Adult ADHD Is the Wild West of Psychiatry(theatlantic.com)
theatlantic.com
Adult ADHD Is the Wild West of Psychiatry
https://www.theatlantic.com/health/archive/2023/04/adult-adhd-diagnosis-treatment-adderall-shortage/673719/
55 comments
As someone with family members with ADHD and as a manager who has had employees with ADHD, the challenge is differentiate and find those cases where it can be "advantageous". Is not easy at all. Also, there are different types and levels of ADHD. It's not a super power to forget things you wanted to remember and being late all the time, there's no benefit on that for anyone. Sometimes the extra creativity or hyper-focus on things that are not a goal for an organization is not an advantage. It's very complicated. I wish I had a solution.
Yeah, agreed. My dad had undiagnosed ADHD until a year or so ago. He loved research and got a PhD, but couldn't do the tasks that were expected of a professor and ended up not getting tenure. After that he struggled to hold a job for most of my childhood.
It's definitely not all upside, especially in modern contexts. But I do believe what I said—he would have thrived in the more Wild West academia of Isaac Newton and John Locke. The things he struggled to do were the accidental complexities of the job of professor, not the truly important aspects of that role.
It's definitely not all upside, especially in modern contexts. But I do believe what I said—he would have thrived in the more Wild West academia of Isaac Newton and John Locke. The things he struggled to do were the accidental complexities of the job of professor, not the truly important aspects of that role.
> He loved research and got a PhD, but couldn't do the tasks that were expected of a professor and ended up not getting tenure. After that he struggled to hold a job for most of my childhood.
This sounds horrific for both the individuals and their families. Talented individuals with so much to offer not finding their place.
> He would have thrived in the more Wild West academia of Isaac Newton and John Locke.
Yes, I agree. I just don't know how to create a system where the strengths of such individuals are leveraged. If an organization of 100 people is trying to build a bridge and the tasks required are challenging for the 1-5 ADHD individuals in the group, the persons will struggle and the organization will struggle. Both individuals and organizations need to get better at routing those individuals to the right places to leverage their strengths. This is true of anyone but 10x more important for ADHD or other disabilities.
> The things he struggled to do were the accidental complexities of the job of professor, not the truly important aspects of that role.
I have mixed feelings about this because sometimes I have heard people dismiss aspects of work they're not good at as not important. E.g I have had sw engineers claim they solved the problem in their head and writing it down and communicating it to others is not important. At large organizations is just as important unfortunately.
This sounds horrific for both the individuals and their families. Talented individuals with so much to offer not finding their place.
> He would have thrived in the more Wild West academia of Isaac Newton and John Locke.
Yes, I agree. I just don't know how to create a system where the strengths of such individuals are leveraged. If an organization of 100 people is trying to build a bridge and the tasks required are challenging for the 1-5 ADHD individuals in the group, the persons will struggle and the organization will struggle. Both individuals and organizations need to get better at routing those individuals to the right places to leverage their strengths. This is true of anyone but 10x more important for ADHD or other disabilities.
> The things he struggled to do were the accidental complexities of the job of professor, not the truly important aspects of that role.
I have mixed feelings about this because sometimes I have heard people dismiss aspects of work they're not good at as not important. E.g I have had sw engineers claim they solved the problem in their head and writing it down and communicating it to others is not important. At large organizations is just as important unfortunately.
> I have mixed feelings about this because sometimes I have heard people dismiss aspects of work they're not good at as not important. E.g I have had sw engineers claim they solved the problem in their head and writing it down and communicating it to others is not important. At large organizations is just as important unfortunately.
Yeah, I get that. I guess when I say "important" I mean that we have hundreds of years' worth of examples of people doing great research and teaching without doing the kind of bookkeeping tasks that my dad couldn't keep up with (I honestly don't remember what they were, but it wasn't communicating—he's an avid writer).
There's no question that that part of the job isn't an inherent part of the researcher skillset, and to the extent that we need it to happen there's no reason it couldn't be either automated or done by a different group of people who have that skillset. For example, I often wonder how much we lost when having a secretary or executive assistant stopped being a available to anyone but the highest level employees.
Yeah, I get that. I guess when I say "important" I mean that we have hundreds of years' worth of examples of people doing great research and teaching without doing the kind of bookkeeping tasks that my dad couldn't keep up with (I honestly don't remember what they were, but it wasn't communicating—he's an avid writer).
There's no question that that part of the job isn't an inherent part of the researcher skillset, and to the extent that we need it to happen there's no reason it couldn't be either automated or done by a different group of people who have that skillset. For example, I often wonder how much we lost when having a secretary or executive assistant stopped being a available to anyone but the highest level employees.
Yes. I think is key to re-assess assumptions about what a job or role profile "should be" and make the requirements and expectations flexible to make room for those differences.
> The people with ADHD aren't a problem, the unnatural world we've created is the problem, and we risk losing an important part of the larger organism that is civilization if we force these people to conform.
This is pretty much what the social model of disability pushes: if society changed with a thought for all some of us wouldn't be as disabled - in my specific case reducing bright lighting, reducing noise pollution, and reducing specific smells would help me a stupendous amount.
This is pretty much what the social model of disability pushes: if society changed with a thought for all some of us wouldn't be as disabled - in my specific case reducing bright lighting, reducing noise pollution, and reducing specific smells would help me a stupendous amount.
[deleted]
I had undiagnosed ADHD for 35 years and I suffered a lot. When my future girlfriend came to visit my place for the first time, I feard that we would not have electricity because I did not pay the bills. Not a money issue, but between all the daunting daily tasks I just was not able to accomplish that task for MONTHs.
I was working on my PhD in CS and didn't get anything done at all. I was in constant fear of getting a task related to Excel, because all these little cells have always made me nervous and furious. I would invest 2-3 hours working around a repetitive task of maybe 20 minutes, because doing it was unbearable. I had always been socially anxious, because for being socially active you need that type of attention that is just hard to maintain. I love being in nature, but going for a walk through the woods? Not possible, because it's "not exciting" enough.
Then a friend gave me some of his pills. I took them for a few days and for the first day of my life I understood how everybody else was feeling, how everybody else could be so confident, behaving confident, just being and feeling normal. I knew that feeling from rare occasions, the absence of all that struggle you are constantly feeling in your body. I had my first normal workday ever. Just going to work, doing work, having a break, later going home. I had never experienced that ever before. And still I didn't believe I had ADHD, never slipped my mind, lol. But then COVID hit and we went into lockdown and homeoffice and I could not work at all and I suffered immensly. I knew that feeling of "I want to do it SO hard, but I just CAN'T" very well, but this time it hit me very hard, for weeks. She convinced me to get diagnosed and here I am, it feels like a distant past already. It was like an instant switch, even though it's a journey to retrain my brain after for decades it had to come up with mechanics to deal with the disorder.
I know there many out there that are/were like me and I know there are many out there that had a quite different experience with their ADHD. Please don't walk around saying society is the problem. Society is not the problem when it comes to depression and it's not the problem when it comes to ADHD. A lot of people would benefit from a different society for sure, but for me and many others it's nothing more than a disorder. It was a miracle I could start a PhD to begin with (and of course getting my Master's was a constant struggle, just as my whole life had been miserable and a struggle). Many others end up drug addicted, dropping out ot school, having a clinical depression, and other nasty stuff. As all mental disorders, we do not know too much about it, but as a matter of fact the medication helps greatly and I am so glad I got finally diagnosed. Some that have ADHD do not suffer that much as I did, but a lot of do. I only wish that my disorder does not get misrepresented as "wouldn't be a big deal in a more open society".
Then a friend gave me some of his pills. I took them for a few days and for the first day of my life I understood how everybody else was feeling, how everybody else could be so confident, behaving confident, just being and feeling normal. I knew that feeling from rare occasions, the absence of all that struggle you are constantly feeling in your body. I had my first normal workday ever. Just going to work, doing work, having a break, later going home. I had never experienced that ever before. And still I didn't believe I had ADHD, never slipped my mind, lol. But then COVID hit and we went into lockdown and homeoffice and I could not work at all and I suffered immensly. I knew that feeling of "I want to do it SO hard, but I just CAN'T" very well, but this time it hit me very hard, for weeks. She convinced me to get diagnosed and here I am, it feels like a distant past already. It was like an instant switch, even though it's a journey to retrain my brain after for decades it had to come up with mechanics to deal with the disorder.
I know there many out there that are/were like me and I know there are many out there that had a quite different experience with their ADHD. Please don't walk around saying society is the problem. Society is not the problem when it comes to depression and it's not the problem when it comes to ADHD. A lot of people would benefit from a different society for sure, but for me and many others it's nothing more than a disorder. It was a miracle I could start a PhD to begin with (and of course getting my Master's was a constant struggle, just as my whole life had been miserable and a struggle). Many others end up drug addicted, dropping out ot school, having a clinical depression, and other nasty stuff. As all mental disorders, we do not know too much about it, but as a matter of fact the medication helps greatly and I am so glad I got finally diagnosed. Some that have ADHD do not suffer that much as I did, but a lot of do. I only wish that my disorder does not get misrepresented as "wouldn't be a big deal in a more open society".
I know that a lot of people struggle a lot with ADHD, and I'm not at all opposed to medication for you and them. My dad struggled to hold down a job for most of my childhood. Had he received his ADHD diagnosis earlier, my early life would have been much more stable. I'm not trying to downplay the degree to which people suffer and their need for help.
However, what you describe feels to me like validation of my point, not a contradiction. Undiagnosed ADHD overwhelmingly becomes manifest in times exactly like what you describe—you were working on a PhD! You were overwhelmed by Excel. You hated repetitive tasks. COVID lockdowns were impossible for you.
The depression and anxiety associated with ADHD are not inherent to the ADHD traits, they're the result of feeling incapable to cope with the modern world. All of the things that you described as overwhelming are accidental complexity that we can and should get rid of. Being a great researcher shouldn't require all of the overhead that we impose on modern PhD candidates. Just living in the modern world shouldn't require all that overwhelming bookkeeping—as just one example, taxes and bills can be and should be mostly automated, but they're not. If you didn't have to keep track of a million tiny things in your life, would you have been anxious and depressed?
Again, in the present reality medication is hugely important for a lot of people like you. But that doesn't mean that the world shouldn't also change to not require keeping track of so many things that add so little value.
However, what you describe feels to me like validation of my point, not a contradiction. Undiagnosed ADHD overwhelmingly becomes manifest in times exactly like what you describe—you were working on a PhD! You were overwhelmed by Excel. You hated repetitive tasks. COVID lockdowns were impossible for you.
The depression and anxiety associated with ADHD are not inherent to the ADHD traits, they're the result of feeling incapable to cope with the modern world. All of the things that you described as overwhelming are accidental complexity that we can and should get rid of. Being a great researcher shouldn't require all of the overhead that we impose on modern PhD candidates. Just living in the modern world shouldn't require all that overwhelming bookkeeping—as just one example, taxes and bills can be and should be mostly automated, but they're not. If you didn't have to keep track of a million tiny things in your life, would you have been anxious and depressed?
Again, in the present reality medication is hugely important for a lot of people like you. But that doesn't mean that the world shouldn't also change to not require keeping track of so many things that add so little value.
It didin't manifest in particular while I did my PhD, that was just the latest phase of my life. Took me 10 years for the Master's and another 10 years for my PhD. I don't think you can imagine the struggle, the fear, the shame, the sadness that came with it my whole life.
As already said, going for a walk was very difficult. Social interactions were very difficult and they can still be difficult when medication wears off in the evening. In general, all my life I wanted to do all kind of stuff, but couldn't. There's nothing society can do about that. It's not all about work either. So, to answer your question: Yes, I still would be anxious and depressed, because I was not able to do what made me relief stress and feel good in general.
I could've learned to be totally fine with ADHD, I was just too stubborn to build my life around that disorder. I kept doing what I wanted to do, not what I could do. I bet your father could've been a perfectly fine sports instructor or carpenter or find another fitting job. I certainly could've, but it luckily never slipped my mind. So we wouldn't need to adapt society, just teach people better what they can and cannot do. That's also much more realistic than "make jobs easier". I don't think, anyone should build his or her life around that disorder and I don't think society should. I did learn how to deal with it though and society should as well, of course. As often, it comes down to balance. A simpler life would've helped definetely.
I oppose your perspective in particular because it's mostly shared by people who deny that ADHD is a disorder, which is just wrong and terrible to think for many that are affacted.
As already said, going for a walk was very difficult. Social interactions were very difficult and they can still be difficult when medication wears off in the evening. In general, all my life I wanted to do all kind of stuff, but couldn't. There's nothing society can do about that. It's not all about work either. So, to answer your question: Yes, I still would be anxious and depressed, because I was not able to do what made me relief stress and feel good in general.
I could've learned to be totally fine with ADHD, I was just too stubborn to build my life around that disorder. I kept doing what I wanted to do, not what I could do. I bet your father could've been a perfectly fine sports instructor or carpenter or find another fitting job. I certainly could've, but it luckily never slipped my mind. So we wouldn't need to adapt society, just teach people better what they can and cannot do. That's also much more realistic than "make jobs easier". I don't think, anyone should build his or her life around that disorder and I don't think society should. I did learn how to deal with it though and society should as well, of course. As often, it comes down to balance. A simpler life would've helped definetely.
I oppose your perspective in particular because it's mostly shared by people who deny that ADHD is a disorder, which is just wrong and terrible to think for many that are affacted.
<3
The constant hope that "tomorrow I will go out and do the thing!" followed by the self imposed guilt of "why can I not just go out and do the thing."
The constant hope that "tomorrow I will go out and do the thing!" followed by the self imposed guilt of "why can I not just go out and do the thing."
Thank you for writing this. I have young family members with ADHD and I really hope they can find the help they need as you did.
I swear, every ADHD post on hacker news, someone comes in here with this uninformed nonsense.
For those of you afflicted with this curse, lookup Dr Russell Barkley’s videos on YouTube. He’s retired now, but was a great ADHD researcher. Really helped me understand what was going on.
For those of you afflicted with this curse, lookup Dr Russell Barkley’s videos on YouTube. He’s retired now, but was a great ADHD researcher. Really helped me understand what was going on.
Dr. Russell Barkley's brother who had ADHD ended up becoming homeless and dying.
He is biased and has a negative outlook on ADD. He talks in a very authoritarian manner.
You should look up other prominent ADHD experts like Ed Hallowell who have a more positive take.
Richard Feynman famously wrote "Science is the Belief in the Ignorance of the Experts". He meant, and explained that "science - a.k.a. research - is in the making, belongs to the (unknown, yet to be discovered) future, while expertise is based on the past, with in-built obsolescence".
You should look up other prominent ADHD experts like Ed Hallowell who have a more positive take.
Richard Feynman famously wrote "Science is the Belief in the Ignorance of the Experts". He meant, and explained that "science - a.k.a. research - is in the making, belongs to the (unknown, yet to be discovered) future, while expertise is based on the past, with in-built obsolescence".
I'm ADHD and I don't buy that "would have made great cavemen, natural movers and shakers" rubbish for a minute. Dude above who was worried he wouldn't have electricity when his g/f came over because he just couldn't handle paying the bill on time? Much closer to the mark. When I got together with my now-wife, she sorted out a water bill I'd been paying on my old place for months because I hadn't gotten around to telling them I'd moved.
My psychiatrist recommended Gabor Maté for what it's worth, but I prefer a really reductionist "it's all about dopamine" model. It might be simplistic, but it has the advantage of being concrete.
My psychiatrist recommended Gabor Maté for what it's worth, but I prefer a really reductionist "it's all about dopamine" model. It might be simplistic, but it has the advantage of being concrete.
> I'm ADHD and I don't buy that "would have made great cavemen, natural movers and shakers" rubbish for a minute. Dude above who was worried he wouldn't have electricity when his g/f came over because he just couldn't handle paying the bill on time? Much closer to the mark. When I got together with my now-wife, she sorted out a water bill I'd been paying on my old place for months because I hadn't gotten around to telling them I'd moved.
As a preface, just so you don't think I don't understand what you're talking about—my dad struggled to hold down a job for most of my childhood and finally got diagnosed with ADHD and started medication after he turned 50. I'm intimately familiar with the impairments that ADHD can cause and the real harm that is possible.
That, said, what you're describing is exactly the kind of modern overhead that I'm talking about—the modern world imposes a million little things to keep track of that ultimately shouldn't be required, which leaves us chronically falling behind on menial tasks. That leads to anxiety and depression that makes things even worse.
In the present reality, medication may be an appropriate patch to quickly restore sanity to people who need it, but I'm unconvinced that we should treat medicating a full 5% of the population for ADHD as a reasonable end goal. There are huge social movements for making accommodations for a portion of the population much smaller than that. There's no reason we can't make substantial changes to accommodate ADHD, especially given that said accommodations would really benefit everyone.
As a preface, just so you don't think I don't understand what you're talking about—my dad struggled to hold down a job for most of my childhood and finally got diagnosed with ADHD and started medication after he turned 50. I'm intimately familiar with the impairments that ADHD can cause and the real harm that is possible.
That, said, what you're describing is exactly the kind of modern overhead that I'm talking about—the modern world imposes a million little things to keep track of that ultimately shouldn't be required, which leaves us chronically falling behind on menial tasks. That leads to anxiety and depression that makes things even worse.
In the present reality, medication may be an appropriate patch to quickly restore sanity to people who need it, but I'm unconvinced that we should treat medicating a full 5% of the population for ADHD as a reasonable end goal. There are huge social movements for making accommodations for a portion of the population much smaller than that. There's no reason we can't make substantial changes to accommodate ADHD, especially given that said accommodations would really benefit everyone.
I get it, because I was diagnosed very late. The sense of opportunities missed is a killer, I feel for him. It's only lucking into a skillset like ours and a wonderful mother, and then wife that let me pull off a reasonable facsimile of adulting for as long as I did - and it was more like "basic functioning" than "thriving".
I've got no problem with the OXO Good Grips argument ("accommodations help everyone"). The only thing I'll take issue with is laying the blame at the feet of the modern world, because I know I'd be just as much of a flake if I lived in a village of 75 people and grew turnips for a living.
I've got no problem with the OXO Good Grips argument ("accommodations help everyone"). The only thing I'll take issue with is laying the blame at the feet of the modern world, because I know I'd be just as much of a flake if I lived in a village of 75 people and grew turnips for a living.
His views, biased as they may be, match the scientific consensus and are backed up by decades of research. Many of his Youtube videos are just him going over studies and meta analyses, and explaining the findings in layman's terms. I have read Russell Barkley's book, "Taking Charge of Adult ADHD" where he encourages you to not just trust his words but try to keep up with latest research and discuss things with a professional. I have recently started reading "Driven to Distraction" by the expert you mention, Ed Hallowell, and the content is very similar to Barkley's, it doesn't sound like their views on the disorder are different.
In fact, here's a quote from Chapter 1 of Hallowell's book:
>In the decades since that time, research has ballooned. Probably the most up-to-date and definitive account of the history and current state of the field is to be found in a book written by one of the great researchers in the area, Russell Barkley; currently in its third edition, his book is entitled, simply, Attention Deficit Hyperactivity Disorder
Maybe their tone is slightly different, but their descriptions of what ADHD is (not a society problem) and the solution they offer (lifestyle changes and medication) are pretty much the same.
In fact, here's a quote from Chapter 1 of Hallowell's book:
>In the decades since that time, research has ballooned. Probably the most up-to-date and definitive account of the history and current state of the field is to be found in a book written by one of the great researchers in the area, Russell Barkley; currently in its third edition, his book is entitled, simply, Attention Deficit Hyperactivity Disorder
Maybe their tone is slightly different, but their descriptions of what ADHD is (not a society problem) and the solution they offer (lifestyle changes and medication) are pretty much the same.
>> His views, biased as they may be, match the scientific consensus and are backed up by decades of research.
This is the problem. Just because he is an expert doesn't mean ALL of his views are correct. For instance Dr. Russell Barkley believed earlier in his career that having sugar in the diet will make ADHD symptoms worse. Years later after much more research he found out that he was wrong and that people with ADHD should sip in a bit of sugared water to focus better.
This is the problem with building a cult around a personality. Science is basically built off of hypothesis. Some of which will be proven wrong by much further research.
There is this thing called Constraint-Induced Movement Therapy (CIMT) developed by Edward Taub, a behavioral neuroscientist. There was extreme skepticism and resistance from the established medical and scientific communities. Taub's work challenged the prevailing belief that little could be done to improve function in limbs affected by neurological damage. At the time, it was widely believed that once certain neural pathways were damaged, they could not be repaired or compensated for effectively. Over time, however, through persistent research and clinical trials, CIMT gained evidence-based support and has become a recognized therapy in neurorehabilitation.
My point is that we should not build a cult of personality and take everything an "expert" is saying as absolute truth. He is right about many things. He could be wrong about some things as well. That's not a bad thing. That is how progress is made.
There is research being done by those who have analyzed nomadic tribes and they found high levels of ADHD like characteristics in those tribe members. The study noted that the traits associated with ADHD, such as impulsivity and a short attention span, which are often seen as challenges in modern structured environments like schools and workplaces, might have been beneficial in the unpredictable and varied challenges of a nomadic lifestyle.
This is the problem. Just because he is an expert doesn't mean ALL of his views are correct. For instance Dr. Russell Barkley believed earlier in his career that having sugar in the diet will make ADHD symptoms worse. Years later after much more research he found out that he was wrong and that people with ADHD should sip in a bit of sugared water to focus better.
This is the problem with building a cult around a personality. Science is basically built off of hypothesis. Some of which will be proven wrong by much further research.
There is this thing called Constraint-Induced Movement Therapy (CIMT) developed by Edward Taub, a behavioral neuroscientist. There was extreme skepticism and resistance from the established medical and scientific communities. Taub's work challenged the prevailing belief that little could be done to improve function in limbs affected by neurological damage. At the time, it was widely believed that once certain neural pathways were damaged, they could not be repaired or compensated for effectively. Over time, however, through persistent research and clinical trials, CIMT gained evidence-based support and has become a recognized therapy in neurorehabilitation.
My point is that we should not build a cult of personality and take everything an "expert" is saying as absolute truth. He is right about many things. He could be wrong about some things as well. That's not a bad thing. That is how progress is made.
There is research being done by those who have analyzed nomadic tribes and they found high levels of ADHD like characteristics in those tribe members. The study noted that the traits associated with ADHD, such as impulsivity and a short attention span, which are often seen as challenges in modern structured environments like schools and workplaces, might have been beneficial in the unpredictable and varied challenges of a nomadic lifestyle.
There are plenty of jobs out there that are perfectly compatible with ADHD. It's just that in our society, we strive to be our best self. Why would I want to build my life around that disorder? Why I would I want to build society around that disorder? You have to deal with it somehow, of course, and a more flexible work environment is beneficial for everybody. But the society is not the problem, having that disorder is the problem.
Just like when you are blind or lost an arm. It's not a problem because society is build around the assumption that people have two arms, it's not a problem because society is build around the assumption that you can see. We should help people to deal with this issues, but saying society is the problem is the wrong way to think about it.
Just like when you are blind or lost an arm. It's not a problem because society is build around the assumption that people have two arms, it's not a problem because society is build around the assumption that you can see. We should help people to deal with this issues, but saying society is the problem is the wrong way to think about it.
Care to elaborate, or was your goal just to be insulting for the sake of it? What specifically did I say that was "uninformed nonsense"? What are the facts that contradict what I said?
If you can't provide something more substantial than vague insults then you're never going to persuade anyone of anything.
If you can't provide something more substantial than vague insults then you're never going to persuade anyone of anything.
[deleted]
Do you have ADHD?
As a Brit with a childhood diagnosis of ADHD and a second confirming diagnosis in adulthood, it amuses me to look at the country where recreational and medical use of cannabis is legal and widely accepted, but there's a lot of pearl-clutching about what a credentialed psychiatrist is saying someone needs and a patient also feels they need.
The way ADHD medication is treated is wild to me. Doctors expect that people will be taking these medications for the rest of their life, and yet society treats these people almost like they're criminals. You can't get too much supply of the medicine. You can't easily travel with it. A pharmacy might just refuse to sell it to you. A future doctor might just decide that ADHD isn't real. And apparently the medicine can also just... run out.
Maybe the medication is just scrutinized too much?
Maybe the medication is just scrutinized too much?
[deleted]
as an adult with ADHD (and a child who was diagnosed at 11) i dont understand the fascination by laypeople with confidential mental health treatment.
if kids can have ADHD surely adults can too. i feel that these types of critical pieces often embolden critics of mental health and i dont quite understand why these people feel so aggrieved by allowing people to participate fully in the modern world
if kids can have ADHD surely adults can too. i feel that these types of critical pieces often embolden critics of mental health and i dont quite understand why these people feel so aggrieved by allowing people to participate fully in the modern world
The real item here is that ADHD threatens a nonADHDer's sense of identity and brings into question the existence of free will, effort, self discipline and self determination.
ADHD is a real condition. People who have it suffer immensely from it. They don't have a sense of time. They don't have a sense of priority. They procrastinate tremendously. They are extremely forgetful and tend to get stuck in an unproductive rut. The moment they swallow a pill.. i.e Adderall, they stop being late. They turn in their assignments completely finished. They can remember better. They won't lose their jobs. They stop procrastinating that much. Basically, they get to be a functional human being.
But, someone who doesn't have ADHD only has their own frame of reference to judge ADHD. People without ADHD also have a tendency to procrastinate. They also tend to be late if they are don't care about being on time. They don't feel the motivation to show up for work etc. And yet, despite not having the motivation they FORCE themselves to show up for work. Despite having a tendency to procrastinate they FORCE themselves to not procrastinate because they know the payoff. They won't be late because they CARE and they know it is DISRESPECTFUL to make the other person wait. Why can't you use a reminder on your iPhone, Google Calendar etc? is their retort. If you are forgetful why don't you write stuff down?
Discipline is a muscle. The more you force yourself to use it the easier it gets the next time. ADHD isn't special. Even I feel like not doing things BUT I FORCE MYSELF TO DO IT.
Why can't you? Instead, you are choosing to take the easier route by swallowing a pill. This is the equivalent of someone choosing to take steroids to build muscle instead of putting in the hard work at the gym.
This is how a nonADHD person thinks. They are proud of working hard and they are proud of their accomplishments. Of doing hard things. Overcoming obstacles etc. But, when they see someone with ADHD struggle they just chalk it down to them being lazy. They don't understand that the ADHD brain is wired differently.
Again, this is not their fault. Human beings cannot relate to anything that is outside of their direct experience.
ADHD is a real condition. People who have it suffer immensely from it. They don't have a sense of time. They don't have a sense of priority. They procrastinate tremendously. They are extremely forgetful and tend to get stuck in an unproductive rut. The moment they swallow a pill.. i.e Adderall, they stop being late. They turn in their assignments completely finished. They can remember better. They won't lose their jobs. They stop procrastinating that much. Basically, they get to be a functional human being.
But, someone who doesn't have ADHD only has their own frame of reference to judge ADHD. People without ADHD also have a tendency to procrastinate. They also tend to be late if they are don't care about being on time. They don't feel the motivation to show up for work etc. And yet, despite not having the motivation they FORCE themselves to show up for work. Despite having a tendency to procrastinate they FORCE themselves to not procrastinate because they know the payoff. They won't be late because they CARE and they know it is DISRESPECTFUL to make the other person wait. Why can't you use a reminder on your iPhone, Google Calendar etc? is their retort. If you are forgetful why don't you write stuff down?
Discipline is a muscle. The more you force yourself to use it the easier it gets the next time. ADHD isn't special. Even I feel like not doing things BUT I FORCE MYSELF TO DO IT.
Why can't you? Instead, you are choosing to take the easier route by swallowing a pill. This is the equivalent of someone choosing to take steroids to build muscle instead of putting in the hard work at the gym.
This is how a nonADHD person thinks. They are proud of working hard and they are proud of their accomplishments. Of doing hard things. Overcoming obstacles etc. But, when they see someone with ADHD struggle they just chalk it down to them being lazy. They don't understand that the ADHD brain is wired differently.
Again, this is not their fault. Human beings cannot relate to anything that is outside of their direct experience.
Your personal ADHD diagnosis is confidential information. Population-level increases in ADHD diagnosis and stimulant prescriptions is not confidential information. It is useful public health information.
I don't think it's fully settled what percent of this increase is due to more ADHD in the population versus a change in standards (the second is not inherently bad).
I don't think it's fully settled what percent of this increase is due to more ADHD in the population versus a change in standards (the second is not inherently bad).
The decreasing usage of nicotine products in western civilization over the last 30 years should also be considered. At least one study has shown nicotine use results in increased concentration for those with ADHD; it's possible the true number of ADHD adults in western society has been accidentally covered up by the last 400 years of nicotine usage.
Was there something in the article that struck you as critical of mental health or aggrieved in some way? It seemed like a pretty reasonable take to me.
Start with the title: "Adult ADHD Is the Wild West of Psychiatry"
Without reading it, you already know what to expect in terms of an opinion. I think it's probably more constructive to say that what we're calling ADHD is more likely several different though very similar disorders. Also worth noting is the comorbidity with autism and how many people have dual diagnoses.
Without reading it, you already know what to expect in terms of an opinion. I think it's probably more constructive to say that what we're calling ADHD is more likely several different though very similar disorders. Also worth noting is the comorbidity with autism and how many people have dual diagnoses.
It's worth noting that journalists rarely get to pick the title for their article. My father worked for a newspaper for a while and always complained about the titles the editor chose.
> It's worth noting that journalists rarely get to pick the title for their article.
I wish this was more common knowledge. I consider myself to be an incredibly voracious reader and I didn't learn this until recently (relatively speaking).
I wish this was more common knowledge. I consider myself to be an incredibly voracious reader and I didn't learn this until recently (relatively speaking).
> “If I give stimulants to the average person, they’ll say their mood, their thinking, and their energy are better,” Goodman said.
Why shouldn't healthy people have access to long-acting stimulants under the supervision of their doctor? Why limit healthcare to interventions that restore health to a minimal baseline? If as Dr. Goodman says, a pill can make the average adult happier, sharper, and more productive, why shouldn't everyone have access to it?
Why shouldn't healthy people have access to long-acting stimulants under the supervision of their doctor? Why limit healthcare to interventions that restore health to a minimal baseline? If as Dr. Goodman says, a pill can make the average adult happier, sharper, and more productive, why shouldn't everyone have access to it?
Those pills have different effects on people with adhd and people without it. A pretty bad explanation trying to keep it simple: The adhd brain basically destroys neurotransmitters in the brain before they can be absorbed by the body. The stimulant will cause a lot more neurotransmitters to be created so that more of them can be absorbed by the body (both the natural NTs and the ones caused by the stimulant). For someone without adhd there wasn't anything stopping the natural NTs before so all the stimulant will do is flood the body with one kind of stuff.
Everyone has the symptoms of ADHD. It's a quantitative condition, not a qualitative one. ADHDers just have them to the point that their lives are significantly impacted.
Amphetamines make everybody better. And if you take too much, they make everybody worse. Look at WWII soldiers, 1950s housewives or 21st century undergrads for examples.
Amphetamines make everybody better. And if you take too much, they make everybody worse. Look at WWII soldiers, 1950s housewives or 21st century undergrads for examples.
That's what I don't get about a lot of medical testing.
I presume Adderall was approved based on tests that lasted a couple years at most. It definitely seems like there is a class of medicine that can be beneficial in the short-term but be likely to produce bad results over decades.
I assume opioids could fall into this category too. In the short-term they could make people happier and more productive, but also their is chance of developing a dependency that may not be noticeable in the data until much later.
If drug X was found to benefit 100% of people for the first 2 years of taking it, but 5% of people developed a dependency that landed them in rehab or worse after 5 years, would we want the FDA to approve it?
I have a lot of libertarian leanings so I am mostly fine with it, but it does seem like the boundaries for what we consider beneficial or not are pretty arbitrary.
I presume Adderall was approved based on tests that lasted a couple years at most. It definitely seems like there is a class of medicine that can be beneficial in the short-term but be likely to produce bad results over decades.
I assume opioids could fall into this category too. In the short-term they could make people happier and more productive, but also their is chance of developing a dependency that may not be noticeable in the data until much later.
If drug X was found to benefit 100% of people for the first 2 years of taking it, but 5% of people developed a dependency that landed them in rehab or worse after 5 years, would we want the FDA to approve it?
I have a lot of libertarian leanings so I am mostly fine with it, but it does seem like the boundaries for what we consider beneficial or not are pretty arbitrary.
I guess thalidomide is the archetypal example in the back of every regulatory authority's mind. Nobody wants to risk a repeat of that.
In the case of Adderall, amphetamine was sold over the counter between the mid-1930s and 1964 (in the UK. Other countries, other dates) so there must have been a fair amount of additional research to take into account.
Interestingly, the first report of amphetamine being a treatment for what we would now call ADHD was 1937. We should have had this sorted out three generations ago; instead I coasted straight on through the school system in the 1980s without attracting a second glance.
In the case of Adderall, amphetamine was sold over the counter between the mid-1930s and 1964 (in the UK. Other countries, other dates) so there must have been a fair amount of additional research to take into account.
Interestingly, the first report of amphetamine being a treatment for what we would now call ADHD was 1937. We should have had this sorted out three generations ago; instead I coasted straight on through the school system in the 1980s without attracting a second glance.
Right. I guess with thalidomide the negative side effects weren't visible until after a pregnancy - which is why it took awhile to catch on.
I'm not saying I"m acutely worried about adderall, just the possibility there are drugs that take decades to show negative effects. It doesn't seem like the testing system we have in place would have any way to detect that.
I'm not saying I"m acutely worried about adderall, just the possibility there are drugs that take decades to show negative effects. It doesn't seem like the testing system we have in place would have any way to detect that.
Adderall does not have different effects on people with or without ADHD; it gives everyone better concentration.
But for ADHD it doesn't just give concentration. It makes everything work properly. Emotions, Impulse control, Organization and so on. Everything that is controlled by neurotransmitters.
It improves those things for everyone else, too. While those symptoms are real, and have plenty of biological underpinnings, they are not distributed bimodally in some way that distinguishes ADHD from “just” having terrible executive function, time awareness, and so on. Same neurotransmitter deal for everyone else.
My point is that the pills cause a ton of extra neurotransmitters - that's the same for everyone. In the adhd brain it has an extra effect of giving the natural neurotransmitters a chance to be absorbed and fullfil their duty. That means that during the effect of the meds the person with adhd also gets to have a functional brain for things unrelated to what the pill affects directly.
The body will get used to it, the effect will wane unless the dosage is increased, and before you know it you cannot function without the stimulant.
You can replace 'stimulants' with 'alcohol' in the quote above and it will still be true.
You can replace 'stimulants' with 'alcohol' in the quote above and it will still be true.
Those arguments apply equally to the use of stimulants for ADHD treatment and to coffee use for a pick-me-up, yet both practices have fierce advocates.
Felt rather unfortunately information light to me — lots of evidence that standards for adult ADHD are lacking, but not a lot of investigation into what those standards should look like.
Agreed. I'm definitely the "target" of this article, as I've just recently been diagnosed in my late 30s with adult ADHD. I feel like I've shown the signs during my childhood - poor grades due to poor attention span, constant fidgeting, and emotional irregularity due to hyperactivity and my impatience of others. Only recently have I thought to actually see anyone about it, as I've started seeing similar signs in my daughter.
Reading through the article, it definitely highlighted concerns I had about my process: lack of available providers (to the point that many wouldn't even accept a call from a new patient), essentially forced to use online services, relatively short discussions before treatment, and ultimately being prescribed stimulants.
Overall, I'm glad I started this process. I definitely feel better on the medication, to the point where I'm able to effectively track my daily tasking, keep cohesive notes, drastically reduce my unintended verbal interruptions of others, and churn work out without context switching so often. I obviously can work without the medication, but it's absolutely a night and day difference to me. Ultimately, I just hope that the progression of the adult ADHD diagnosis and discovery continues to mature, and online services aren't completely cut off from the space.
Reading through the article, it definitely highlighted concerns I had about my process: lack of available providers (to the point that many wouldn't even accept a call from a new patient), essentially forced to use online services, relatively short discussions before treatment, and ultimately being prescribed stimulants.
Overall, I'm glad I started this process. I definitely feel better on the medication, to the point where I'm able to effectively track my daily tasking, keep cohesive notes, drastically reduce my unintended verbal interruptions of others, and churn work out without context switching so often. I obviously can work without the medication, but it's absolutely a night and day difference to me. Ultimately, I just hope that the progression of the adult ADHD diagnosis and discovery continues to mature, and online services aren't completely cut off from the space.
Perhaps we should not look to The Atlantic to make medical treatment and standards recommendations. The article is a good summary of the situation, makes a good case for complicating factors (comorbidities in adult adhd, rogue prescribers in telehealth), and is largely fact focused.
That said, the answer to "what is the solution" is that it takes time to figure out what the best treatment plans are and feedback success and failure into diagnostics. It is a process of never-ending improvement. For example depression was known to Hippocrates and despite that multiple thousands of years of history we still don't have a 100% success rate diagnostics and treatment for it. Adult ADHD is only about 10 years old. Odds are by the time it grows up the current symptoms will lessen. But in the meantime, people seeking treatment for it should be aware that they are part of an ongoing experiment, i.e. they are in the Wild West.
That said, the answer to "what is the solution" is that it takes time to figure out what the best treatment plans are and feedback success and failure into diagnostics. It is a process of never-ending improvement. For example depression was known to Hippocrates and despite that multiple thousands of years of history we still don't have a 100% success rate diagnostics and treatment for it. Adult ADHD is only about 10 years old. Odds are by the time it grows up the current symptoms will lessen. But in the meantime, people seeking treatment for it should be aware that they are part of an ongoing experiment, i.e. they are in the Wild West.
It also skirted over the medication shortage. This is a big deal: some medications have been unavailable for months, all are in short supply, pharmacists are pissed, and patients are suffering. Despite this I’ve yet to find an in-depth explanation of how we got here.
If you're talking about Elvanse in Europe, it's a combination of "manufacturing issues" and "increased demand". I'm pretty sure it's mostly manufacturing issues, because although there was a bump in diagnoses due to WFH it wasn't a massive bump.
Takeda (who manufacture Elvanse in Europe) are being very coy about what "manufacturing issues" means. Their latest estimate for a return to full production is Q2 2024, but it's slipped before.
/r/adhduk is quite good at tracking updates around shortages.
Takeda (who manufacture Elvanse in Europe) are being very coy about what "manufacturing issues" means. Their latest estimate for a return to full production is Q2 2024, but it's slipped before.
/r/adhduk is quite good at tracking updates around shortages.
ADHD wasn't identified as a disorder until recently because it wasn't a disorder until recently. For most of human history, the traits associated with ADHD would have been at worst a wash and in many cases advantageous to have in small numbers within a community. The adults that I know with ADHD are disproportionately likely to be the movers and shakers in their worlds—they work well under pressure and make things happen. You don't want everyone to be that way, but having a portion of the population that can't sit still has huge advantages.
That only changed when we moved into the 20th century and started expecting 100% of the population to be okay with sitting quietly in a chair for 6 hours a day for 12 years of their lives and then, if they had any kind of ambition, to do more sitting in chairs working a white collar job until retirement.
The people with ADHD aren't a problem, the unnatural world we've created is the problem, and we risk losing an important part of the larger organism that is civilization if we force these people to conform.