Back "in-the-day" when we let kids roam free in their neighbourhoods, they could at least "play" themselves out... Now, constantly cooped-up, no wonder they cannot sit still...I hear this a lot, and I think it's true but also sort of beside the point. First of all, how do we know that the ADHD-ers back then ended up ok? Maybe they were fine while they were wandering around the neighborhood but fell apart when they grew up and it was time to clock in for their 12 hour factory shifts. Maybe they ended up, as adults, self-medicating with alcohol and other drugs the same way that today's ADHD-ers do. But I also think that the contemporary economy means that there aren't a whole lot of jobs for adults who have attention problems, and having ADHD as an adult is likely to be a problem even if you were given plenty of time to roam as a kid.
Overall, I'm sure that most of the adults like my partner ended up just fine.Why? What makes you so sure? My family history is littered with people who didn't end up particularly fine.
Following the Peasants' Revolt, English constables were authorised under a 1383 statute to collar vagabonds and force them to show support; if they could not, the penalty was gaol.[21] Vagabonds could be sentenced to the stocks for three days and nights; in 1530, whipping was added. The presumption was that vagabonds were unlicensed beggars.[21] In 1547, a bill was passed that subjected vagrants to some of the more extreme provisions of the criminal law, namely two years servitude and branding with a "V" as the penalty for the first offense and death for the second. Large numbers of vagabonds were among the convicts transported to the American colonies in the 18th century.[22]We were far more efficient at segregating, labeling negatively, rather than to assist people, and then removing such "undesirables" from society, while simultaneously convincing the "normal" majority that they were actually "naturally" different from these "others", who had, the culture asserted, to make them feel safe, and normal, and special, and different from these "failures" by "nature", in times past... Debtors prisons will one day be magical places of study for the time traveling historians from the future studying ADD/ADHD in past societies.
During the 16th century in England, the state first tried to give housing to vagrants instead of punishing them, by introducing bridewells to take vagrants and train them for a profession. In the 17th and 18th centuries, these were replaced by workhouses but these were intended to discourage too much reliance on state help.
The growing movement toward social concern sparked the development of rescue missions, such as America's first rescue mission, the New York City Rescue Mission, founded in 1872 by Jerry and Maria McAuley.[23][24]
In smaller towns, there were hobos, who temporarily lived near train tracks and hopped onto trains to various destinations. Especially following the American Civil War, a large number of homeless men formed part of a counterculture known as "hobohemia" all over America. This phenomenon re-surged in the 1930s during and after the Great Depression.[25][26]
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In general, in most countries, many towns and cities had an area which contained the poor, transients, and afflicted, such as a "skid row". In New York City, for example, there was an area known as "the Bowery", traditionally, where alcoholics were to be found sleeping on the streets, bottle in hand.
The Great Depression of the 1930s caused a devastating epidemic of poverty, hunger, and homelessness. There were two million homeless people migrating across the United States.[27]posted by infinite intimation at 12:12 PM on January 29, 2012 [16 favorites]
The MTA Cooperative Group study involved a clinical trial evaluating the relatively long term (14 months) effects of stimulants on ADHD symptoms. The authors found that the use of stimulants was superior to behavior therapy (MTA Cooperative Group, 1999). Similarly, Brown et al. (2005) reported that a review of the empirical literature suggests that nonpharmacologial interventions alone were inferior to the use of stimulant medication. The authors do report that the combined use of medication and other therapies is effective and may result in smaller doses of stimulants. Barbaresi et al. (2006) reported results from a long term observational study. These authors found that the results regarding the efficacy of stimulant medications found in clinical trials with relatively short follow-up periods were similar to the results over their longer observational period. The empirical literature has found that the use of stimulant medication has been effective at managing the core behavioral symptoms of ADHD. These included indicators of behaviors such as impulsivity and distractibility. Far less evidence was found that these medications increased academic performance (Brown et al., 2005).posted by infinite intimation at 1:53 PM on January 29, 2012 [2 favorites]
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A broader question about the total value of pharmaceuticals involves the net benefit of these medications. There is a growing debate in the literature specifically about whether new drugs are worth more than their costs. The largest debate in the literature focuses on whether spending on these new drugs lead to even larger decreases in non-prescription drug spending , whether they are cost effective (i.e., they provide enough health benefits to outweigh their costs relative to an alternative treatment method), or neither. We focus this section on existing evidence concerning the net benefits of these medications in terms of cost savings from nondrug health spending. This focus results from the fact that it is currently the most compelling area of debate between researchers regarding the value of pharmaceuticals.
Finally, we will discuss the growing body of literature focusing on the non-health benefits of pharmaceuticals. Traditionally, evaluations of medications focus on solely health benefits of prescription drugs. Increasingly, medications are intended to treat chronic conditions and therefore can generate a variety of non-health benefits. For example, the development of effective treatments for mental health conditions can result in lower crime rates and the distribution of anti-retroviral medications for HIV/AIDS patients in Africa has been shown to increase productivity and labor force participation. The studies discussed in this section provide clear evidence about the growing value of pharmaceutical medication in everyday life.
In nearly every analysis, the originally randomized treatment groups did not differ significantly on repeated measures or newly-analyzed variables (e.g., grades earned in school, arrests, psychiatric hospitalizations, or other clinically relevant outcomes).posted by crayz at 2:10 PM on January 29, 2012 [1 favorite]
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Type or intensity of 14 months of treatment for ADHD in childhood (at age 7.0–9.9 years old) does not predict functioning six-to-eight years later. Rather, early ADHD symptom trajectory regardless of treatment type is prognostic. This finding implies that children with behavioral and sociodemographic advantage, with the best response to any treatment, will have the best longterm prognosis.
And maybe none of this would be a concern if we stopped being so goddamned concerned with everyone being "normal"I'm truly not interested in being normal. I'm interested in not having the power turned off because I forget to pay the bill. I'm interested in not being late for work every day because I can't find my keys to lock the door behind me. It would be awesome if I could concentrate on conversations with people so that I could be an active and considerate friend. I have fucked up at work in ways that have caused other people a lot of grief because I've forgotten to do small but important things. This isn't just about me adhering to stupid social conventions. It really interferes with my life in non-trivial ways. It interferes with my life even though I happily have lots of friends who appear to find my eccentricities charming.
The comment, was, however in the context of wondering how people with ADD coped in the world before medication was developed or became vogueThis is such a weird question to me, because I grew up hearing stories about my great-grandfather and grandfather, both of whom were brilliant men who couldn't get their acts together. What happened to them was that they scraped by on the economic margins. Sometimes they didn't scrape by and relied on charity or help from family to make do. They beat their wives. They weren't very good fathers. They weren't hobos, but I don't think anyone would count them happy or successful people. I imagine they weren't the only people like that.
Back "in-the-day" when we let kids roam free in their neighbourhoods, they could at least "play" themselves out... Now, constantly cooped-up, no wonder they cannot sit still...What about adults? I suppose there were plenty of factory jobs that didn't require lots of mental energy, but it's not just a kids disease. It's not something just grow out of.
I think in most cases, depression, ADD, asperger's, etc, shouldn't really be thought of as 'disease', although they certainly are inconvenient in a modern society. They're just normal expressions of human diversity, for the most part. And it's the environment we're living in that makes them pathological.Yeah I agree with this. Just like some people are physically weak. If we had a society where physical strength was necessary for survival, and we had steroids, people would probably need to take them. Of course some people would complain that people just need to work out harder, or whatever.
I've heard anecdotally that the withdrawal from Ritalin can be along the lines of heroin withdrawal.I didn't like ritalin, because the actual process of coming off of any given dose is pretty unpleasant. But I didn't take Ritalin every day and had no problem on my days off, and I had no problem quitting altogether. I've stayed off of meds for several years at a time before deciding to start up again. I now take the extended release Adderall, which doesn't really have a noticeable crash. I take two days off every week, and I try to take an extended stimulant vacation a couple of times a year. It's not difficult for me to do that. Taking a day or week off doesn't feel like I imagine withdrawal feels. If you're taking stimulants according to your prescription, I just don't think that coming off of them should be a problem.
they'd also immediately prescribe drugs and I don't want to take them.I've never felt pressured to take meds, and I feel like my doctors have respected my decision not to take them at times when I've decided not to.
I don't know how everyone on drugs remembers to take them.This is a challenge for me. (And it's not just about my Adderall, because I have a couple of other prescriptions that I need to take every day.) I put my pills next to the coffee machine, because I won't forget to drink coffee in the morning. I also have my morning routine really ritualized in general. If I stray from my routine, I often do forget to take my pills, so I don't stray from my routine.
From what I hear, the forgetting to take the time-factor-y drugs, or not taking them on time, or forgetting a dose (multiple doses a day!) or taking it too late or whatever, is a bad thingIt's ok to miss a dose altogether. They're not like birth control pills, where they don't work unless you take them every day. If I forget to take my Adderall, I just can't concentrate for that particular day. It is true, though, that I don't want to take it too late in the day, because I need it to wear off by bed time. My rule is that if I haven't taken it by 8:00 AM, then I'm not going to take it that day. I'm on the time-release formula, so I only need to take one dose a day.
We understand that the predisposition to getting a diagnosis of A.D.H.D. has a lot to do with what kind of genetic complement you’re born with, and then how that genetic complement interacts with the environment throughout early development. Prenatal exposure to cigarettes, for example, may impact the genes differently when you have a genetic predisposition to A.D.H.D.. Several studies have shown that maternal smoking in pregnancy increases risk for hyperactivity-impulsivity later in life, and a recent study suggests that that effect may be greater if the fetus has a certain genotype.(my emphasis)
Postnatally, there may be differences in childhood as well. We have interesting research showing that in families where there’s a lot of conflict in the home, a lot of arguing, that has a very negative impact on kids with A.D.H.D. in terms of leading to greater impairment, greater problems.
Appearing in the latest edition of The Journal of Politics published by Cambridge University Press, the research focused on 2,000 subjects from The National Longitudinal Study of Adolescent Health. By matching genetic information with maps of the subjects' social networks, the researchers were able to show that people with a specific variant of the DRD4 gene were more likely to be liberal as adults, but only if they had an active social life in adolescence.Finding statistical links on frequencies of random genes - not an actual full explanatory "x -> y -> z -> ADHD" theory, does zero damage to the idea that this should be better understood as maladaption to a broken society/environment, which is what needs fixing
Yes, if you have a broken leg, we want to treat the broken leg... but we also want to know how you broke your leg so we can prevent it from happening again.Which is what science is for. But the people complaining about ADHD are nonscientists who are just bitching about what they see as the problems of modern society in general.
For broken legs, car accidents, ADHD, PTSD, lung cancer, etc etc, all of these include many avoidable cases which are imposing enormous economic and social costs.No, there is a difference between worrying about people breaking their legs and worrying about broken bones being 'over diagnosed'. There are lots of little breaks that might have gone unnoticed without x-rays and CAT scans and so on, but now we can find them and prevent them from getting worse. That's not a problem, that's a good thing.
Do people getting Viagra have to listen to the pharmacist berate them, or sneer at them, and imply, suggest and hint that their customers are addicts, or dependent, or part of a "drug abuse culture"?It's more like talking about how people who take viagra just aren't man enough to get it up.
I am ashamed at how many elementary school courses I nearly failed, not because I didn't understand the topics, or couldn't engage in thought, discourse, and recitation of idiotic atomized context free factoids on the topic; but because I forgot about, and was late handing TITLE PAGES FOR UNITS.that remind me of one of the most enraging moments of my k-12 academic life. It wasn't even for points, it was just a contest.
RESULTS:posted by OmieWise at 8:08 AM on January 30, 2012 [7 favorites]
More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P < .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.
If stimulants worked for those writers, why not for me? Who wouldn't want to think faster, be less distracted, write more pages? I asked half a dozen psychiatrists about the safety of using nonprescribed Adderall for performance-enhanced journalism. Most of them told me the same thing: Theoretically, if used responsibly at a low dosage by someone who isn't schizophrenic, doesn't have high blood pressure, isn't on other medications, and doesn't have some other medical condition, the occasional use of Adderall is probably harmless. Doctors have been prescribing the drug for long enough to know that, unlike steroids, it has no long-term health consequences. Provided Adderall isn't snorted, injected, or taken in excessive amounts, it's not highly addictive—though without doctor oversight, it's hard to know whether you're in the minority of people for whom the drug may be dangerous.posted by delmoi at 8:53 AM on January 30, 2012 [1 favorite]
As an experiment, I decided to take Adderall for a week. The results were miraculous. On a recent Tuesday, after whipping my brother in two out of three games of pingpong—a triumph that has occurred exactly once before in the history of our rivalry—I proceeded to best my previous high score by almost 10 percent in the online anagrams game that has been my recent procrastination tool of choice. Then I sat down and read 175 pages of Stephen Jay Gould's impenetrably dense book The Structure of Evolutionary Theory. It was like I'd been bitten by a radioactive spider.
As a side note, Jesus, what the fuck is wrong with school teachers? All of these stories about title pages and pencil-shaming make me want to start slapping people.I'm guessing a lot of this was in the 70s/80s? Probably trying to prepare people for a world where computers wouldn't catch and correct any mistakes they made. Think about the corporate world without computers, or even calculators -- no computerized spreadsheets: all the math needed to be done by hand and at the same time there could be no errors. So obviously math and with no errors. So we all learned a way of doing math that was tedious and unenlightening, required a pencil and paper, but was unlikely to produce errors. And they drilled it into people so it would become routine (and boring as hell)
These conversations frequently go poorly on MetaFilter. They occupy the ticklish area at the meeting point of medicine, culture, stigma, redemption, public health, public policy, profit, and personal responsibility.People disagreeing with each other does not make a conversation bad, it makes it good. The problem is when people get too emotional over a topic and can't discuss it at all. But I don't see that here.
AbstractNote that this is not the same thing as saying that there are not biological factors, just that other factors are more important. One of the issues with biology as explanation, as it's currently used, is that it's mostly not nuanced very well, and biology is just kind of assumed to trump everything else.
The development of inattentiveness and hyperactivity in middle childhood was investigated using a prospective longitudinal approach. Endogenous and exogenous predictors measured in infancy and in early and middle childhood were examined independently and in combination. In early childhood, quality of caregiving more powerfully predicted distractibility, an early precursor of hyperactivity, than did early biological or temperament factors. Caregiving and contextual factors together with early distractibility significantly predicted hyperactivity in middle childhood. While environmental variables also predicted hyperactivity in later elementary years, these factors did not improve the prediction beyond the influence of hyperactivity in early elementary years. The findings support a developmental view of the origins and course of hyperactivity in childhood, that is, that the emergence and persistence of AD/HD symptoms depend on developmental history along with current circumstances.
It would be easy to extend this list of accomplishments, as both the effort and the output in this field have been extraordinary. Despite this progress, however, a counter-trend has occasionally arisen that at times erodes a developmental perspective: the tendency to treat biological correlates of functioning, and even characteristic child behavior, as somehow lying outside of the domain of development—of simply being endogenous givens. Reflecting this, the vast majority of current studies in the psychiatric literature simply compare those who do and do not qualify for some disorder on some biological variable (see, for example, the review of fMRI studies of ADHD by Dickstein, Bannon, Castellanos, & Milham, 2006). Given the integrated nature of development, it is impossible to avoid discovering large numbers of such differences. Seriously disturbed functioning will doubtless manifest in brain/body just as in interpersonal relationships and daily functioning.This is clearly a guy who has done a lot of work in this area, has well-developed and nuanced views, and is prepared to discuss them.
However, studies that reveal some difference in brain physiology between two groups, even those that use children, cannot answer the basic developmental questions of origins and course, but can only stimulate developmental inquiry. We can spend $21 million on the neurophysiological correlates of anorexia, as Chavez and Insel (2007) describe, and learn almost nothing about how individuals develop this problem. This is not because genes and neurophysiology are unimportant, but because they derive their importance within complex developmental analysis. Only developmental studies can reveal whether obtained associates are true antecedents, markers, or consequences of a disordered process. Experience influences physiology just as physiology influences experience (Grossman et al., 2003). Only developmental studies can reveal how genetic or physiological features interplay with the other features of a developing problem.
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Back "in-the-day" when we let kids roam free in their neighbourhoods, they could at least "play" themselves out... Now, constantly cooped-up, no wonder they cannot sit still...
(I am a parent of a little guy who will absolutely NOT stop moving for any reason... it is so bad we have a mini-trampoline in our living room...)
Or is it cultural - are we expecting ever more, cramming more curriculum?
I dunno. Plus - there is also evidence that ADHD can be inherited - is it again genetic or behavioural?
posted by jkaczor at 9:48 AM on January 29, 2012