ADHD as a binary diagnosis seems odd to me. It seems within a normal range of spectrum that we're all on. Modern schooling and white collar work are so radically different from the environment where we evolved that it's surprising how well we've adapted.
Clearly ADHD medications work, which is wonderful. But why do we need to label people with a "disorder" in order to give them the meds?
Why is psychiatry so dead set on binary yes/no diagnoses, and labeling everything as a disorder? Is that the consequence of having to code records for insurance? Something related to prescription laws? Or is it an underlying mistake in psychiatry to think there is one right way to be, and other states are wrong?
Clearly ADHD medications work, which is wonderful. But why do we need to label people with a "disorder" in order to give them the meds?
The drug war paranoia makes it necessary. So does the bureaucratic system that allows only people with an official diagnosis to obtain any kind of medication, even mood modifiers that are inherently subtle and personal.
Well, it doesn't prohibit all kinds of medication. Lots of people who are using adderall (also known as amphetamines, benzedrine, or dexedrine -- a popular self-administered medicine until the 1970s) and the like would be using truly dangerous tobacco and liquor if amphetamines were not available.
It's not about insurance. The pills themselves are very cheap to make and most formulations are not under patent.
As long as we need to put people in jail for using these substances, we're going to need a way to mark whose use is legitimate and whose isn't. Measuring who has health insurance and a good stable relationship with a doctor is a good way to tell whom to imprison and whom not to.
Methamphetamine incidentally is different from adderall only by a single methyl moiety and has almost indistinguishable clinical effect in matched doses, though meth has longer lasting side effects due to the hydrophobic methyl group allowing the medicine to persist longer in fatty tissues.
Indeed, I find a lot of people self diagnosing themselves as ADHD because they find it difficult to sit still and stare at a screen for 10 hours at a time.
> Clearly ADHD medications work, which is wonderful. But why do we need to label people with a "disorder" in order to give them the meds?
Take a look at the medical warnings for Adderall. There are other mental disorders (e.g. bipolar disorder and schizophrenia, among others) that Adderall can easily make worse. It's nowhere near as simple as "these pills help you focus so take them if you want".
why do we need to label people with a "disorder" in order to give them the meds?
My understanding is that it is pretty straightforward; most meds (particularly psychological meds) have potential for abuse and are generally destructive for people who don't really need them.
It might be cool if we could identify exactly how ADHD every person on the planet is, and prescribe precisely the right amount of Adderall, but this has 3 problems:
- We have no way of identifying this!
- Prescriptions are in units of pills, not nanograms of active substance
- What is the ideal level of focused vs. unfocused, anyway?
Because they are dangerous and bad for you. Maybe if you have the disorder, curing your illness outweighs the danger of the pills. But otherwise there is no reason to take them.
This article conflates a lot of mental health topics via the lens/story of single family that unfortunately has a wide range of behavior difficulties.
Risperdal is mentioned in the same breath as the standard ADHD precriptions. This is an anti psychotic which is meant to be prescribed to help manage recurrent aggressive / violent behavior and has a huge slew of side effects.
In contrast, most prescription stimulants used to treat (actual) ADHD have no side effects that persist after the cessation of taking the medication.
Likewise, it is well established fact that ADHD medications such as Adderall and Concerta are only effective when coupled with behavior therapy of some sort.
The larger picture behind this is that these adhd medications when taken at their recommended dosages help to make it easier to enter a focused state (as in the metaphorical sense of reducing the activation energy for a chemical reaction), and so direct efforts to develop the habits/ behaviors that are difficult with unmanaged ADHD are needed to attain any long term value out of ADHD medication.
point being: nothing new in this article, just lots of anecdote and a story built out of a single families mental health issues. Like wise the statistic that relevant diagnoses are increasing + a handy quote from a single doctor does not establish a systematic trend that should call to question the validity of a health condition.
this is also separate from the question of whether a school system designed around the time of the industrial revolution is still appropriate today
"this is also separate from the question of whether a school system designed around the time of the industrial revolution is still appropriate today"
Agreed! Non-single parent (and the not so poor) family's can compensate with attention, added education and more possibilities to explore and learn.
I think you nailed it in your last sentence. Where are the articles that point out how industrial 'batch' education is no longer serving kids of the present (the future)?
I know techy types who like technological solutions and probably felt they benefited from using such drugs are overrepresented on this site, but did no one else register the defeatist, victimhood justifications for using the drugs?
Trying to solve a social problem with technology misses the point. I highlight these two quotes:
From the article: “I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”
We have to modify the kid???
Also from the article: “We are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications.”
the only tool???
Modifying human beings because we have no alternative? If you ask me, the side effects of this approach are not just the potential side effects of the drug on the individual, but complacency in not addressing the problems' causes, creating dependency of a social class on a drug, teaching children to take drugs to solve problems, creating a belief we have no alternatives, perpetuating a system that bores children and punishing them for their boredom, and so on.
Does nobody else wonder what other unintended consequences such a policy might create, independent of the drugs' safety or not?
This is kind of reflective of health care in general actually. The system in use (this isn't just the United States by the way, it's most of the Western world) is that we live in some state of 'healthiness' for most of our lives, where we do not interact regularly with health professionals (not just doctors) - except perhaps a pharmacist to fill some regular prescription.
Our interactions are clustered -after- we are deamed unhealthy. Only once the need is most urgent do try to become 'healthy' again. This predictably leads to a culture that favours drugs and surgery as solutions. This is so engrained that health care practically IS synonymous with drugs and surgery. This bias exists in everyone, from the health care professionals, to those who are sick, to those to who are healthy, to those who would lead us. We all have it.
The 'unintended consequences' of such a policy are the problems facing nearly all 1st world health care systems. Surging costs, potentially unsustainable growth, constant doubts of effectiveness (and actual questionable effectiveness in some areas), and in general, a culture that more or less treats staying healthy as a bang-bang control system.
"Nobody can bring any medicine containing Methamphetamine or Amphetamine (Adderall and so on) into Japan. If you are found with any medicine containing Methamphetamine or Amphetamine illegally in Japan, you can be arrested as a criminal on the spot, immediately, without a warrant in principle."
Japan had an amphetamine epidemic in the 1950s, and has had a major down on them ever since. Asian countries in general seem to treat drug problems as something foisted on them by western imperialists, a belief for which there is some historical basis; but it has also become a convenient narrative that's preferable to the loss of face involved in admitting that any of one's citizens might have a tendency towards abusing drugs or be disenchanted with the status quo.
"Nobody can bring any medicine containing Methamphetamine or Amphetamine (Adderall and so on) into Japan."
It's the same in the USA without special permits. Methamphetamine and adderall are both classified under the same Schedule 2 criminal rubric. The investigation and prosecution of doctors who prescribe adderall, knowingly or not, to patients who then resell it to people without insurance or access to health care employs thousands -- probably tens of thousands -- of DEA and local police.
What annoys me with this, is are we going to get kids going through school, graduating from University, while taking amphetamines and then coming into the software industry and working 18 hour days without breaking a sweat?
If so, where's my option to get these meds? Oh wait, I can't because I'm not ADHD, and because I wasn't "diagnosed" as a kid, it won't happen now.
I really hope the older programmers in our industry won't have to compete with people-on-drugs in the future... but it'll happen won't it?
>I really hope the older programmers in our industry won't have to compete with people-on-drugs in the future... but it'll happen won't it?
Of course we'll have to compete, and of course we'll use medicine, brain implants, gene therapy, you name it, because it's either that or irrelevancy. Lets be grateful for our profession, because it has a chance to become irrelevant last.
Although I'm not sure what the air-quotes around "diagnosed" are intended to mean, I suspect it's because you doubt it's a legitimate dysfunction?
Regardless, on your point about being diagnosed as an adult: I was diagnosed as having ADHD as an adult. It's not unheard of. The only reason I wasn't diagnosed as a teenager was that I wasn't hyperactive — just incredibly distractible — and I was smart enough that I performed "acceptably" in school. I've wondered, though, what I could have leveled-up to if I hadn't been fighting my distractibility.
Anyway, I was diagnosed at around age 30, was on meds (Wellbutrin) for about two years, and developed good skills and organizational techniques, so that I don't need the medication any longer. Ultimately, it wasn't the medication that taught me the skills; they just cleared my head and allowed me to develop them on the side.
If you genuinely think that you might have ADHD (specifically, ADHD-inattentive-type, like me), you'd do well to talk to a psychiatrist.
If someone goes through school and university on these pills that would be what 8-12 years on speed? They are not to be envied.
And 18 hour work days take a toll on you regardless of whether you are taking pills or not. It is more dangerous if you are taking pills because then you do not notice the effect on your body.
I genuinely wonder why is it about competing in the workspace; instead cooperating in the workspace?
The demand for programmers is not constant; it grows with the number of talented programmers, as many new projects now become feasible.
What attention is being paid to the potential long term effect of these stimulants on the serotonergic & dopaminergic systems of these young people's brains? Prescribing such powerful neurotoxins to young people who's brains are still very much in a developmental stage seems risky to say the least.
Some of the more hazardous side effects of adderall:
• Dangerous increase in blood pressure
• Tachycardia or a high pulse rate
• Irregular heart rate
• Difficulty breathing
• Chest pain
• Allergic reaction that includes swelling and redness in the eyes or throat
• Migraine headaches
• Syncope or losing consciousness
• Blurry or double vision
• Seizure activity and excessive and uncontrollable shaking
• Extreme nervousness and paranoid delusions
• Mood swings that include hostility and severe aggression
• Depression
Also note that during college I was a 6'2, 210lb guy who experienced these effects from adderall with as low as a 10mg dosage. Some kids are prescribed 2-3 times that amount. Luckily for me, I decided it wasn't worth the side effects and I'd rather deal with any attention problems on my own. I feel sorry for the kids who never had the choice.
I find it interesting to what lengths parents go to improve their children's grades. The fact that grades indeed go up after taking those pills just make this worse: people believe to see "measurable" success.
“We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid." - To me that is the gist of the article. We failed to provide an enjoyable learning experience for kids, so we have to make them enjoy it.
Or we just switch off the bits inside them that yearn for enjoyment in the first place. Our kids are either academic robots or suffering from a disorder of being human, and thus imperfect.
I wouldn't be surprised if he loses his license for saying this. I've seen other doctors lose theirs for prescribing it too much. The government is really strict on this one, even mandating production limits.
I've lived my whole life with untreated ADHD, and experienced issues all across life because of it, not just work or school. It took many months to get the proper treatment for it (i.e. medications), and perhaps it's a good thing it's that difficult.
But if I encounter anyone who has the "everyone has trouble focusing" crab mentality that I've had told to me, even by psychiatrists themselves, I'll punch them square in the jaw.
I see the main problem of said pills in the following:
Schools are boring, horrible and pointless experience. But if you're drugged enough you may just ignore that and happily buzz along like a zombie. Which in turn will lead you to not becoming angry with this crap, and not using yourself to change schools in the future.
Drugs for children seem to breed conformists. And conformism is bad because it ignores problems until they overhelm and crush the society.
[+] [-] paulsutter|13 years ago|reply
Clearly ADHD medications work, which is wonderful. But why do we need to label people with a "disorder" in order to give them the meds?
Why is psychiatry so dead set on binary yes/no diagnoses, and labeling everything as a disorder? Is that the consequence of having to code records for insurance? Something related to prescription laws? Or is it an underlying mistake in psychiatry to think there is one right way to be, and other states are wrong?
[+] [-] WildUtah|13 years ago|reply
The drug war paranoia makes it necessary. So does the bureaucratic system that allows only people with an official diagnosis to obtain any kind of medication, even mood modifiers that are inherently subtle and personal.
Well, it doesn't prohibit all kinds of medication. Lots of people who are using adderall (also known as amphetamines, benzedrine, or dexedrine -- a popular self-administered medicine until the 1970s) and the like would be using truly dangerous tobacco and liquor if amphetamines were not available.
It's not about insurance. The pills themselves are very cheap to make and most formulations are not under patent.
As long as we need to put people in jail for using these substances, we're going to need a way to mark whose use is legitimate and whose isn't. Measuring who has health insurance and a good stable relationship with a doctor is a good way to tell whom to imprison and whom not to.
Methamphetamine incidentally is different from adderall only by a single methyl moiety and has almost indistinguishable clinical effect in matched doses, though meth has longer lasting side effects due to the hydrophobic methyl group allowing the medicine to persist longer in fatty tissues.
[+] [-] jiggy2011|13 years ago|reply
[+] [-] fpgeek|13 years ago|reply
Take a look at the medical warnings for Adderall. There are other mental disorders (e.g. bipolar disorder and schizophrenia, among others) that Adderall can easily make worse. It's nowhere near as simple as "these pills help you focus so take them if you want".
[+] [-] unknown|13 years ago|reply
[deleted]
[+] [-] sliverstorm|13 years ago|reply
My understanding is that it is pretty straightforward; most meds (particularly psychological meds) have potential for abuse and are generally destructive for people who don't really need them.
It might be cool if we could identify exactly how ADHD every person on the planet is, and prescribe precisely the right amount of Adderall, but this has 3 problems:
- We have no way of identifying this!
- Prescriptions are in units of pills, not nanograms of active substance
- What is the ideal level of focused vs. unfocused, anyway?
[+] [-] hristov|13 years ago|reply
[+] [-] carterschonwald|13 years ago|reply
Risperdal is mentioned in the same breath as the standard ADHD precriptions. This is an anti psychotic which is meant to be prescribed to help manage recurrent aggressive / violent behavior and has a huge slew of side effects.
In contrast, most prescription stimulants used to treat (actual) ADHD have no side effects that persist after the cessation of taking the medication.
Likewise, it is well established fact that ADHD medications such as Adderall and Concerta are only effective when coupled with behavior therapy of some sort.
The larger picture behind this is that these adhd medications when taken at their recommended dosages help to make it easier to enter a focused state (as in the metaphorical sense of reducing the activation energy for a chemical reaction), and so direct efforts to develop the habits/ behaviors that are difficult with unmanaged ADHD are needed to attain any long term value out of ADHD medication.
point being: nothing new in this article, just lots of anecdote and a story built out of a single families mental health issues. Like wise the statistic that relevant diagnoses are increasing + a handy quote from a single doctor does not establish a systematic trend that should call to question the validity of a health condition.
this is also separate from the question of whether a school system designed around the time of the industrial revolution is still appropriate today
[+] [-] digitalengineer|13 years ago|reply
[+] [-] calydon|13 years ago|reply
[+] [-] spodek|13 years ago|reply
Trying to solve a social problem with technology misses the point. I highlight these two quotes:
From the article: “I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”
We have to modify the kid???
Also from the article: “We are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications.”
the only tool???
Modifying human beings because we have no alternative? If you ask me, the side effects of this approach are not just the potential side effects of the drug on the individual, but complacency in not addressing the problems' causes, creating dependency of a social class on a drug, teaching children to take drugs to solve problems, creating a belief we have no alternatives, perpetuating a system that bores children and punishing them for their boredom, and so on.
Does nobody else wonder what other unintended consequences such a policy might create, independent of the drugs' safety or not?
[+] [-] icegreentea|13 years ago|reply
Our interactions are clustered -after- we are deamed unhealthy. Only once the need is most urgent do try to become 'healthy' again. This predictably leads to a culture that favours drugs and surgery as solutions. This is so engrained that health care practically IS synonymous with drugs and surgery. This bias exists in everyone, from the health care professionals, to those who are sick, to those to who are healthy, to those who would lead us. We all have it.
The 'unintended consequences' of such a policy are the problems facing nearly all 1st world health care systems. Surging costs, potentially unsustainable growth, constant doubts of effectiveness (and actual questionable effectiveness in some areas), and in general, a culture that more or less treats staying healthy as a bang-bang control system.
[+] [-] D3|13 years ago|reply
[deleted]
[+] [-] bemmu|13 years ago|reply
"Nobody can bring any medicine containing Methamphetamine or Amphetamine (Adderall and so on) into Japan. If you are found with any medicine containing Methamphetamine or Amphetamine illegally in Japan, you can be arrested as a criminal on the spot, immediately, without a warrant in principle."
[+] [-] anigbrowl|13 years ago|reply
[+] [-] WildUtah|13 years ago|reply
It's the same in the USA without special permits. Methamphetamine and adderall are both classified under the same Schedule 2 criminal rubric. The investigation and prosecution of doctors who prescribe adderall, knowingly or not, to patients who then resell it to people without insurance or access to health care employs thousands -- probably tens of thousands -- of DEA and local police.
[+] [-] veb|13 years ago|reply
If so, where's my option to get these meds? Oh wait, I can't because I'm not ADHD, and because I wasn't "diagnosed" as a kid, it won't happen now.
I really hope the older programmers in our industry won't have to compete with people-on-drugs in the future... but it'll happen won't it?
[+] [-] EliRivers|13 years ago|reply
On the downside, I dread to think of the code speed-freaks would churn out after 18 hours jazzed up, ten years into their addiction.
[+] [-] vl|13 years ago|reply
Of course we'll have to compete, and of course we'll use medicine, brain implants, gene therapy, you name it, because it's either that or irrelevancy. Lets be grateful for our profession, because it has a chance to become irrelevant last.
[+] [-] charliepark|13 years ago|reply
Regardless, on your point about being diagnosed as an adult: I was diagnosed as having ADHD as an adult. It's not unheard of. The only reason I wasn't diagnosed as a teenager was that I wasn't hyperactive — just incredibly distractible — and I was smart enough that I performed "acceptably" in school. I've wondered, though, what I could have leveled-up to if I hadn't been fighting my distractibility.
Anyway, I was diagnosed at around age 30, was on meds (Wellbutrin) for about two years, and developed good skills and organizational techniques, so that I don't need the medication any longer. Ultimately, it wasn't the medication that taught me the skills; they just cleared my head and allowed me to develop them on the side.
If you genuinely think that you might have ADHD (specifically, ADHD-inattentive-type, like me), you'd do well to talk to a psychiatrist.
[+] [-] hristov|13 years ago|reply
And 18 hour work days take a toll on you regardless of whether you are taking pills or not. It is more dangerous if you are taking pills because then you do not notice the effect on your body.
[+] [-] guard-of-terra|13 years ago|reply
[+] [-] bluedanieru|13 years ago|reply
[+] [-] lucvh|13 years ago|reply
[+] [-] Synaesthesia|13 years ago|reply
[+] [-] susanhi|13 years ago|reply
[+] [-] tdfx|13 years ago|reply
[+] [-] sebastianmarr|13 years ago|reply
“We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid." - To me that is the gist of the article. We failed to provide an enjoyable learning experience for kids, so we have to make them enjoy it.
[+] [-] smegel|13 years ago|reply
[+] [-] dschiptsov|13 years ago|reply
Cognitive-behavior therapy is the way to re-train, re-program, unlearn a wrong habit.
There are sub-conscious habits, of course, which we cannot "see" without a training.
[+] [-] jamesbritt|13 years ago|reply
[+] [-] D3|13 years ago|reply
[deleted]
[+] [-] lnanek2|13 years ago|reply
[+] [-] throwaway9549|13 years ago|reply
But if I encounter anyone who has the "everyone has trouble focusing" crab mentality that I've had told to me, even by psychiatrists themselves, I'll punch them square in the jaw.
[+] [-] Baba_Chaghaloo|13 years ago|reply
[deleted]
[+] [-] ernesth|13 years ago|reply
Since 1999, the name of the drug was changed but the debate seems exactly the same.
[+] [-] guard-of-terra|13 years ago|reply
Drugs for children seem to breed conformists. And conformism is bad because it ignores problems until they overhelm and crush the society.
[+] [-] wavesounds|13 years ago|reply