of view is helping a younger me and a younger you: future generations. It is prescribing a sociological solution to this problem. One where my mother wouldn't have had nearly as much anguish from the neuroticism of managing her own deficits while also trying to manage mine. One where in my twenties, I wouldn't have struggled trying to form foundational habits (like brushing my teeth longer than 10 seconds and twice daily).

They describe providing support systems that go beyond just medicating. But for those of us who didn't have all the structural support needed to thrive, medication is absolutely necessary, there is no question about it. For future generations, maybe we can lessen the need for these medications, because they do have side effects for some people independent of the benefits.

Probably the most frustrating part of these types of discussions are when someone who is so insular, so lacking in the ability to understand what it's like to be someone else, that they can't understand that the forming and ingraining of basic functional habits does not come natural to everyone.

How did I actually go about getting the medication? A private psychiatrist, like you say; paid out of pocket (the total cost of the psych and meds being $160/month total). Someone who was OK with not being overly critical of how I described the problems I was having because they were going to be paid for it without insurance bullshit. Then GoodRX to get a lower price on the amphetamines. In other words... an existing support system already had to be in place for me to be able to get the medication. I don't really need it anymore, or rather, I don't need it all the time.

I'm wishing the best for you, please don't give up hope. Even with some semblance of a support system, my situation was shitty, so I can't imagine what it's like for you, but--well, there is no but. I hope you get where you want to be.

onewheeltom• 2 years ago

I’ve managed to make it to retirement age with inattentive ADHD having only been fired from one job. I wish I could tell my daughter (with ADHD) how to deal with it. It’s all so exhausting…

notjoemama• 2 years ago

The fact the article is blocked puts a damper on being able to converse. I just opened a letter from a health care provider, a third party to a clinic that ran tests from my primary care provider, whose notice was about a data breach. Basically, everything was taken. Everything. If you ask, the answer is yes. I'm disinclined to create yet another account on another site that I have to keep track of at the moment.

About the topic. My wife has inattentive ADD and it has put a great deal of tension on our relationship. A few things have improved after she got meds. Because of the fears around stimulant medication, and some intentional scarcity by Pharma, the costs have increased and they are now more difficult to get. I have to wonder...is this "new perspective" simply a reaction to those issues? Is it a reality that leaving everything you pick up in the house where ever you distractedly last left it, having multiple bills sent to collections agencies, and struggling to maintain a normal friendships, not...a disorder?

I do think people are affected to varying degrees, like most things. And I have no way of knowing whether that's a point the article mentioned. But I am suspicious given the problems of the medications that effectively treat the decrease in activity of the executive function in the brain. Cognitive behavioral therapy is NOT a cure-all.

If you are curious about ADHD/ADD, I highly recommend looking for presentations by Dr. Barkley on YouTube.

bookofjoe• 2 years ago

https://archive.ph/HPXe2

TomK324• 2 years ago

I second watching Russ Barkley PhD on Youtube. Inspiring that he still covers the topic in retirement because he views it as the most underdiagnosed disorder in psychology despite being so easy to be treated. In regards to meds, this is stupidity and avoidable https://www.youtube.com/watch?v=eRPeU1DYOWA

nashashmi2• 2 years ago

Instead, they say, ADHD may simply represent another point on the spectrum of neurodiversity: the range of different ways of thinking and behaving that count as normal.

Every disorder comes in this category. All are equal. Including the person who cannot pay attention and the person who pays too much attention to details.

I had severe ADHD and a version of autism growing up. I never got any treatment. And by the time I was in college, I realized EVERY INDIVIDUAL has some mental impairment that causes them to not do as well as the next person. I refused to take medication at this point.

Over time into adulthood, I was able to reduce the ADHD symptoms. It came up every few months for weeks at a time. I would just take a time out and become quiet during those weeks. I reduced my autism somehow as well. Both illnesses were out effectively out of consideration. Several years later I go to a stressful workplace and within 6 months my ADHD and autism return.

I now understand why I had it in the first place. It was induced. And it was dysfunctional parenting. I am still trying to distill precisely what factor is inducing the illnesses.

My definition of autism is the development of the mind is skewed in one direction and becomes unable to grow and develop in other areas of life. My definition of ADHD is dissatisfaction with the current state of things causing the mind to jump around on to various topics. The skewed thinking of the mind and dissatisfaction of the current topic is induced from rash reactions in response to sudden stresses. I think the causes are fault blaming, irrational gravities, fear, anxiety, and pressure changes... that could be either coming from within or from elsewhere.

LaundroMat• 2 years ago

If you don't want to I understand completely, but could you elaborate on what the dysfunctional parenting entailed?

nashashmi2• 2 years ago

fault blaming, irrational gravities, fear, anxiety, and pressure changes

TomK324• 2 years ago

I now understand why I had it in the first place. It was induced. And it was dysfunctional parenting. I am still trying to distill precisely what factor is inducing the illnesses.

You realize that their parenting is likely to have been like that because they have ADHD as well? Financial troubles, drug abuse, forgetting or neglecting your kids and all sorts of spontaneous decisions come with being a parent with ADHD. You won't be able to break this cycle if you don't own your ADHD properly.

burnt-resistor• 2 years ago

If it impairs someone to where they can't work, can't prioritize tasks, can't finish things, and can't organize their thoughts then it's patronizing to tell them they are "normal and don't have a problem, and just need to work harder".

seba_dos12• 2 years ago

And just because I was lucky enough to be able to organize my life in a way that lets me be productive even though I can't prioritize tasks, finish things or organize my thoughts doesn't mean everyone can or that I'll be able to continue doing so indefinitely.

gxonatano• 2 years ago

"Disorder," at its most basic, simply describes a lack of order, which is not the same thing as a congenital disease. These days, we tend to over-identify with a given diagnosis, as if it were a permanent condition. People talk about their ADHD diagnosis as if it were a fact as permanent about them as their eye color. And for those that have struggled with ADHD their whole lives, it can certainty feel permanent. But if your room's in disorder, you _can_ tidy it up—, even if it takes you all year. "Disorder" in this sense is a description of state, rather than an inherent property.

Furthermore, the attention which is in disorder with ADHD is a skill which can be acquired. You can train your attention like you train a muscle. There's a real proliferation, these days, of medical and chemical treatments for ADHD. And many of them really help people. But if your goal is to build muscle, maybe what you need isn't a steroid injection, but an exercise. Some of the best ways to train one's attention are the oldest. Zen Buddhism, for example, has been around for fifteen hundred years or so, and has a lot of evidence behind it. If you sit in zazen for a full sesshin, at around ten hours a day for a week or two, you will undoubtedly start to develop strong powers of attention. But even ten minutes a day is effective. Hard work, daily, at training your attention, _will_ turn disorder into order.

okwhateverdude• 2 years ago

This is a hilariously bad take. I am going to guess you do not have ADHD? The people that do and cope successfully without medication, will probably count in your book as having exercised that muscle. But that problem doesn't actually go away. They are coping with it. It is a constant maintenance that takes energy away from simply being. It is permanent regardless of how much woo-woo meditation they do, unless you have actual evidence that this is an effective treatment?

snuxoll• 2 years ago

People talk about their ADHD diagnosis as if it were a fact as permanent about them as their eye color

Because it is, that's a fact. The defining characteristic of ADHD is a lack of dopamine, a physical variation in the brain itself, and that will never go away for somebody who has the condition.

ghostpepper• 2 years ago

The article seems to contradict this:

Scientists looking to simplify matters with a checklist of biological markers of adhd have come up empty-handed. Two people with adhd may exhibit similar symptoms caused by entirely different underlying psychological and neurological processes. Imaging studies that have examined the structure and workings of the brain have failed to agree on what, if anything, characterises the adhd brain.

drewcoo• 2 years ago

"Disorder," at its most basic, simply describes a lack of order

That's not what disorder means here, though.

In the case of psychology, a "disorder" it's a difference from the status quo. "Normal" is a very hazily-defined human range and anything else is "abnormal." And the recognized boundaries of normal move over time and with context.

Being gay used to be considered a disorder.

Today, believing you experience magical miracles is a disorder unless it's in a religious context.

vitriolix• 2 years ago

I'm of the opinion that we should instead work on destigmatizing people with mental disorders. I find it descriptive and don't buy into this superpower BS

coldblues• 2 years ago

ADHD is one of the most well-researched disorders, and medication is very effective. Removing the "disorder" label would only lead to people not getting the help they need. In Europe it is already an awful situation with psychiatrists completely ignoring your symptoms or using outdated information for diagnosis such as not being able to sit still or say the days of the week backwards (I shit you not, that was a hard requirement that exempted me from diagnosis).

For some reason, neurotypicals really want to normalize our disorder so that we can be exempted from proper medication and treatment because we're just like them but just a little quirky. It makes me very angry to think that instead of just giving people medication, one of the most effective treatments, they'd rather just employ "accommodations" that nobody is going to care about properly implementing, if they even barely help at all.

TomK324• 2 years ago

Know what my untreated ADHD (not for long I hope, finalized my diagnosis last week) costs me every single week because I don't work as much as I should be able to? 1000 Euros if not 1500. Every single week. I have enough of working as a freelance developer with a minimal amount of work getting done and my bank account in constant overdraft. Gimme meds.

Cieric• 2 years ago

While I understand the point of the article mainly being about adapting environments to better suit ADHD, I do disagree with the idea that it shouldn't be treated like a medical disorder. I was diagnosed with ADD (before they were merged into one disorder,) And it did effect a lot of my ability to learn in school. Unless it was something that I was interested in even outside of school. I'm well aware that this is my own opinion, but the rapid influx of people exhibiting these issues seems unusual. I'm wondering if this could be caused by some environmental factors during and even before childhood. Having some form of diagnoses would be a help to potentially finding the root cause of the issue.

While this claim is unfounded (I have yet to see any research around it.) I think the current increase in ADHD like symptoms could be something like the leaded gas issues of the 1960s - 1970s.

I would rather minimize the issues than trying to workaround them as even with the mitigations in place it'll still effect abilities to work on things that people do like.

SaberTail• 2 years ago

I think it's at least plausible that ADHD traits could have been useful in the hunting and gathering environment humans evolved in. Being more inclined to pay attention to new things in your environment might make you more likely to discover threats and new food sources. Being able to hyperfocus might be useful if you are practicing persistence hunting and following prey for hours. These traits become a "disorder" because they're not as well suited to capitalist modes of production.

legitster• 2 years ago

As someone who has probably has severe ADHD, I've never felt like it's a disorder. It's just the way my brain works. It's the way it's always worked.

I was good at school, despite having a complete inability to study. I have a very successful career and just have a set of good and bad habits that work for me. I see the exact same behavior in my father and in my children. I just consider it part of my personality.

I don't understand why people are so obsessed with sticking labels on everything. It's really easy to draw a circle around any set of behaviors or attributes and give it a name.

I was given the exact same set of challenges as everybody else growing up. I was also given the freedom to solve them in my own way. And now I can solve the same set of problems as everyone else can, just in my own ways.

I don't know if my peers who received intervention faired any better. If anything, it seems like attempts of making their childhood easier through medication and special curriculums just left them blindsided by adulthood.

seba_dos12• 2 years ago

With support nets in place, it can feel like "superpower". Once those fall apart, it feels like "disorder".

By "support nets" I mean anything around you that's preselected to amplify your strengths rather than weaknesses. A successful person will have accrued those over many years - a job with enough novelty, profitable interests, an understanding partner, self-regulation routines, tons of "life hacks" around... but sometimes those fall apart and reveal the real difficulty. And, it turns out, you may not have as much time for rebuilding them available as an adult as you did growing up.

xcrunner529• 2 years ago

I can see a lot of that but I wonder what the solution is for many who have it who said their anxiety was actually caused by untreated ADHD.

Sir_Twist• 2 years ago

I have ADHD. I am not a doctor, and I don't have any real authority on the subject beyond my personal experience. But one thing I have observed about discussions on ADHD is that people with ADHD tend to fall on a spectrum, with a wide range of severity and presentation of symptoms. So I think it is unfortunate that these discussions make such broad, sweeping claims about what ADHD is and isn't, and what impact it really has.

I can't speak for anyone else, so I will just speak for myself: I am a college student, and my normal experience is having to fight tooth and nail for capturing every deadline, every little detail - the actual "difficulty" of the class is not what makes it difficult for me. I have had to construct systems around my symptoms: an "inbox" notebook for deadlines, a complex to-do list system, a system of pages upon pages where I break down large tasks into smaller ones, because only then will it be possible to get them done. A sleep tracking notebook, a notebook for exercising, a time blocking journal, and so on. I manage to get by, and I get good grades, but every morning I wake up prepared for war. I am in a permanent state of playing blitz chess against my mind's most insatiable distractions - a hard problem to solve with a system, since the only thing making me use a system is myself. I don't use TikTok or any other social media, which has garnered more than a few odd looks from my friends over the years, but frankly I consider it completely necessary.

I don't think about my ADHD as a part of my identity, or a part of my personality. It is, however, a disorder. Unless the world magically reconstructs itself around these symptoms, this will continue to be the case, because I simply do not have the same abilities as the average person in any given task of attention or impulse. Of course, the "average person" doesn't really exist; everyone has their own issues, their own reasons to wake up prepared for war. Everyone has something going on that deeply concerns them, whether others know it or not. But, for me, ADHD would not make sense if it weren't a disorder. It is a constant disabling factor in my life. Given that ADHD is one of the most well-researched and scientifically demonstrated neurological conditions, I doubt it is going anywhere anytime soon. But my ADHD is not a normal way to interface with the world. It was never "solved" with positive reinforcement from teachers, nor is it restricted to the classroom. Such a fundamental issue is not solved with basic accommodations - there is no silver bullet against the monkey in my head.

All of that being said, this is just my own experience, and my own thinking. I'm sorry for the long wall of text, but a lot of these discussions take the person out of the disorder, and consider broad swaths of the population according to the commenters' personal sociological constructions of the world, so I wanted to contribute my own individual experience here.

Researchers are questioning if ADHD should be seen as a disorder

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