Comment by TangoTrotFox | Hacker News Reader

Comment by TangoTrotFox | Hacker News Reader

FiveThirtyEight ran an article on ADHD prescriptions [1]. It's getting pretty silly. If people don't know ADHD was not recognized as a disorder until 1968. And the popularity of drugging people for it didn't really take off until the 90s when a pharmaceutical industry astroturfing group called CHADD (Children and Adults with Attention Deficit) started marketing ritalin hard. Since then the use of using various pharmaceutical stimulants has become extremely widespread - jumping up by multiple orders of magnitude.

I'm unsure what the latest numbers are but they offer the data to 2013. And just between 2008 and 2013 adult usage of ADHD medication doubled. It was at 2.8% and has likely continued to rapidly increase. That's completed dwarfed by what we're now doing to kids and particularly boys. In 2013 we were up to 9.8% of all boys 12-18 years taking ADHD drugs. And those numbers again were, and presumably still are, rapidly increasing.

I have this likely decreasingly controversial view that history is not going to look back so kindly on psychology and our decision to start pretending we can create a pill for everything. I mean what could possibly go wrong getting 10%+ of boys setup with stimulants, and increasingly often other sorts of psychotropics as well, from their earliest and most critical developmental years?

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Of course I'm sure people will now respond with how these drugs saved their life and without them they'd be homeless, in prison, etc. To these people I have a simple logical question. Let's assume this is true that you would indeed be homeless, in prison, etc without these drugs. We now see these drugs numbers are absolutely skyrocketing to the point that sizable chunks of our entire population are on them. So if we go back in time, why don't we see skyrocketing prison/homelessness/etc as a consequence of people not being able to have these drugs? Given the exponential increase in prescribing rates you don't need to go back far. We should be able to see huge and causably linked differences just over the last decade or two.

[1] - https://fivethirtyeight.com/features/dear-mona-how-many-adul...

The realities are a lot more mundane than your last paragraph tries to paint them. I was 29 when I finally got treatment (therapy + low dose of adderall). I had been making 100k for years. It's perfectly possible to have an okay life with ADHD.

But stuff falls through the cracks. You forget to brush your teeth. To pay your bills. There was a year when I was making over 150k and every single quarter, as often as was possible, my water got shut off to my house. I had to shower at the gym and call the company with my tail between my legs and pay over the phone and it was turned on 2 days later. I had the money. I had the desire to pay the water bill. I just... couldn't. It was stupid. I felt like a caveman, scared that a coworker in my open office would overhear this frantic call and wonder WTF was wrong in my life that I couldn't pay my water bill.

I turned down promotions onto the manager track because it felt ethically dubious to manage people when I couldn't even manage myself. Do you want a person who can't remember to pay their water bill to be pulling the strings of your career lader? I stayed on the IC Principal track to try and localize the logistical fallout of my inabilities.

It's a little better now. It's not the difference between homelessness and elon musk. It's the difference between a guy who pays his bills on time, has a clean dishwasher, and goes to the dentist, versus a guy who is constantly browbeaten by everyday life as the shit that most people think of as routine and invisible derails you over and over in tragicomic ways.

I'm not sure what statistic would capture that. On paper, barring a decrease in collections notices and faster email response time, I appear to be exactly the same person.

But my life is better now. There are still cracks in the sidewalk – my life is still pretty scattered, but you're not as likely to lose a leg when you trip on one.

Amen. I'm on medication but even with it I used to forget to pay bills frequently despite having the money. I'm better now, mostly because I have a loving and supportive fiancee who helps me organize my life.

This is my experience being diagnosed with ADHD at 29 as well. Things seemed fine from the outside. Well paying, stable work. However, I had an incredibly difficult ability to do anything that needed intrinsic motivation, and my self-image began suffering as a result. I was constantly finding motivation from external factors and/or fear of rejection/failure and/or adrenaline to accomplish anything.

The first time I took a central nervous system stimulant (Modafinil as a nootropic) I could suddenly book my dentist appointments, and book a doctor's appointment to talk about mental health, and book holidays I'd been putting off. And read several chapters of a book in one sitting. And make my bed and remember to brush my teeth. And check in with friends I hadn't heard from in a while. Normal life stuff. Is this what neurotypical people can do!? I wish my frontal lobes had more activation and bloodflow by themselves.

My GP didn't understand how I could think I had a problem since I could maintain a 9-5. My family compared me to my less "obedient" ADHD older brother and never had me tested. I am pretty sure my mother has it but is in denial.

Dr. Russell Barkley has some great videos explaining how ADHD is an intention disorder, and how knowing and doing are separate parts of the brain.

Thanks for sharing! There's a lot of misinformation about ADHD out there. I'm glad that there are treatments that help right away (unlike most psychiatric conditions).

I can't speak for others, but my family history is full of people who ran from the law, got knocked up too young (or knocked someone else up at a young age), got involved in the use and/or selling of drugs, and faced difficulties because of impulsive behaviors that were probably related to undiagnosed to ADHD.

None of my generation, many of who have been treated for ADHD since childhood have had problems with the law or been/got anyone teen pregnant so far. I don't think they do hard drugs either. Progress!

My 10 year old was diagnosed (via a thorough neuropsych evaluation, not by annoyed teachers) and my wife and I have been very leery of medication. It's not that we doubt the efficacy, but we do have concerns about its effects on growing brains and, most importantly, want our guy to be able to manage things himself.

Step one has been to help him become more self aware of what's going on. We use lots of checklists and consistent routines to ease the load on his executive functioning. We also work to break bigger projects into lots of small chunks. Working on a thing for 2 hours is hard, but working on a thing for 15 minutes is pretty easy. We'll also set a timer during homework and have mandatory "run around and do something" breaks after 30 minutes of homework. At school, he'll even ask to take a test in a separate area of the room, or ask to go walk up and down the stairs a few times when he's getting restless.

In our case, things are working w/out drugs. He's learning school materials, and the positive feelings he's getting from not being in trouble more at school and getting his homework done have made a nice feedback loop for continuing to stay with the program. That said, I'm sure there are cases where progress is impossible and medication is the only option to get results.

"why don't we see skyrocketing prison/homelessness/etc as a consequence of people not being able to have these drugs"

Look at crime numbers in the past. You may notice that crime has been dropping for decades.

As for people without criminal tendencies, there used to be good jobs for people without a high school diploma, that would enable a person to raise a family in a good town in a nice house with one income.

And of course a lot of people with untreated ADHD probably died young from reckless behavior.

Treating infections with Penicillin only took off after people figured out it helps a lot.

If it’s a physiologically based condition we should be able to observe it in other population groups. I’ve heard that the French don’t medicate their hyperactive children; they send them to cooking school. Some articles have explored how paranoid schizophrenia has been handled among American native tribes (shamans, medicine men, etc) and how it manifests differently among cultures (in Africa historically people seem to get laughing voices while in the US and a lot of the West threatening voices).

For similar reasons, I suspect most of the correlations of ADHD with substance abuse and poor social relationships have more to do with how we treat our peers in the US.

Then there’s the hunter-gatherer theory for how ADHD may have actually been advantageous but I have little insight into how well that’s accepted.

The french do medicate children who are diagnosed with ADHD, but they don't depend on medication to the extent that the US does. Ideally, where medication is needed it is used along with therapy including cognitive behavioral therapy and teaching other life skills and coping mechanisms. In the US where our healthcare is prohibitively expensive and we're all overworked and have far less time to spend on ourselves many kids and adults with ADHD get the pills but very little other help. France also has a different means of diagnosing the condition which leaves some people with ADHD unable to get diagnosed and for others diagnosis is long and difficult. There is a even support group for french families dealing with problems getting a diagnosis.

I can see how ADHD could have been somewhat advantageous in the past but even in a world where you don't have to clock in to work at a specific time 5 days a week or pay your bills each month being able to choose when and to what extent your attention is focused would always be beneficial. I'm sure people with ADHD have always suffered even if their illness was at times a benefit for the group.

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