Doctor: ADHD, as currently defined, does not exist

http://time.com/25370/doctor-adhd-does-not-exist/

by onedev • 12 years ago

106 137 12 years ago

Pxtl2• 12 years ago

I feel like this headline is terribly irresponsible. People with mental health issues suffer from a stigma associated with them, as well as denial of their suffering.

Going out with both guns blazing to say their condition does not exist - not that it's a symptom of a larger problem, or that it's a gross oversimplification of a number of unrelated diseases, but instead the crude headline "doesn't exist" - that only makes the situation worse.

There are many people out there who need stimulant medication to function properly in their lives for very good reasons. Yes, their attention deficit may be a symptom of a complex problem, but the fact is that it exists.

Unless you have a better idea how to treat it, I don't see what this kind of article accomplishes beyond making it harder for anyone to take the condition seriously.

colechristensen• 12 years ago

It sells.

Do you have an alternative? Do we regulate what the news is allowed to say? How do we prevent such poor quality journalism?

News is entertainment (sadly, and mostly worthless), expecting it to be anything else these days is foolish.

pessimizer2• 12 years ago

Saying that a certain medical condition doesn't exist isn't a denial of the suffering of people who suffer, it's a denial of the label that's been placed on that suffering.

As long as an attack on bad science continues to be interpreted by a segment of sufferers as a personal attack, sufferers groups will never exist as anything other than tools for drug companies to subvert the scientific process.

Pxtl2• 12 years ago

Imagine reading an article on punctuated equilibrium with the headline "Darwin is Wrong". Technically true, but WTF? Or a discussion of potential side-effects of the H1N1 vaccine with the headline "Vaccines Kill People".

Just because it's true doesn't mean you don't need some tact.

Also, I notice you've assumed I'm a sufferer. You might want to put away the "jump to conclusions mat" and maybe just try having a little empathy?

darkarmani13• 12 years ago

As long as an attack on bad science

The bad science is this book that pretends to have evidence on its side.

Xylakant2• 12 years ago

Unless you have a better idea how to treat it

Actually, if you read the article until the end, it proposes a better idea to treat it: Do not lump together all the conditions that lead to the symptoms together. Treat them as individual conditions with different causes and administer appropriate treatment - don't just hand them pills because it's simple.

I sincerely doubt that stimulants are the best treatment we can give those people. They may help in the short term, but they're highly addictive and your body develops a tolerance. What are you going to do once those people are tolerant to medication? Wave your hand in the air, tell them "bad luck, you developed a tolerance, now have a nice day". Medication may be required in some cases, but it's often only the beginning of a treatment. You need to solve or at least tackle the complex problem to really help them - and assigning a simple label doesn't always help.

trillium6• 12 years ago

I've personally known someone who has taken Ritalin type meds for 20+ years and did extremely well on it. In addition, my research indicates that tolerance to ADHD meds is uncommon and typically a person can be kept on one dose for years.

vincetogo• 12 years ago

This guy is putting on his white overcoat and trying to look like a scientist, but he doesn't actually cite any real research in favour of his claim, and instead uses anecdotal evidence ("Usually, once the original condition is found and treated, the ADHD symptoms go away" and such) rather than statistics to support his conclusion and sell his book.

This isn't to say he's incorrect in his conclusion, he just isn't supporting it very well. I would hope the book has referenced stats but this article isn't very promising. He's not too far removed from a pilot claiming his story about a flying saucer must true because he was in the airforce.

For the record, I've been diagnosed with ADHD and have plenty of anecdotal evidence that it's for real, but may be suffering from confirmation bias.

batoure• 12 years ago

Yes I agree, in fact I think it is particularly concerning that these op'eds are getting picked up by more recognized news outlets. He wrote an almost identical piece for the daily mail last week.

http://www.dailymail.co.uk/health/article-2577814/The-eminen...

this is clearly just self promotion

benched• 12 years ago

As a sufferer of various mental things, I feel like the suffering and problems can be real, and the diagnoses and explanations still carry a heavy bullshit component.

darkarmani13• 12 years ago

"It’s time to rethink our understanding of this condition, offer more thorough diagnostic work, and help people get the right treatment for attention deficit and hyperactivity."

What condition? Doesn't the title say this condition doesn't exist? This article is just trying to sell his book.

Besides the fact that qEEG has shown differences in activity in adults that identify with having ADHD.

nickff• 12 years ago

Article authors often have no input on the how their piece is titled, so I would not be so quick to judge the journalist.

bryanlarsen2• 12 years ago

The book has the same title.

darkarmani13• 12 years ago

That's the title of the guy's book.

hellogoodby32• 12 years ago

He isn't denying that ADHD doesn't exist but instead he is saying that it exists as a symptom of other ailments. His title is a bit inflammatory, but that doesn't disprove his argument. The article is much better than you are giving it credit for.

darkarmani13• 12 years ago

but that doesn't disprove his argument

His argument is ridiculous. ADHD is defined as symptoms and we don't have a full understanding of the underlying cause. Everyone knows that the drug treatment only treats the symptoms. If his argument is that we are only treating the symptoms then he hasn't added any knowledge. If he knows the "cure" why doesn't he make the claim: "I know how to cure ADHD?"

hyperion2010• 12 years ago

Terrible title. Especially since there are actually people who believe that the title is true in the literal sense. The fact that we can further subdivide something based on etiology or any other criteria doesn't mean that it does not exist.

MBCook7• 12 years ago

It's amazing how many people here are skipping the qualifier in the title, taking it as "ADHD does not exist".

watwut3• 12 years ago

That is the title of both the original time.com article and the book written by its author. The qualifier "as currently defined" is only on HN.

bryanlarsen2• 12 years ago

My suggested title/tldr: ADHD is a symptom, not a disease.

It's an interesting article, but that title is going to derail conversation.

darkarmani13• 12 years ago

But that's always been the case. They don't understand the root cause or have a definitive test for the symptoms (except recent qEEG tests).

eam• 12 years ago

Pretty funny. Just yesterday I was at Barnes and Noble checking out some Malcolm Gladwell books in the psychology section and right next to them was a book with the title ADHD Does Not Exist. I didn't get a chance to take a peek at it because I was too occupied reading the first couple of pages from Gladwell's Blink which was pretty captivating.

JohnBooty15• 12 years ago

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.

djyaz1200• 12 years ago

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) :)

JimboOmega3• 12 years ago

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.

MBCook7• 12 years ago

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.

jptman• 12 years ago

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.

skywhopper2• 12 years ago

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.

JimboOmega3• 12 years ago

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.

trillium6• 12 years ago

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

JohnBooty15• 12 years ago

  > 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.

chimeracoder• 12 years ago

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.

visarga• 12 years ago

I don't like that it's classified as a disorder. It's a different style of cognitive activity, with its advantages and disadvantages.

darkarmani13• 12 years ago

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."

DanielBMarkham2• 12 years ago

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.

jaggederest• 12 years ago

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)

JoeAltmaier• 12 years ago

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.

JohnBooty15• 12 years ago

  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.)

siphor• 12 years ago

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.

spacedmountain3• 12 years ago

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.

JohnBooty15• 12 years ago

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.

jasonlotito4• 12 years ago

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).

zeidrich2• 12 years ago

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!"

JohnBooty15• 12 years ago

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.

eruditely2• 12 years ago

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.

darkarmani13• 12 years ago

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...

300bps• 12 years ago

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?

eruditely2• 12 years ago

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.

Houshalter3• 12 years ago

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.

NextUserName9• 12 years ago

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.

runawaybottle• 12 years ago

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.

Houshalter3• 12 years ago

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".

lolwutf• 12 years ago

Horse shit.

There's lots of very well-vetted science supporting the problem of ADHD and attention span disorders. Ditto for the pharmaceutical interventions that are the main-line treatment for them (amphetamine is one of the most well-studied drugs in existence).

Sad to see Time sinking to clickbait headlining.

com2kid• 12 years ago

The article is dangerously mistitled.

That multiple actual mental health conditions exist that all have been labeled ADHD is well known by the research community. There are multiple causative factors that can lead to ADHD symptoms, and what have traditionally been referred to as different subtypes of ADHD respond to different types of treatment.

This is hardly news! It is also where there are multiple treatment strategies for ADHD, until we get a better naming scheme in place (and make no mistake, the lack of proper names impacts both communication and how we think about the problem), we are stuck with using the catch all term ADHD. (Though some people have split into using ADHD-PI from primarily inattentive, it often doesn't respond to stimulant treatment at all.)

Now I fundamentally disagree with the author's final assertion that "everyone is misdiagnosed" is pure BS.

Primary evidence is that there are structural brain differences in people who have ADHD. The portion of the brain responsible for self control is dramatically smaller. Arguing that "it isn't real" when there is literally missing brain matter is disingenuous at best.

Next up, people with untreated ADHD have THREE TIMES the rates of auto accidents.

Now, maybe, just maybe, ADHD isn't real at all, and instead psychologists have spent their time and energy coming up with the best auto insurance risk test ever!

But I doubt it.

clienthunter• 12 years ago

This man is peddling a book. I'm not saying that precludes his correctness but it does mean that the more analytical of us should apply a little more salt to our appraisal of his motivations than a journalist might.

JeremyMorgan• 12 years ago

Exactly what I was thinking.

nerdo• 12 years ago

Is ADHD considered a disability? If so, looking at the timeframe (2008-2012), and the population segment (young adults), this could be the product of a backdoor welfare program, where ADHD diagnoses are the fig leaf employed.

lilsunnybee• 12 years ago

I don't think so, as far as receiving financial assistance for mental health conditions in the US. In fact except for developmental disorders and conditions involving psychoses (schizophrenia), I've heard that it is quite difficult to get any sort of assistance, regardless of how severely your life has been affected, without a good lawyer at least.

Millennium• 12 years ago

It might be better to say that the current definition of ADHD is grossly inadequate. The problems start from issues as basic as treating ADHD as one monolithic "thing," when in fact it is a symptom that can arise from many different diseases, some of which respond better to different medications than others, and some of which do not respond to medication at all. By treating them all as a single disease, we do almost all of their sufferers a grave disservice.

MBCook7• 12 years ago

It might be better to say that the current definition of ADHD is grossly inadequate.

Isn't that why the qualifier ', as currently defined,' is in the title?

EDIT: watwut pointed out to me elsewhere that the qualifier is only on HN and not in the original title.

richardlblair3• 12 years ago

Some folks are missing the point.

Both the definition of ADHD and the treatment plan for it (in North America) are broken. In France, just 0.5% of children suffer from ADHD (opposed to ~5% in North America), and with those children they find the root cause of the issue and deal with that. They tend to shy away from medication. This is, more often than not, the proper treatment option for behavioural issues.

People need to realize the DSM, in its current state, is a massive cash cow for Big Pharma. When it comes to ADHD specifically, they needed a bigger market, welcome Adult ADHD.

Finally, I realize a lot of people suffer from attention issues. I don't disagree that these things need to be dealt with, but a catch-all diagnosis isn't really the way to do that. I'm much more interested in finding the actual problem, and fixing that.

trillium6• 12 years ago

Off the top of my head, roughly 7% of kids in the US have ADHD and roughly 4-5% of adults have ADHD.

20% of boys of a certain age have currently been diagnosed with ADHD.

watwut3• 12 years ago

If the definition of ADHD includes 20% of all boys, then I'm inclined to believe the definition takes in too many kids. If 1 in 5 kids has it, then it is normal behavior in that age range.

ebiester• 12 years ago

No. The sufferers still suffer. They're just called "lazy" instead.

I too hope we can find a better solution one day, but I have all sorts of hopes for mental health treatment.

conradfr• 12 years ago

I'm French, have ADHD and had to discover by my own at 28 years old that it was an existing condition. I guess (hope) it's better recognized nowadays but still I suspect it's underdiagnosed and also you only have access to Ritalin and Concerta as possible medication with many restrictions to fulfill a prescription.

Yet it's often presented in the media as "the obey pill that Americans give to their children".

As a coincidence there is currently a shortage of Concerta until mid-April ... great.

richardlblair3• 12 years ago

By no means am I saying that ADHD isn't a thing, shouldn't be treated, and doesn't require drugs in some cases.

I'm sorry to hear about your circumstances, and hope things are going alright for you now.

jasonlotito4• 12 years ago

I wouldn't trust France when it comes to pediatric statistics.

JohnBooty15• 12 years ago

I think the author of the Time article can hardly complain if people are missing the point, since his article and book have the deliberately inflammatory title of "ADHD Doesn't Exist."

  People need to realize the DSM, in its current state, 
  is a massive cash cow for Big Pharma. When it comes to 
  ADHD specifically, they needed a bigger market, 
  welcome Adult ADHD.

If I was going to design a "cash cow" in the pharma market... well, I certainly wouldn't know how, but I wouldn't pick a diagnosis where one of the most popular drugs (Adderall) is cheaply available in generic form and can only be produced in restricted quantities due to fed regulations because it's a controlled substance.

  In France, just 0.5% of children suffer from ADHD 
  (opposed to ~5% in North America)

Replace "suffer from" with "are diagnosed with." Remember, there are countries in the world where 0.0% of children are diagnosed with ADHD, and there are countries where depression and homosexuality "don't exist" because they're not recognized.

It certainly seems likely that it's overdiagnosed in the U.S., but we can't learn anything concrete by looking at diagnosis rates in other countries.

  I'm much more interested in finding the actual problem, 
  and fixing that.

Amen to that, but telling people their condition "doesn't exist" (the author's words, not yours, obviously) is harmful, not helpful.

jasonlotito4• 12 years ago

In France, just 0.5% of children suffer from ADHD (opposed to ~5% in North America)

That's false. You are grossly misquoting the article.

"the percentage of kids diagnosed and medicated for ADHD is less than .5%."

Diagnosed AND medicated. The French are very much against medication for any mental condition. They also don't share the same method to diagnose, and their methods for treatment are less than desirable.

So, combining those cultural attitudes toward treatment and my experience with French doctors and pediatricians (whose first suggestion for autism treatment was literally "put him in a home and forget about him"), holding them up as a shining example is only done by those in ignorance.

http://www.psychologytoday.com/blog/here-there-and-everywher... http://www.psychologytoday.com/blog/suffer-the-children/2012...

ChikkaChiChi• 12 years ago

Experts like this jackass and Andrew Wakefield should be held accountable for criminal misconduct when the publish crap like this.

Sensationalistic 'findings' that lack a concise scientific method that have an ulterior motive are harmful to those people that expect information from experts to be presented without bias.

skywhopper2• 12 years ago

The author appears to have a philosophical issue with the DSM itself, more than a useful argument. One could make the same complaint about many of the conditions defined in the DSM. The DSM faces an insurmountable challenge in attempting to taxonomize mental issues. In "reality" next to none of the syndromes and disorders there "exist", except in terms of collections of symptoms and treatments, and assumptions about what's "normal".

Honestly nothing he says goes against anything anyone who's done even a cursory study of ADHD will already know. But he leaves out a lot that folks without much familiarity with ADHD won't already know, such as that many people with ADHD take medicines other than stimulants: anti-depressants, blood pressure medicines. A lot of drugs have been found to address the underlying problems, and each class works differently in different people.

The fact is that, like every other aspect of brain chemistry and function, we understand very very little about ADHD. That doesn't mean that it doesn't exist or that people with the disorder should stop taking medicine that works for them. It means we need to study it more to find out how to better describe and explain all the intricate connections between behavior, diet, genetics, environment, sleep, screens, family, school, work, weather, vitamins, and drugs interplay to create what we now call ADHD.

mrxd• 12 years ago

The author appears to have a philosophical issue with the DSM itself

I find that hard to believe. He argues that some cases of ADHD are caused by bipolar disorder and depression, which have DSM definitions.

shittyanalogy• 12 years ago

A doctor? Intelligent discussion doesn't start with "one guy thinks". Authority is not a reason for scientific conclusion.

bpm140• 12 years ago

The author could have just as easily written "Cancer, as currently defined, does not exist" or "Arthritis, as currently defined, does not exist".

In all of these cases, the the catch-all phrase is used to describe a handful of similar symptoms that stem from a wild variety of causes.

This is why we won't be curing cancer any time soon. We may cure a specific type of cancer, but we're going to have to cure each type of cancer in a specific a relevant way.

If the author wanted to say "ADHD is actually a catch-all term for a variety of root causes that would be better treated with specificity" I would be all over that. But, hey, page views.

a3voices• 12 years ago

Did ADHD exist when people were hunter-gatherers? If not, it is not a real disorder in my book.

scott_s• 12 years ago

Counterpoint: "ADHD and Brain Chemistry", by Steven Novella: http://theness.com/neurologicablog/index.php/adhd-and-brain-...

Also, except on the same topic from the podcast "The Skeptics Guide to the Universe": http://www.youtube.com/watch?v=-MLdvKzLl6k

ajcarpy20053• 12 years ago

In my research, ADHD seems to be basically inflammation[1] of the brain. Think: bacteria, free radicals, active immune response, underactive detox and circulation, etc.

Some approaches which are most useful seem to be: Magnesium, Green Tea &/OR L-Theanine, GABA, SAMe, Milk Thistle, Fish Oil, Cholesterol, Vitamin D (Sunlight), etc.

I would say there is no silver bullet. But I would say unambiguously that vitamins and minerals and occasionally herbs are low hanging fruit compared to a pharmaceutical approach. Drugs aren't used as "building blocks" in cells or biochemistry. Drugs modulate various activity in our body which can help but typically is not without some kind of side effect or not as affective as providing enough of the "raw materials" our body needs.

Attention Deficit Hyperactive Disorder definitely exists although the way it's predominately treated really doesn't help solve the deeper causes of the disorder.

[1] http://www.ncbi.nlm.nih.gov/pubmed/24240495

JohnBooty15• 12 years ago

I don't doubt that inflammation is one of the myriad things that can cause attention issues.

One thing to realize re: supplements is that, by biological design, it's really hard to get chemicals into your brain simply by digesting them.

There are a lot of steps between eating something and it winding up in your brain.

I mean, the very first thing that happens to ingested items is a bath in the insane mixture of acid and bacteria that is your stomach. A lot more has to happen before it even reaches your brain-blood barrier, which is a thing specifically designed by evolution to keep things out of your brain.

ajcarpy20053• 12 years ago

The mechanisms of action that I'm referring to don't depend upon physically transporting molecules into the brain. Also, as it turns out, even inflammation in your gut or elsewhere changes the signals that the nerves send to the brain. And levels of neurotransmitters in the brain are absolutely impacted by what's going on in the rest of the body...regardless of the BBB.

What specific point are you trying to make about the Blood-Brain Barrier? And stomach acid? Sorry but neither of those things somehow render the foods and chemicals we ingest meaningless! Your HCL won't somehow break down Magnesium! Even Vitamins will mostly make it through intact.

I'm not a scientist but I don't get my information from Men's Health magazine either...I research reputable scientific studies and make reasonable connections.

MikeTLive• 12 years ago

QUOTE "For my second group of patients, who have severe attention issues, I make them undergo a full evaluation to find the source of the problem. Usually, once the original condition is found and treated, the ADHD symptoms go away."

And, when the original condition is the required 14 or so traits of ADHD, which using your "over 20" treatments do not solve, do you decide this is non-ADHD with ADHD Symptoms ?

asshole.

NextUserName9• 12 years ago

Lets get half the population on ADHD Drugs, then the other half on Anti-depressants. Then we as individuals don't actually have to deal with any personal challenges, not even controlling the growing, intrusive and overreaching power of government.

NextUserName9• 12 years ago

Modern civilization has certainly invented ADHD. It used to be that if you had ADHD, you probably weren't a banker, lawyer or politician. You certainly would not work in a cubicle and rot away all day. You also lived 15 years longer than your sedentary counterpart. You would do a more physical job. Physical work often creates the necessary stimulation that so many of these ADHD cases need.

The argument that it just isn't fair that someone's mind is more suited for a desk job than someone else, so we should put them on equal footing by administering drugs the rest of their lives is a flawed and slippery slope mentality. Do we say the same the same thing for aspiring athletes who weren't born with the muscle mass to play pro football? "Lets make things fair and pump this kid full of roids so he can be an all pro linebacker"...

Severe ADHD sufferers I agree should be given medication, but the majority That I personally know (some of whom I worked with before and after meds) should just have changed careers. They still have problems while on the meds and also have to deal side effects from the mind altering drug they are using. Those I know who have either pursued alternate careers, or switched are much happier overall.

Imagine that, doing what traditionally, naturally was done leads to greater happiness... Wow

JohnBooty15• 12 years ago

Physical work isn't necessarily easier for those with ADHD than desk jobs. In high school and college I had some physical jobs. Those jobs are often menial, and the monotony and repetition are really the opposite of what those with ADHD (especially those with ADHD and high intelligence) are "naturally" suited for.

  Do we say the same the same thing for aspiring athletes 
  who weren't born with the muscle mass to play pro 
  football?

We don't "pump them full of steroids" because unlike the (admittedly imperfect) ADHD treatments we have now, muscle-building steroids have negative side effects that greatly outweigh their benefits.

We do give them the best medical care possible. If an aspiring athlete breaks a leg or has plantar fasciitis, we treat those things. We don't just say, "guess you weren't meant to be an athlete."

  It used to be that if you had ADHD, you probably weren't a
  banker, lawyer or politician.

Yeah, and if you had bad eyesight, you were probably steered away from those professions as well.

And if you were left-handed people assumed you were under demonic influence or something.

And if you were dyslexic people assumed you were stupid.

I'm glad people like me are winning against people like you.

NextUserName9• 12 years ago

Physical work isn't necessarily easier for those with ADHD than desk jobs. In high school and college I had some physical jobs. Those jobs are often menial, and the monotony and repetition are really the opposite of what those with ADHD (especially those with ADHD and high intelligence) are "naturally" suited for.

You simply had the wrong type of physical jobs. There are physical jobs that are mentally challenging as well.

We don't "pump them full of steroids" because unlike the (admittedly imperfect) ADHD treatments we have now, muscle-building steroids have negative side effects that greatly outweigh their benefits.

OK then change steroids to HGH.

We do give them the best medical care possible. If an aspiring athlete breaks a leg or has plantar fasciitis, we treat those things. We don't just say, "guess you weren't meant to be an athlete."

Apples to oranges. Bones heal naturally. ADHD does not go away by "resting".

Yeah, and if you had bad eyesight, you were probably steered away from those professions as well.

And if you were left-handed people assumed you were under demonic influence or something.

And if you were dyslexic people assumed you were stupid.

I'm glad people like me are winning against people like you.

I see you are missing the point. How about this. In 20 years, 90% of people working in office jobs are taking ADHD medication Only 5% of them really have ADHD, but the rest have learned that they can concentrate longer and be more productive by using it. Now those with ADHD are no better off (on a relative scale) than those before these medications were invented. They often cannot compete with their non ADHD counterparts and lose their jobs (just like before ADHD meds came around). As a side effect, now billions of people on earth are taking a drug everyday that alters various things in their mind. They no longer think naturally and with the rational that they were born with. You think that this is good? This is where we are heading.

Like I said in another post, in those I know who changed careers VS those who take drugs every day, the ones who changed careers are far happier and have better quality of life mentally and physically.

Don't you want to be happier? Blame yourself and this system which has nudged you out of your natural path.

darkarmani13• 12 years ago

The argument that it just isn't fair that someone's mind is more suited for a desk job than someone else, so we should put them on equal footing by administering drugs the rest of their lives is a flawed and slippery slope mentality. Do we say the same the same thing for aspiring athletes who weren't born with the muscle mass to play pro football? "Lets make things fair and pump this kid full of roids so he can be an all pro linebacker"...

Except that isn't the argument. Just like we don't try and save premature babies to try and "be fair" and we don't treat suffers of diseases to "be fair." There is no slippery slope argument here. The onus is on you to prove that there is in fact a slope and then to show how slippery it is.

Physical work often creates the necessary stimulation that so many of these ADHD cases need.

Who are you to tell sufferers the best way to treat their condition? Don't you think it is best for people to get a say in their treatment?

NextUserName9• 12 years ago

The slippery slope is obvious. More and more people today are put on drugs to deal with problems that used to be dealt with naturally and without side effect. Secondly, more and more average people who don't really need these medications still get on them because they enhance their concentration and productivity. They give them abilities (an edge) that only a few in the general populace naturally have. Why is this bad? because these are mind altering drugs that people will take every day forever.

This type of behavior modification has always had (and always will) consequences.

sizzle2• 12 years ago

I remember reading an interesting hypothesis of adhd being an evolutionary trait/advantage, anyone know anything about this? I have not been able to find it.

Doctor: ADHD, as currently defined, does not exist

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