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The Drugging of the American Boy
March 28, 2014 10:53 AM   Subscribe

By the time they reach high school, nearly 20 percent of all American boys will be diagnosed with ADHD.
posted by Sokka shot first (116 comments total) 17 users marked this as a favorite

 
I read this entire article, and as a man who was once a boy who was debatably over-medicated and under-counseled and consequently felt like a constant rule-breaking loser fuck-up, much of it resonated quite deeply with me.

That said, there's a paragraph about halfway through the piece where a dude says some pretty gross and unhelpfully gender-essentializing things about boys and girls, which ill-considered opining includes the absurd phrase "girlification," so be ready for that, I guess. I mean, it's Esquire.
posted by Sokka shot first at 10:54 AM on March 28 [19 favorites]


Now imagine that he is suffering like this because of a mistake. Because a doctor examined him for twelve minutes, looked at a questionnaire on which you had checked some boxes, listened to your brief and vague report that he seemed to have trouble sitting still in kindergarten, made a diagnosis for a disorder the boy doesn't have, and wrote a prescription for a powerful drug he doesn't need.

...which is why we need better healthcare in this country. We need for parents to be able to afford doctors who will spend more than 12 minutes with a child before prescribing a potentially fatal drug, and those parents need to be empowered to get a second opinion.
posted by roomthreeseventeen at 11:11 AM on March 28 [14 favorites]


I've had a vague curiosity about two seemingly contradictory trends in American life for some time. It seems like in some ways we're more tolerant than we've ever been, when it comes to superficial things like clothing, tattoos, church attendance or lack thereof, all these social markers that used to bind society tight like a corset. Perhaps also when it comes to deeper things like race and sexuality as well, despite the never-ending spate of stories about minorities being victimized without consequences for the aggressors.
Yet at the same time we're less tolerant than ever; witness well-intentioned but taken to absurd extremes zero-tolerance policies in school on weapons, drugs, physical contact, even on kids' writing about violence. The kid suspended for taking a razor away from a student who was cutting themself and giving it to a teacher, or the kid who was almost expelled over blowing up her chemistry experiment. And on and on. In many ways it feels like there is much less room for slack or error for young Americans specifically but also for Americans in general than there once was. I don't know if I'm old enough to actually judge this and I am sure at least some of it has to be chalked up to increased economic insecurity and some to the media's eternal quest for outrage fodder, but I would be interested in finding out if theres any good sociological investigation into other explanations.
posted by Wretch729 at 11:14 AM on March 28 [11 favorites]


I wish they'd had ADD in the early 80's. Seems like I would have benefited from being medicated.
posted by josher71 at 11:16 AM on March 28 [3 favorites]


By the time they reach high school 30% of kids will need vision correction for near sightedness. The vision correction industry, bad teachers and the doctors are conspiring to hand out eye glass prescriptions like they are candy rather than recognizing that kids are just lazy. 20/20 is just an arbitrary standard of vision anyway, if only kids spent less time reading and more time outside they wouldn't have these problems. A doctor gave me a vision perspiration once and I got headaches and had trouble driving therefore nearsightedness is just made up. Of course with parents refusing to discipline their children, it is really their fault.....
posted by humanfont at 11:21 AM on March 28 [80 favorites]


This article claims the ststistics came from the CDC, but the CDC's numbers don't match.
Also, the CDC doesn't mention how many of those diagnosed were prescribed "powerful drugs".
posted by rocket88 at 11:24 AM on March 28 [3 favorites]


I can't help wondering if the reduction in PE and Music programs in schools might have something to do with it. Both engage kids physically, emotionally and developmentally in a different way than schoolwork and both have fallen under the axe over the same period as the rise of ADD diagnosis.
posted by George_Spiggott at 11:24 AM on March 28 [22 favorites]


I was "hyperactive" (that's what they called it then) as a kid in the mid-70's. I was on Ritalin for a few months, but it gave me sleep problems, so my folks took me off it. In the ensuing years, I went through learning disabilities, behavior problems, abused my share of substances and got in my share of trouble. But even now as a more or less stable adult, I guess I'm still ambivalent about all this.
posted by jonmc at 11:26 AM on March 28 [3 favorites]


This wasn't something I cared or thought about until I started fostering children. All of the school age foster children I've met have been diagnosed ADHD and medicated accordingly. The problem is that PTSD in young children looks a lot like ADHD but requires vastly different treatment.

Also, talking about side effects from meds, try giving a stimulant to a child who is supposedly ADHD but is actually hyper vigilant. It was like living with a scared feral cat. But when we tried to get the diagnosis corrected we ran into a bunch of strange roadblocks. Well, it turns out that PTSD is the sort of diagnosis that will often get a kid's level of care moved up (meaning whoever takes care of them gets more money from the state) while ADHD is considered de rigueur and does not.

I wish that the demands we made of children didn't require such feats of focus and calm. I think even children with ADHD would be better served by a responsive environment that allowed them to at least decrease their need for medication. I feel like my children and many other are medicated and labeled simply because they don't do what society and their schools want and instead of examining if those wants are misplaced we put the blame on the child. I imagine that also makes it harder for people who actually have ADHD to be treated with the care, respect and accommodations they need to be successful.
posted by Saminal at 11:32 AM on March 28 [24 favorites]


"God bless the women's movement—we needed it—but what's happened is, particularly in schools where most of the teachers are women, there's been a general girlification of elementary school, where any kind of disruptive behavior is sinful. What I call the 'moral diagnosis' gets made: You're bad. Now go get a doctor and get on medication so you'll be good. And that's a real perversion of what ought to happen. Most boys are naturally more restless than most girls, and I would say that's good. But schools want these little goody-goodies who sit still and do what they're told—these robots—and that's just not who boys are."

Hey Ned, you might consider that the reason why "any kind of disruptive behavior" in schools is "sinful" is because teachers don't usually have the kind of resources or support that would allow them to accommodate kinesthetic learners, or those with short attention spans. When teachers are under pressure to get their students to score well on standardized tests, they need to cover as much material as possible, as quickly as they can, which usually entails having an entire class sit and listen or work for extended periods of time. In a more ideal environment, there would be outlets for restless kids, but teachers don't usually have that kind of luxury.

It's not actually because female teachers are trying to "girlify" boys.
posted by corey flood at 11:33 AM on March 28 [34 favorites]


20/20 is just an arbitrary standard of vision anyway, if only kids spent less time reading and more time outside they wouldn't have these problems.

I have actually heard this argument made unironically.

These articles always talk about boys being made to sit still and listen like it's a new thing. Were schools in the 1950's, or the 1900's, laid-back places with lots of unstructured active playtime, and the whole perception of stern schoolmarms/nuns doing drills out of grammar books with a smack for those who got out of line is just made up? Or are these advocates willing to twist history beyond recognition to bolster their ideas about boys being girlified by feminists and big pharma?

(There is lot of sexism around ADHD issues for some reason: treatment is up among women, so one insurer, Express Scripts, is launching a campaign essentially claiming that they're faking it to get weight-loss drugs.)
posted by Ralston McTodd at 11:34 AM on March 28 [14 favorites]


ADHD is real, but I'm sure there are lots of co-morbid issues and marginal diagnoses going on out there, as well as an education system not adapted to our real natures. For example, look at the impact later start times in school has on teenagers academic performance. That's biology in action.

Also, if you look into living with ADHD, there are loads of conservative treatment options besides medication. Some of them might tie into some old wisdom about boys as well, as exercise is very important, and increasingly recognised as such for both physical/mental health and learning.

I have a bit of ADHD, but I've never considered pharma solutions, as getting lots of other things in place in life and regular exercise takes care of most of it. As well as recognising the advantages that ADHD brings as well as the costs.
posted by C.A.S. at 11:35 AM on March 28


I've sometimes wondered if it doesn't complicate the issue that before boys get to school in the first place, many of them seem to be given a lot more freedom, and then it's twice as hard for them to adjust to a regimented setting because they haven't spent the previous five years being conditioned for it.
posted by The Underpants Monster at 11:36 AM on March 28 [3 favorites]


God bless the women's movement—we needed it—but what's happened is, particularly in schools where most of the teachers are women, there's been a general girlification of elementary school, where any kind of disruptive behavior is sinful.

Has the ratio of female-to-male elementary school teachers increased since the mid-twentieth century? I had the impression it had been a female-dominated field since way before then.
posted by The Underpants Monster at 11:42 AM on March 28 [5 favorites]


I wish they'd had ADD in the early 80's

They had what I think they called "hyperactivity" back then, a couple of kids in my class had it and had to take ritalin. They were actually pretty disruptive kids without it, prone to violent temper tantrums. It's anecdotal, but when I was a kid they seemed to get it down to kids that might have actually needed it.
posted by Hoopo at 11:47 AM on March 28


As an adult that definitely has ADHD, all I can say is that I'm grateful that in school I was smart enough to be able to get good grades without paying attention -- no one noticed my ADHD until I started attending a magnet school as a high school junior.

My sister was diagnosed with ADD (correctly, in my mind there is no doubt about either of us) as a child but even with a correct diagnosis the "treatment" made problems worse. Even when she refused to be drugged, the school system treated her like she had a serious learning disorder when really she just needed to be allowed the freedom to do things her own way.

Putting her in the slow-kid tracked classes certainly didn't help with her disorder which, as I should know, tends to cause the biggest problems when the person with AD(H)D is bored.
posted by unknownmosquito at 11:51 AM on March 28 [2 favorites]


It could very well be that we are over-diagnosing ADHD, but this is the very article that isn't going to persuade me. Someone looks at the numbers; says "those can't be right, can they?"; cherry-picks an anecdote of someone being diagnosed with ADHD after a twelve-minute visit; talks to two arguably-notable people who say "yeah, it's an epidemic"; points a crooked finger at pharmaceutical companies (who always make good villains, like Nazis in the movies); and then talks about One Man who is going a Different Way.

The blurb at the beginning says this…
The shocking truth is that many of those diagnoses are wrong, and that most of those boys are being drugged for no good reason—simply for being boys.
…and then utterly fails to support that claim in the article. It even skimps on the anecdotes — I searched the article top to bottom and I could find only one story about a kid that started on medication, then went off it. That child did so because of side effects, and he eventually went back on the medication at a lower dosage, and everyone's happy.

I would like to see an article about this that doesn't resort to the fear-mongering and the knee-jerk "let kids be kids" bullshit. If this is as serious a topic as the article alleges, then it deserves to be talked about at a level that doesn't put "common sense" on the same plane as medical expertise.
posted by savetheclocktower at 11:57 AM on March 28 [16 favorites]


"God bless the women's movement—we needed it—but what's happened is, particularly in schools where most of the teachers are women, there's been a general girlification of elementary school, where any kind of disruptive behavior is sinful. What I call the 'moral diagnosis' gets made: You're bad. Now go get a doctor and get on medication so you'll be good. And that's a real perversion of what ought to happen. Most boys are naturally more restless than most girls, and I would say that's good. But schools want these little goody-goodies who sit still and do what they're told—these robots—and that's just not who boys are."

AAAAARGHSDPOSERNJSDFPODVN DO YOU KNOW NOTHING OF CURRENT EDUCATIONAL THEORY?

Also, look at the term "disruptive"; if it's actually "disrupting" other students then, yeah, it's a problem in the classroom. This doesn't mean everyone sits still all the damn time -- hell, I'm the librarian now and I still work in stretches and stuff.* Even in the library and certainly in most classrooms, there are plenty of opportunities for movement. Teachers aren't some morons who know nothing of children and only like girls with good handwriting. This paragraph is horrific and upsetting and offensive and also, yeah, there are plenty of restless and antsy girls too.

Also, although I could be wrong since I don't know a ton about historical education, didn't schools used to be a man teaching all boys who sat in rows and copied stuff out of books? So why is the problem that women don't understand boys?

ALSO, in reference to "the women's movement" (and, incidentally, fuck the sentiment "God bless the women's movement...but") I've heard it hypothesized that part of the reason we're struggling to find good teachers (and nurses) now is that those used to be basically the only jobs open to women, so most of the smart and ambitious women became teachers or nurses. This means that, now that other fields have opened up, there's a drain of talented people away from those professions. If your point is "women have more opportunities so we have a smaller pool of potential teachers", um, fine, I guess, but if your point is "the women's movement allowed women to teach, which is just ADORABLE, but women shouldn't really be in charge of boys because they don't understand their special, precious needs" (not a literal quote) then shut up because you clearly have no understanding of teaching, child development, or the women's movement.

If you create a society where childcare is a female responsibility and then blame women for doing it wrong, and also believe women can't understand men, and also have no idea how schools actually function, maybe you should stop and think a moment before you write bullshit articles.

*The other day I read Make Way for Ducklings with some of my younger classes and we practiced quacking and waddling and flapping like ducks.
posted by Mrs. Pterodactyl at 12:02 PM on March 28 [62 favorites]


So what's the alternative?

Lemme guess: Dianetics?
posted by Sys Rq at 12:05 PM on March 28 [4 favorites]


re: sys rq

how about.. simply not giving stimulants to children the same way we don't give them booze or pot?
posted by unknownmosquito at 12:06 PM on March 28 [1 favorite]


how about.. simply not giving stimulants to children the same way we don't give them booze or pot?

Or vaccines?
posted by Sys Rq at 12:08 PM on March 28 [6 favorites]


Vaccines aren't psychoactive. That's not a valid comparison.
posted by unknownmosquito at 12:10 PM on March 28 [4 favorites]


That's ridiculous. You're comparing vaccines to speed. They are not comparable even if you think amphetamines are appropriate treatment for children!
posted by Justinian at 12:10 PM on March 28 [3 favorites]


how about.. simply not giving stimulants to children the same way we don't give them booze or pot?

Because we'd like to hang onto the baby while throwing out the bath water?
posted by griphus at 12:11 PM on March 28 [11 favorites]


I've heard it hypothesized that part of the reason we're struggling to find good teachers (and nurses) now is that those used to be basically the only jobs open to women, so most of the smart and ambitious women became teachers or nurses.

Interesting. There's a shortage of nurses, but also a lot of nurses who can't find jobs. The shortage comes from not having enough people to train good nurses.

However, nursing is now a really lucrative career, with starting salaries in the mid 50s, and the potential to make 70 or 80 thousand a couple of years in. I think you're also going to see more of a gender balance because of that.

I bet you would too if teachers got paid that much.
posted by MisantropicPainforest at 12:12 PM on March 28 [2 favorites]


Anyway, I sure as hell hope none of y'all ever get the look on your face that my mom did when I was 24 and she finally asked me if my life would've gone a bit more smoothly if she'd done what my uncle and aunt did and not ignored textbook ADHD symptoms.

If you want to be jerkishly reductive about it, some kids benefit greatly from speed, because it turns out "speed" is a loaded term for a therapeutic chemical substance.
posted by griphus at 12:16 PM on March 28 [28 favorites]


I didn't imply that they don't benefit greatly from it. But I would submit that "Adderall" is just as loaded a term given the many millions of dollars of marketing and such behind it.
posted by Justinian at 12:20 PM on March 28


how about.. simply not giving stimulants to children the same way we don't give them booze or pot?

Or hormonal birth control pills for young women.
posted by humanfont at 12:21 PM on March 28


I think its worth noting that, in practice, the alternative to medication is often....just yelling at kids.
posted by MisantropicPainforest at 12:23 PM on March 28 [14 favorites]


But I would submit that "Adderall" is just as loaded a term given the many millions of dollars of marketing and such behind it.

Well, yeah, because they couldn't sell it as "dexedrine" anymore because if you want to talk about loaded terms, there's a generation of people for whom the idea of feeding dexedrine to a child would be considered inherently abusive just because of the long period of time when dexedrine was a severely underregulated substance and caused a lot of problems.
posted by griphus at 12:23 PM on March 28 [2 favorites]


I think its worth noting that, in practice, the alternative to medication is often....just yelling at kids.

Or a paddlin'.
posted by George_Spiggott at 12:25 PM on March 28 [1 favorite]


(I mean I'm being a bit reductive about this as well, but there's good reasons to keep people from immediately associating the very concept of "ADHD medication" with the stigma of unregulated stimulant abuse.)
posted by griphus at 12:27 PM on March 28 [2 favorites]


That's true, griphus. Of course I think the distinction between regulated stimulant use and unregulated stimulant abuse is somewhat arbitrary and fuzzy.

My issue with such a widespread use of amphetamines in children is not simply knee jerk snark. It does help kids concentrate. And some of those kids actually need it (and many do not). But I don't think we have much idea at all about the long term effects of medicating kids with speed/dexedrine/whatever and my educated guess is that they will turn out to be more serious than we currently believe.

In fact we just discovered one possible negative long term effect in the last few months; kids who are treated with stimulants have a significantly higher long term risk of obesity. That's counter intuitive but there is evidence for it.
posted by Justinian at 12:30 PM on March 28 [1 favorite]


Well, there's a very bright line between stimulant abuse and stimulant use: the prescribing physician's prescription. "Stimulant use" is following it and "stimulant abuse" is what happens when you exceed that without a doctor's permission.

Are there shitty doctors? Without a fucking doubt. We don't have a heinous synthetic opiod problem in this country because everyone is knocking over pharmacies with loaded guns. But no one seeing a decent doctor is prescribed ADHD medication with the instructions "go wild." It's either "take one per day" for extended release formulations, or "take as needed not to exceed Y times per day and not without Y hours between dosages."

At some point "the drug can seriously hurt you if not taken to strict guidelines" has to fall closer to "a car can kill you if you don't know how to drive it." There was significant uptuck in prescriptions in the the 1990s and the long-term studies on that era are still out, it's not like we're giving kids some mysterious substance from Planet X. We've been prescribing Methylphenidate (ritalin) since the 1960s and dexedrine since the 1930s.

And as far as things like "long term risk of obesity," that's sort of effect is something many people on many medications face. People on certain medications face a seizure risk they wouldn't otherwise, for instance and tardive dyskenesia is a well-known effect of others. Psychopharmacology is a notorious crapshoot as anyone who has seen a psychiatrist will tell you. And absolutely no one would argue that we shouldn't be more careful with what medicines are prescribed to children or people in general and shouldn't study the effects closely, moral panic and stigma over mental health medication -- stimulant-based or not -- just keeps kids from getting treatment they need.
posted by griphus at 12:48 PM on March 28 [8 favorites]


Ya know, whenever I read these things it strikes me how rarely anyone directly asks the kids what they think. Parents, doctors, teachers, drug companies... the article only gives a voice to those with power who, while ostensibly acting in the children's interest, frequently have very different notions of what the real problem is. The biases of power being what they are, I find that pretty troubling, and as someone who spent much of high school inappropriately stuffed with pills (despite scoring very well on all the various tests and being in the top of my class), I can say with some confidence that many of the students we're discussing might argue it's the schools and petty, authoritarian teachers who need to be changed rather than anyone's brain chemistry. I suspect many of them might tell you that sitting in class for hours on end is often pretty pointless and hellish. But the children don't get a say, do they?

Plus, there's this sort of thing:
The thing is, studies tracing the impact of ADHD meds report no improvement in academic performance in the long term, as Nature reports in a new review of existing research, and kids taking the drugs are in some cases more likely to drop out of school.

[...]

When the researchers in that study asked parents and teachers to evaluate ADHD children’s scholastic performance before and after medication, they found that though the children’s grades stayed the same, adults believed they improved, reports Nature.

Worse, parents’ and teachers’ inclinations to mistake manageability for academic improvement could actually be exacerbating children’s academic problems.

posted by Wemmick at 12:50 PM on March 28 [5 favorites]


how did this soapbox get under me who put this here
posted by griphus at 12:53 PM on March 28 [5 favorites]


This article is a bit sensational. And that sidebar!
posted by zscore at 12:54 PM on March 28


Vaccines aren't psychoactive. That's not a valid comparison.

Vaccines are a solution to a problem, as are stimulant medications. "how about.. simply not giving stimulants to children the same way we don't give them booze or pot?" is not a solution to anything.
posted by Sys Rq at 12:58 PM on March 28 [5 favorites]


I got lucky. I was diagnosed when I was six (in 1988, so yes they did have this, but my carpool did not know what ADD meant, so take that as you will), which still amazes people and makes them doubt the doctors. But I was observed for several days as part of a battery of tests. I don't remember them, but I've been told about them (well, I do remember being upset that I didn't quite get to the end of row of the vocabulary card and thus did not get ice cream). Apparently, the psychiatrist told my parents to forget about college and just focus on keeping me out of jail. I cannot say how glad I am that my parents ignored her.

I spent three years going through every therapy that my parents could think of (although I am pretty sure I never ended up in any sort of cognitive work) before we tried any medication. And the side effects were frightening in a way. I was a skinny kid and I started losing weight. I remember vaguely that I was in the 90 something percentile for height but in the 20 something for weight. I taught myself to eat while not hungry, for fear of being pulled of the medication.

I had stopped crying daily at school. I was not getting into fights on a regular basis. I had been at the top of my class since second grade, but I was no longer horrible about it.

Anyway, now that I've explained my anecdotal experience here, allow me to explain what stimulants did for me and have done for most of the people on them I have talked to: they allowed me to slow down. I could suddenly think for a second before reacting. In my memory, which given my age at the time is suspect, it was nearly a night and day situation. Suddenly, I had friends. I could talk with and in fact became friends with one of the kids who used to tease me (I don't think it was bullying from him, although I did experience some of that).

With my brain slowed down, I also had the ability to finally learn coping strategies. I learned to resist the impulses both on and off medication.

I'm still on meds these days. On the days I forget to take them it feels like my brain is wrapped in cotton wool, for lack of a better term. This is a feeling that I do not know of any cognitive tricks or coping strategies that can avoid it.

I also taught for a few years. I have seen kids who were diagnosed who did not need it. I have seen (although these days it seems to be a small percentage) of kids who most likely should go and see a shrink to see if that is what is affecting them.

The biggest issue that I, and I think a lot of people have with facing up to the over-diagnosis, is that for ages the attitude encountered was that every diagnosis was in excess. I also strongly suspect that it is over diagnosed among wealthier populations more than poorer ones.
posted by Hactar at 1:00 PM on March 28 [16 favorites]


griphus: I just realized that something I take for granted is not obvious. I don't sometimes refer to amphetamines used to treat ADHD as "speed" in an attempt to stigmatize ADHD medication but in an attempt to partially de-stigmatize speed. Because an awful lot of people, even here on Metafilter, still think it's some kind of demon substance and that Tommy or Mary's ADHD medication is completely different.
posted by Justinian at 1:01 PM on March 28


However, nursing is now a really lucrative career, with starting salaries in the mid 50s, and the potential to make 70 or 80 thousand a couple of years in. I think you're also going to see more of a gender balance because of that.

I bet you would too if teachers got paid that much.


It probably should be noted that working conditions for both nurses and teachers tend toward the sucky side of the street right now; for many qualified people, the salary alone isn't enough to balance that out.
posted by The Underpants Monster at 1:03 PM on March 28 [1 favorite]


I don't sometimes refer to amphetamines used to treat ADHD as "speed" in an attempt to stigmatize ADHD medication but in an attempt to partially de-stigmatize speed.

Then you'd do well to put some more thought into your pronouncements on behalf of that destigmatization campaign because:

"You're comparing vaccines to speed. They are not comparable even if you think amphetamines are appropriate treatment for children!"

...in defense of the opinion of someone who thinks ADHD medication is more akin to people's casual use of alcohol and marijuana than to a different stigmatized prescription medication sure does sound like that same moral panic horseshit.
posted by griphus at 1:10 PM on March 28 [6 favorites]


That stuff about "girlification" is just horrible b.s. As a male who has normal testosterone levels but who nevertheless managed to be respectful and not disruptive in 12 years of public school without having my spirit crushed, it's selling kids short to suggest that they can't obey basic rules. "Boys will be boys" is one of the dumbest aphorisms ever spoken. Poorly parented boys not given any limits and given terrible macho examples by their dads will be boys.

I do agree that we seem to be way over-diagnosing ADHD and related problems but this article wouldn't convince me if I didn't already think that. Obviously kids with real chemical imbalances or other issues do exist (my best friend was on Ritalin). But in the case of my own kids, things like how much screen time they get, whether they are punished for bad behavior, what they eat, whether they get exercise on a given day, how tired they are etc. all have a *Very* noticeable effect on whether they seem to be perfect kids or monstrous hell-beasts. And I sure see a lot of non-parenting in public. Also I can't help but think of someone I worked with whose kids supposedly had ADHD. The parents were a mess and the dad constantly played Call of Duty and stuff with the kid, who was like 8. My kids only sort of vaguely know what guns even are at that age ... point being it was hard not to see the parents and think "well that's why that kid is so messed up."

I'm not minimizing real health issues, just saying that I'm the most laid back dad ever (I thought) and I am appalled at how few limits and how little guidance a lot of kids seem to be given.
posted by freecellwizard at 1:12 PM on March 28 [5 favorites]


Vaccines are a solution to a problem, as are stimulant medications. "how about.. simply not giving stimulants to children the same way we don't give them booze or pot?" is not a solution to anything.

From context I think you're trying to defend the comparison between ADHD medication and vaccines, but that's the only way I can tell.
posted by LogicalDash at 1:16 PM on March 28


in defense of the opinion of someone who thinks ADHD medication is more akin to people's casual use of alcohol and marijuana

I don't see how that comment is a defense of anyone's opinion. It's not a defense at all; I was taking issue with a comparison made between vaccination and amphetamines. That's not a reasonable comparison even if you think ADHD meds are appropriate, as I said. You can point out flaws in an argument without it being an endorsement of the opposite argument.
posted by Justinian at 1:16 PM on March 28


As a male who teaches 1st and 2nd grade I'll say that in my experience there is no 'girlification' of the classroom, every teacher I work with knows that some kids (not just boys) need to move around and we accommodate them in various ways (my kids are learning to juggle this year; some teachers use those big yoga balls as chairs, there are dozens of strategies in my school alone), no teacher ever tells parents that their child needs drugs of any kind (seriously, we're not allowed to), and there seems to be an economic difference here, too, as in every part of education... at my very affluent school I've had many very active kids but very, very few who are on any kind of meds.

On a related note...

Please, parents, if your child does have a male teacher in the lower grades, don't go on and on about how great you think it is that a man is teaching little kids and how all the little boys need a strong man as a role model... it's insulting to all the female teachers who do just as good a job teaching your kid how to read and do math and be a little person.
posted by Huck500 at 1:17 PM on March 28 [33 favorites]


Anyway, now that I've explained my anecdotal experience here, allow me to explain what stimulants did for me and have done for most of the people on them I have talked to: they allowed me to slow down. I could suddenly think for a second before reacting. In my memory, which given my age at the time is suspect, it was nearly a night and day situation. Suddenly, I had friends. I could talk with and in fact became friends with one of the kids who used to tease me (I don't think it was bullying from him, although I did experience some of that).

This is in alignment with current understanding that ADHD is primarily concerned with lack of inhibition capacity. I wasn't diagnosed as a kid, and it took a long time but I finally developed coping mechanisms to improve my inhibition, but I still have trouble with it.
posted by davejay at 1:22 PM on March 28 [1 favorite]


These articles always talk about boys being made to sit still and listen like it's a new thing. Were schools in the 1950's, or the 1900's, laid-back places with lots of unstructured active playtime,

Yeah, but the answer then was discipline, not re-wiring a more compliant brain. (That's not to say that ADD isn't real and medication helps a lot people. But the comparison misses the mark.)
posted by spaltavian at 1:33 PM on March 28


Or just not graduating high school.
posted by Zalzidrax at 2:04 PM on March 28 [2 favorites]


Teachers do not make diagnoses. Parents, which includes male parents, make decisions about their children's health care, including the daughters who have ADHD.

Stimulant medication is also prescribed to people whose cognitive functions are declining for any number of medical reasons, which may correlate to age (at both ends) way better than gender...

So many gender-essentialist tropes...It isn't gentleperson's quarterly, is it?
posted by childofTethys at 2:40 PM on March 28 [1 favorite]


What is Howard Glasser's training and what has been his scientific involvement with ADHD research? Is he considered an expert by people like Russell Barkley (who is I think the expert on ADHD)?
posted by scunning at 2:44 PM on March 28 [1 favorite]


That said, there's a paragraph about halfway through the piece where a dude says some pretty gross and unhelpfully gender-essentializing things about boys and girls, which ill-considered opining includes the absurd phrase "girlification," so be ready for that, I guess. I mean, it's Esquire.

Yea, there's some poop smeared on that paragraph. The point about schools going "you're bad, now go get medication and be good" is real though.

It happened to my friends in public school. It happened to me at a private school. They literally, straight up told my parents "your kid is out of control and needs medication. he can't come back until he gets it".

This is something that needs to be attacked. It's more bullshit in my opinion than even TV and other advertisements for medication which should be federally illegal. This needs to be filed under the "discrimination against a disability" statutes that already exist.

Teachers do not make diagnoses.

Yea, sometimes they do though. or at least they say things they have no place saying along the lines of "i think your kid has add or adhd, you need to get them medication now".

...which is why we need better healthcare in this country. We need for parents to be able to afford doctors who will spend more than 12 minutes with a child before prescribing a potentially fatal drug, and those parents need to be empowered to get a second opinion.

This runs all the way up and down the class structure. As a kid, my parents were middle class+ and my family could afford for my mom to stay at home with me or at most only have a part time job as a florist she wanted to have. As such, when this sort of thing came up she hunted down the better doctors and took me to several. They all had that exact 12 minute bullshit reaction. We had to go to like five before she finally took me to a very good psychiatrist who actually wanted to do a bit more digging before she started shoveling drugs into me. The general consensus seemed to be "oh this drug isn't working? well lets try 12 more!"

The basic system and rubric by which doctors deal with this kind of thing needs to be changed. Overworked doctors at the city health org low income clinic are not the problem.

I also hate the whole "how about we not give children DRUGS?!?!" thing. For people who need it, this stuff is priceless. It's on the same level of importance as antidepressants for some people, which is to say you need it to function in society. The problem is that it at least appears that too many kids are getting prescribed it, and some may not need it and it may be a kneejerk thing.

I really wish that people would avoid:

A. IT'S THE AMERIKKAN BIG PHARMA INDUSTRIAL COMPLEX MARKETING MACHINE AT WORK annnnd
B. The shockingly close to antivaxer "our kids shouldn't be on drugs!" or
C. the huge conspiracy theory bits in general honestly, including stuff exaggerating how widespread this is or may be. show your work if you're gonna go there. if there's no way for us to do that because we can't get to the data, well lets avoid getting loose change in here.

Discussions about this turn to shit very easily. Stay calm and rational and avoid conflating things with inflammatory shit.

And, full disclosure, as was implied above i was a kid who went through this. Eventually they realized "Oh, hey, he just has mild autism i guess" but it sure took long enough because so many doctors and other people just wanted to shove ritalin and other stimulants and stuff on me.
posted by emptythought at 2:49 PM on March 28 [4 favorites]


When teachers are under pressure to get their students to score well on standardized tests, they need to cover as much material as possible, as quickly as they can, which usually entails having an entire class sit and listen or work for extended periods of time.

Well, if you're judging teachers on how well their students do on standardized tests, it only makes sense that they'd prefer standardized students.
posted by Kirth Gerson at 3:10 PM on March 28 [1 favorite]


It happened to my friends in public school. It happened to me at a private school. They literally, straight up told my parents "your kid is out of control and needs medication. he can't come back until he gets it".

Just a heads up that, per my understanding, this is illegal (at a public school, anyway); under the IDEA children are legally entitled to a free, appropriate public education and you cannot exclude a child for not taking their medicine. Not saying that this isn't what your friends' families were told, just that, in case anyone else is told this, it is not true as far as I know; your child is allowed to attend public school regardless and you should check with a lawyer.
posted by Mrs. Pterodactyl at 3:11 PM on March 28 [3 favorites]


However, nursing is now a really lucrative career, with starting salaries in the mid 50s, and the potential to make 70 or 80 thousand a couple of years in. I think you're also going to see more of a gender balance because of that.

I bet you would too if teachers got paid that much.


I hope so. I think both boys and girls would be better served by this. However a bigger barrier to men teaching (especially younger age kids) is the very prevalent attitude that any male who wants to work in a field where he has access to little kids is some kind of pedophile (yes, I was told this by a career counselor when I was looking at what to major in for college-while I was in high school).

Please, parents, if your child does have a male teacher in the lower grades, don't go on and on about how great you think it is that a man is teaching little kids and how all the little boys need a strong man as a role model... it's insulting to all the female teachers who do just as good a job teaching your kid how to read and do math and be a little person.

I agree that they can do as good a job, however it really isn't a stretch to say that boys can benefit from strong (which I mean "positive" and they probably do also) male role models they have close contact with than it is to say that girls benefit from seeing strong female role models (any other underrepresented group-and male grade school teachers are most definitely underrepresented vs males in society and see my above statement for why that might be and why kids not have any other close contacts outside of the family group).

Not seeing that male role model patterning good behavior and being able to talk to them about things could most definitely lead to behavior problems. And while i don't really buy into gender essentialism being biological driven and inescapable, our society sure as hell does show this pattern (the boys will be boys issue)so is it any wonder that the kids are? especially those without access to a decent male role model in the home?
posted by bartonlong at 3:47 PM on March 28 [1 favorite]


School systems have been sued successfully by parents who experience teachers spouting off about diagnoses or medication recommendations. It's better in that context, and many, many educators know not to even hint in that direction.
posted by childofTethys at 4:31 PM on March 28


griphus: "how did this soapbox get under me who put this here"

Thank you for standing on it. Parents trying to make difficult decisions about how to treat a kid diagnosed with ADHD deserve to hear a balanced view in defense of treatment options that have been greatly stigmatized by uneducated fearmongering.
posted by Dr. Zira at 4:32 PM on March 28 [6 favorites]


All of us on the gender spectrum benefit from a variety of teachers. You want your daughters to know that men, women and transgender people are capable professionals with children, as well as your sons. Comment on their professional abilities and achievements, that is their work, which is driven by their mind & heart.

The pedophile comments are vitriolic gender- essentialist gatekeeping, and the statements should be called out for the falsehoods that they are. The media take one data point and inflate it until it eclipses common sense. Also, if men are driven out of profession, wages may be kept artificially low due to cultural conditioning. Diversity helps everyone.
posted by childofTethys at 4:52 PM on March 28 [1 favorite]


It's tough. I was diagnosed as "hyperactive" back in the 60s, and put on Ritalin. I don't remember how it affected me. My son, now 8, seems ridiculously hyperactive. My wife, very anti-medication refuses to allow him to be diagnosed with ADD, as it's just a way to medicate children. While I'm not a fan, and think ADD is way over-diagnosed, I am certain it would help my son...
posted by Windopaene at 5:13 PM on March 28 [2 favorites]


Just a heads up that, per my understanding, this is illegal (at a public school, anyway); under the IDEA children are legally entitled to a free, appropriate public education and you cannot exclude a child for not taking their medicine. Not saying that this isn't what your friends' families were told, just that, in case anyone else is told this, it is not true as far as I know; your child is allowed to attend public school regardless and you should check with a lawyer.

The amount of blatantly, definitely illegal things like that i witnessed(or didn't really grok at the time, but was later brought up offhandedly by my parents... or as an angry memory by them) was appalling.

Private schools will just openly say it because they can. But public schools will say something like that, then when pushed on "you can't say that!" go "Oh, well obviously your child needs an IEP/to be in special ed!" and then the parents back down. They used the "Oh, you'll be in special ed then i guess" as a smirking club so much that i heard of.

Just because people have sued and won doesn't mean that people who can't afford to go that route don't get boned over, and that their kids don't get cattle-chuted to doctors who are then fed the pre-loaded conclusion thing of "my kid acts like this, and my teacher says this is what he needs to be productive in school because he acts like XYZ".

One of the things that i learned very early in life, and have continued to see all my life is that laws only apply if you're in a disadvantaged position. They are merely suggestions to people in positions of power, and lawsuits are often just costs of doing business and at most the deck chairs getting shuffled.

how did this eeyore suit get on me who put this here
posted by emptythought at 5:26 PM on March 28 [2 favorites]


I think a huge part of this is economic pressure. Way back in the day, more hyperactive kids or those with minor ADHD would just have been assumed to be shitty students. They'd either fail out, drop out, or graduate with poor grades. However, back then, that wasn't so bad; there was a lot of opportunity if you were clever and active and worked hard, and a lot of people weren't educated (and most didn't go to college), so it wasn't a big deal.

Now, kids are absolutely screwed if they don't do well in school; not finishing high school is looked at as a massive character flaw that will prevent you from getting even the most non-academic job, and the opportunities for people without either college degrees or vocational training (which ADHD would also interfere with) are slim to none. So you have to do well at school. Standardized testing keeps bad students from being waved through the system, and schools are held to account for their performance. So there's no way out for people who don't fit well into the system.
posted by Mitrovarr at 5:32 PM on March 28 [4 favorites]


Emptythought I think with your autism and your education you experienced some of the same problems those a generation before experienced with the educational system their ADHD. There are probably kids today who have some as yet less well described condition that are now pushed into programs for kids on the autism spectrum.

While I understand your experience was crap, please understand that there are many kids who actually have ADHD and for whom the medication has been incredibly effective.
posted by humanfont at 6:16 PM on March 28 [1 favorite]


Absolutely - something technically being illegal is one thing. Being able to get those laws enforced is another thing aaaaaaaaltogether. If I had a dollar for everything I experienced or saw going on in public schools and state univiersity that I know was technically illegal, well, I probably still wouldn't have enough to have retained a good enough lawyer to have actually gotten any of them stopped.

And as an adult in the workplace, it's been the same thing. There have been so many times that employers have violated just my rights under the Americans with Disabilities Act, but I needed the job badly enough and they weren't afraid enough of a lawsuit that they knew they could get away with it.

Laws only mean as much as the punishments associated with breaking them, as we see over and over again on Wall Street.
posted by The Underpants Monster at 6:30 PM on March 28


[One comment deleted; please don't do the FTFY thing, just say what you want to say.]
posted by LobsterMitten at 6:33 PM on March 28 [1 favorite]


I voluntarily saw a doctor as an adult to get an ADHD diagnosis because I was worried I would fail to complete my graduate degree (just like I'd nearly failed to complete my undergraduate degree). With the help of prescription medication, I finished my course, but I still have very mixed feelings about those drugs. I think they're more dangerous than a lot of people realize, even for adults who have more of a sense of what is and isn't 'right' for them, and the idea that the "appropriate" way to take stimulants is to take the same amount every single day is crazy to me. It only works that way for children because they have the same school schedule every single day, otherwise stimulants really seem to me like the kind of thing you should only take as needed.
posted by subdee at 6:50 PM on March 28


Like maybe it's because I'm on the edge of this disorder, but stimulants affect my mood a lot. I have trouble sleeping while I'm taking them, I feel like a cokehead motormouth even if I don't say anything, and the crash after they wear off feels an awful lot like depression. And I mean just for instance, hasn't there been a lot of research recently about genetic links between ADD, depression, autism and bipolar disorder? The last thing you want to give a bipolar or overly-anxious kid is a stimulant.
posted by subdee at 6:59 PM on March 28


emptythought: "The general consensus seemed to be "oh this drug isn't working? well lets try 12 more!""

Just chiming in that this was my experience too. There definitely appears to be a tendency toward trying one drug after another until something works or the side-effects get out of hand. As a kid they ran me through most of the alphabet from Adderall* to Zyprexa**, and the experience left me with the conviction that there was (and I assume still is) very little discipline in the prescribing of psychoactive pharmaceuticals. Couple that with lax diagnostic standards, and if someone wants a normal kid medicated, there are few barriers preventing it. The bias is toward pills.

*no benefit, but it did give me a resting heart rate of 100 bpm. Not fun.
**huge wtf for that one. Zyprexa is indicated for schizophrenia and bipolar disorder, and I had neither the symptoms nor a diagnosis for either. I'm not sure why I was prescribed it, but I suspect it's related to the 1.4 billion dollar fine Eli Lilly & Co. was given for illegal off-label marketing...
posted by Wemmick at 7:00 PM on March 28 [2 favorites]


Gosh, a lot of you seem to think that wanting to avoid giving your kids speed is like not wanting to give your kids vaccines.

Question for the "speed for kids" group - if this is really such a health problem, why is it confined to the United States? Most of the rest of the world doesn't give their kids stimulants to fix their problems in such enormous quantities, and they seem to be doing perfectly well.

> We've been prescribing Methylphenidate (ritalin) since the 1960s and dexedrine since the 1930s.

And yet I couldn't find one single study on the long-term effect of medical stimulants on pediatric patients...?

Another question for the "speed for kids" group - when do you expect the kids to get off the speed? If they spend years of their life studying under the influence of stimulants, how do you think they're going to do the first year they after they've quit? Are you really going to quit the speed in the last year or two of high school - risk not getting into the college of your choice? Or quit in college, and risk flunking out a year at ruinous expense?

By the time your "ADHD" kid has graduated from college, they will have been using stimulants for the majority of their lives...
posted by lupus_yonderboy at 7:17 PM on March 28


And yet I couldn't find one single study on the long-term effect of medical stimulants on pediatric patients...?

As someone who works in clinical trial work, I will check to see if Johns Hopkins has a study like this going on currently.
posted by josher71 at 7:26 PM on March 28


when do you expect the kids to get off the speed?

Well, who says they need to? I do agree that having such drugs available "as needed" is probably a better idea than taking them every day - most of my personal acquaintances with the childhood ADHD diagnosis have settled into this sort of use pattern in adulthood and this is the goal I would set for long term.
posted by atoxyl at 7:42 PM on March 28


Another question for the "speed for kids" group - when do you expect the kids to get off the speed?

As an adult "on speed" why should I stop taking my medicine? You have a problem with me taking Nexium for the rest of my life too?
posted by griphus at 7:46 PM on March 28 [8 favorites]


lupus_yonderboy: "By the time your "ADHD" kid has graduated from college, they will have been using stimulants for the majority of their lives..."

You'd better spell out what's on the other side of that ellipsis, because I'm not following. I am 31 years old and I have been taking Adderall since I was 14. If I find a non-stimulant treatment that works as well as Adderall, I'll happily switch over. Until then, I'm doing just fine.

If you, as a parent, are OK with giving your child a stimulant at the age of 10, then you're almost certainly OK with that child continuing to take that stimulant at the age of 18.

I don't want to appear to argue that a parent shouldn't be concerned about putting their child on an amphetamine salt. Obviously that's a choice that has to be considered carefully, and if there were an equally effective alternative (as there surely is in some cases) then it's worth taking. But stimulants are, by far, the most effective class of drugs that we currently have to treat this disorder, and a whole bunch of kids would be worse off than they are now if they didn't have them as a treatment option.
posted by savetheclocktower at 7:54 PM on March 28 [8 favorites]


(Also, having been born in "the rest of the world" and raised by old country parents, I would be a lot more careful about where you take your child-rearing examples from. The fact that Americans don't consider hitting their children acceptable is considered a sign of lax discipline and lazy parenting in much of the world. Maybe we'd have less cases of ADHD if we started hitting kids again?)
posted by griphus at 7:55 PM on March 28 [3 favorites]


I absolutely agree that it's important we learn more about the long-term effects of starting kids on stimulants (and frankly, pretty much every other psychiatric drug out there too), and that using drugs as base-level classroom management tools isn't ethical or defensible.

However, this article and many, many others like it always seem to take the position that no kid should ever be on psych drugs for any reason, ever. That whatever issues are going on can always be fixed by extra time on the playground. I was diagnosed with ADHD at age 29 and I wish it had been a more common diagnosis in my own childhood. Maybe then I wouldn't have spent thirty years developing a variety of insane coping mechanisms for getting work done, which served me well through elementary school, high school, and college, but fell completely to bits when I got to grad school and lived on my own for the first time and ended in a major depressive episode, panic attacks and dropping out of my program ABD with no money or decent job prospects. Maybe I wouldn't have let so many of my important friendships from high school and college completely fall apart after graduating because I can barely remember to keep in touch with my own close parents and sister on a regular basis without multiple reminders a day. Maybe I'd have learned at some point to keep my living space in some semblance of liveability, rather than a hundred piles of clutter I can never seem to contral and that make me feel like I'm doomed to someday blossom into a full-scale hoarder.

And I'd rather not even start on the awful gender crap going on here. These panicked "oh-no-what's-happening-to-our-boys" articles just serve to further keep the incidence of ADHD in girls and women invisible - if teachers and parents think of it associated entirely with hyperactive boys, it's very unlikely girls with ADHD - especially those with inattentive type - will ever get diagnosed, much less have access to treatment, before their coping patterns and behaviors have been going on so long that they're incredibly difficult to change, even with medication.

lupus_yonderboy, you say "By the time your "ADHD" kid has graduated from college, they will have been using stimulants for the majority of their lives..." and I do get your meaning, I really do. But assuming that this would automatically be a bad thing for every kid, regardless of circumstances, comes off to me as similar to the more general sentiment that mental illnesses such as depression or ADHD are really just laziness and can be fixed with simple physical solutions or brute force willpower. Just as there are almost certainly children who may suffer consequences from being inappropriately medicated, there are also children who will almost definitely suffer consequences if they, like me, spend ten or twenty-plus years developing behavior patterns based on living with an untreated mental illness. It's just not as simple as this article paints it.
posted by augustimagination at 8:02 PM on March 28 [13 favorites]


> But assuming that this would automatically be a bad thing for every kid, regardless of circumstances,

Who said that? No one!

If your kid needs meds, then they get meds. People have conditions that require medication, and some of those conditions are psychiatric, and sometimes you end up taking drugs for the rest of your life because it makes your life better. Better living through chemistry, absolutely.

I'm not talking about that - we're talking about giving these drugs to 20% of all kids. 20% of kids hooked on stimulants, potentially for life! We're talking about ADHD drugs as routine, daily drugs, not exceptional drugs for temporary therapy.

And again, please note that they don't do this in other countries, and their kids seem to do fine.
posted by lupus_yonderboy at 8:21 PM on March 28 [1 favorite]


Worldwide prevalance of ADHD

Global Variation in Diagnosis and Treatment

Another question for the "speed for kids" group - when do you expect the kids to get off the speed?

Speaking as a dad of a "kid on speed" and a recently diagnosed member of the group - I don't. The same way I wouldn't expect him to get off insulin if he was diabetic. He may choose to go off it when he's older, and that's ok - there are ways to manage without the meds, and I know plenty of folks with it for whom the side effects are too unpleasant. But for right now - given that he's doing better academically across the board, as well as socially - we're going to stay the course.

I used to be like you, before my son was diagnosed. Believing this was all some scam, or some cheap way of avoiding addressing the real problems kids were having. Now I know a lot better.

Being on ADHD meds is not about gaining an advantage. It's about being able to deal with the world. I haven't yet found a way to describe to someone who doesn't have it what that first day of having the right prescription at the right dosage is like, but it changes a lot of your perspectives. The meds are a starting point for learning some coping skills and strategies that I was never able to master despite repeated attempts; about finally being able to succeed at things that I watched others do with ease but I could never do. And it's about realizing that those problems I had throughout my life were not some moral failing or character flaw.

It used to be pretty easy to dismiss depression and say that sufferers should just stop being sad.

Here's where I am at with these discussions: It is entirely possible for a medication to both work and be over-prescribed; for it to be suitable for some people but not others; for big pharma to be both pushing it and for it to be doing good; for a condition to exist and for it to be over-diagnosed; for a condition to be poorly understood but still exist. But it's always easier to think of things in a binary way, isn't it?

It needs to be better diagnosed - we're too quick with it, absolutely. And yet it took me a lot of work to find a doctor who was (a) open to an adult presenting with it as a concern, and (b) willing to work with me on a diagnosis. It needs to be monitored and assessed as an ongoing condition in a person's life - these are powerful meds, with attendant side effects. But the fact that we're still evolving these processes is not a reason to dismiss it or say we should stop.
posted by nubs at 8:21 PM on March 28 [10 favorites]


> The fact that Americans don't consider hitting their children acceptable is considered a sign of lax discipline and lazy parenting in much of the world.

In the first world - Europe, Canada, Australia, Japan, that sort of thing - in these countries they are generally much less tolerant of physical abuse of children, not more. In Scandinavia, you can go to jail for striking your kid.

Not that this has anything to do with the matter at hand...
posted by lupus_yonderboy at 8:23 PM on March 28 [1 favorite]


> The same way I wouldn't expect him to get off insulin if he was diabetic.

If 20% of Americans were taking insulin for diabetes, it would be a health catastrophe.

SOME kids will profit from taking these drugs, absolutely. Overall, it seems obvious that we're dramatically over-medicating American children.
posted by lupus_yonderboy at 8:24 PM on March 28 [1 favorite]


20% of American children are not diagnosed with ADHD, much less on stimulants. The article itself states that "in 2013, the CDC released data revealing that 11 percent of American schoolchildren had been diagnosed with ADHD" and provides no data to back up the claim a few sentences later that by high school, one in five boys is diagnosed.

According to the CDC, during 2007-2010, 2.5% of the total population of children under 18 years were currently taking a stimulant drug for any reason. This is a far cry from a panicked health catastrophe. It is NOT obvious that we are dramatically over-medicating anyone, and dramatic articles which make up numbers and privilege "common sense" over medical research may actually be doing more to undermine children (and consequently, adults) who legitimately have ADHD than they are helping children who are unnecessarily medicated.
posted by augustimagination at 9:04 PM on March 28 [7 favorites]


and provides no data to back up the claim a few sentences later that by high school, one in five boys is diagnosed.

Key Findings: Trends in the Parent-Report of Health Care Provider-Diagnosis and Medication Treatment for ADHD: United States, 2003—2011
6.4 million children reported by parents to have ever received a health care provider diagnosis of ADHD , including:

1 in 5 high school boys
1 in 11 high school girls
I assume that's where the article got it - from the CDC.
posted by Justinian at 9:16 PM on March 28


Oh, and it looks to me like you read your own link incorrectly; according to table 92 4.2% of kids under 18 had used CNS stimulants in the past 30 days. I dunno, 4.2% of kids taking CNS stimulants just in the past 30 days when the sample was taken seems awfully high to me.
posted by Justinian at 9:20 PM on March 28


The class "psychoactive drugs" also includes caffeine and diphenhydramine, so I don't think this is such a rhetorical trump card.
posted by en forme de poire at 9:30 PM on March 28


I mean children have pretty easy access to say, the OTC CNS stimulant Coca Cola.
posted by en forme de poire at 9:32 PM on March 28 [2 favorites]


You forgot chocolate. Chocolate is psychoactive.
posted by Justinian at 9:32 PM on March 28 [1 favorite]


You're correct, Justinian - I was reading the number for girls instead of the one for all kids. The statistic about 1 in 5 high school boys having ever been diagnosed with ADHD seems to me to be misleading - this would include all kids who were ever misdiagnosed or whose parents had misunderstood a diagnosis as having been for ADHD.
posted by augustimagination at 9:33 PM on March 28


Sure, but I don't think the idea that "up to 1 in 5 high school boys misdiagnosed as having ADHD" would be very comforting to someone who thinks it is often... wait for it... over-diagnosed.
posted by Justinian at 9:35 PM on March 28


Okay, but the focus here is on who's being medicated. Diagnosis does not always lead to medication, and the article conflates those two things when it uses its figure of "1 out of 5 high school boys" diagnosed to lead off its argument about over-medication. It is not true that 20% of high school boys, or even 20% of all boys, are medicated for ADHD.
posted by augustimagination at 9:41 PM on March 28 [1 favorite]


By the time they reach high school 30% of kids will need vision correction for near sightedness. The vision correction industry, bad teachers and the doctors are conspiring to hand out eye glass prescriptions like they are candy rather than recognizing that kids are just lazy. 20/20 is just an arbitrary standard of vision anyway, if only kids spent less time reading and more time outside they wouldn't have these problems. A doctor gave me a vision perspiration once and I got headaches and had trouble driving therefore nearsightedness is just made up. Of course with parents refusing to discipline their children, it is really their fault.....
posted by humanfont at 11:21 AM on March 28 [47 favorites +] [!]


What is supposed to be clever about this? This is a ridiculous analogy.

Being short-sighted is the result of the physical shape of your eyeball; there's no disagreement in medical circles about the existence of the condition, its severity, its rate of diagnosis or its treatment. Because you can take a photo of it, basically.

Things like ADHD and anxiety and depression are easy to under- or over-diagnose precisely because they do not have a clear physical cause. You can't MRI a person's brain and see the misshapen Attention Gland or something.
posted by Salamander at 9:49 PM on March 28 [6 favorites]


It can't be inferred from that data, anyway. We don't actually have the data about what fraction have ever been medicated so far as I am aware, only how many have been medicated in the past 30 days.
posted by Justinian at 9:49 PM on March 28


Using the past 30 days is a sampling procedure. If the CDC's survey methodology is sound, those figures represent the estimated usage in the population of children under 18 as a percentage of the total. Asking parents about medication use over the past year or a longer time period would, under perfect circumstances, give the same result, and in reality would likely give a less accurate estimate as our ability to remember daily activities deteriorates over time.
posted by augustimagination at 10:02 PM on March 28 [2 favorites]


I seem to recall there actually is substantial disagreement on what the epidemiological causes of myopia are and how to treat it so that it doesn't progress badly (e.g whether to prescribe bifocals for young people). There's also clearly both a genetic and an environmental component since myopia is much more common in recent years. Finally, the treatment of myopia doesn't depend on getting some amazing picture of your lens and working backwards: you go to an optician and answer whether A or B looks better. That's honestly pretty close to my experiences with psychiatric medications. And lots of medicine is practiced wIthout having to be understood in mechanistic detail.
posted by en forme de poire at 3:05 AM on March 29 [4 favorites]


Trust me, I'm very experienced with how myopia is diagnosed and treated, having been diagnosed with severe myopia and astigmatism at the age of 3. I've had glasses, contact lenses, LASIK, and back to glasses. I've had my eyeballs poked, prodded, sliced and measured with every instrument possible.

The point is that nobody with an ounce of sense thinks that children are possibly being over-diagnosed with myopia, because it's measurable in a way that ADHD simply isn't.
posted by Salamander at 5:53 AM on March 29


The point is that nobody with an ounce of sense thinks that children are possibly being over-diagnosed with myopia, because it's measurable in a way that ADHD simply isn't.

Sorry, nope. Myopia is diagnosed entirely based on the patient's word that lens 2 is better than lens 1. What's to keep anyone from faking it to get glasses? And how many people really need glasses, anyway? All these hipsters just wear them to look cool.

This is what you sound like.
posted by Sys Rq at 8:52 AM on March 29 [5 favorites]


Also you don't have to pee in a cup to prove you are wearing your glasses correctly. Nor must you obtain a physical written prescription to refill your contacts each month. Getting regular fills of your schedule II meds for ADHD can be very challenging.

The argument of over diagnosis seems largely based on a reaction to the statistic of 20% and the stigma of medication. Yet consider the prevalence of statin drugs for high cholesterol, blood pressure medication, heartburn meds, the regular use of antihistamines or NSAIDs for soreness and headaches. Really ADHD is just a common problem like all the others. For most people with ADHD, the medications improve their quality of life in an almost instantaneous and profound way.
posted by humanfont at 9:11 AM on March 29 [4 favorites]


I've often wondered if I have/had add as a child. Being a girl growing up in the 80s, there was no way I was going to get diagnosed. I was smart but couldn't pay attention worth a damn. I was always learning on my own self-guided study, jumping from one topic to the next. I read books by skipping around, going to a different book, revisiting the old book some time later. My grades were terrible because homework couldn't hold my interest. But I always tested really well. I was the kid in school that had a book hidden inside a text book; only it wasnt a comic book, it was either a novel or reference book.

I was unbelievably lucky to have a library within biking distance (or a long walk or a city bus), so I could indulge my self-guided approach to learning. I was a butterfly of knowledge, flitting from one topic to the next. At first my parents encouraged my library habit, but eventually I was banned from checking out more books than I could carry. So I took it as a personal challenge, and got a giant duffle bag and could carry an obscene amount of books on my bike.

I barely made through school. I aced most tests except those requiring memorization or math. (math didn't come until later and it's still a weak spot.) The irony, perhaps is that I only managed to get through school because I accidentally self medicated with Sudafed. I had severe allergies and took it nearly daily. I suspect the little school learning I did was because of that, and I had no idea at the time. I later got in to a community college, but dropped out for a career that required a lot of self guided, multifaceted learning. Which was perfect for me. I could switch gears as easily as I needed to to be successful.

But I look back at the wasted opportunities. I was lucky, a combination of accidentally self-medicatinf and having access to learn in a way that matched my fleeting attention and then stumbling into a career that supported my style of learning was shear luck. But I think of how much more I could have done had I the ability to focus.

The express scripts study and society in general have a bullshit notion about boys and the disorder, missing women completely. I wonder with the express scripts study, how many women in there post high-school experience realize something is wrong and are now comfortable enough to see out treatment. I have too much other medical shit going on to bother with a diagnosis at this point, but I could easily see doing that if my circumstances were different... I hate the idea that as a woman, the medical industry would be wondering if I'm just chasing down a way to lose weight. And that any other woman in a similar circumstance would face the same scrutiny.

On the other hand, if girls aren't diagnosed as much, then clearly, we're trying to emasculate boys. So yes, another damned if you do, damned if you don't.
posted by [insert clever name here] at 9:25 AM on March 29 [6 favorites]


For most people with ADHD, the medications improve their quality of life in an almost instantaneous and profound way.

That's true; but stimulant medications would also improve the quality of life for someone without ADHD in almost instantaneous ways. So whether or not their quality of life improves isn't really the question, it's how high their quality of life was before starting the medication!
posted by Justinian at 1:17 PM on March 29 [1 favorite]


"Quality of life" is too broad, though I don't necessarily disagree with the rest of that. If you improve on some metric not related to organization, impulse control, etc (like feeling "good") that wouldn't matter. But definitely amphetamines help people without ADHD as well.
posted by en forme de poire at 2:41 PM on March 29


Wouldn't "feeling good" be the very definition of improved quality of life?
posted by Justinian at 3:04 PM on March 29


Right. That's why I think "quality of life" is overbroad.
posted by en forme de poire at 3:23 PM on March 29


Oh I see, yeah I misunderstood you.
posted by Justinian at 3:58 PM on March 29


I have absolutely no dog in this fight - not a parent, don't have ADHD. But I wish I could find unbiased, non-axe-grindey information on whether kids truly are being overdiagnosed nowadays, or if ADHD is, in fact, more prevalent than we imagine, and we are playing "catch up" to past underdiagnosis.

Apparently, kids in (much of) Europe are far less frequently diagnosed with ADHD and given medication than kids in (most of) the US. So are US kids being overdiagnosed, or is it that kids in Europe are, in fact, being underdiagnosed and undertreated?

So help me, I ask Dr. Google, and it's so tough to wade through the polemics. Either Big Pharma is evil or "socialized" health care is evil.

One in five sounds like a lot, but I am prepared to accept that maybe there just ARE that many kids with ADHD as I am to think that too many are wrongly diagnosed. I don't know.

And I don't see how modern classrooms are less regimented than ones in the 1950's, or the one-room schoolhouses in Laura Ingalls Wilder's day. I can believe there is less recess, but less freedom? Weren't kids in the 50's expected to sit at desks and be quiet almost all of the time they weren't on the playground - boys and girls alike? I don't think "overly regimented" classrooms are an evil modern feminist creation.
posted by Rosie M. Banks at 5:15 PM on March 29 [1 favorite]


Justinian, my understanding is that there is a qualitative difference in the way people with ADHD can respond to amphetamines. To start with, the doses prescribed for people with ADHD are much smaller (my reading on Erowid indicates it's about a third or less) than the amount consumed by people taking these drugs recreationally. That's not counting people who are habituated to recreational drugs and apparently can consume entire grams at a time. That's fifty times the typical ADHD dose!

The people with ADHD who take these lower doses don't typically report euphoria, at least not once their correct dose is established. Instead they report an ability to do things they literally couldn't do before: keep appointments, remember things they had to do, listen to conversations. In contrast, people taking the drugs recreationally report euphoria (sometimes) as well as vastly increased energy, and only some increased degree of focus. It's possible that those people actually had undiagnosed ADHD, but in any event the focus was not the primary thing they reported. And, of course, these were people who already had the ability to manage appointments &c.

So saying that "stimulant medications would also improve the quality of life for someone without ADHD" is not really true. It isn't true at the same dose levels, and it's not true in the same ways. It's like saying that morphine would make both everybody happier, both people with and people without chronic pain. That's sort of true, but it's mostly false, and it's the sort of statement that seems deigned to lead to a false conclusion: if everybody would "benefit" from the drug then the difference is merely one of degree, and there is no pressing reason to prescribe it to anybody. And that's simply not the case.
posted by Joe in Australia at 8:30 PM on March 29 [10 favorites]


Wow, I was poking around to try to find support for the idea that amphetamines help people without ADHD just as much -- and you know, I may have to eat a little crow here. It does seem that there's some evidence that people without ADHD who take amphetamines do not actually perform better than on placebo, instead, they just think they do [PDF]. And further, from the intro of the article: "Several studies have found that participants who perform worse than average when on placebo are more likely to be enhanced by stimulants (Farah et al., 2008; de Wit et al., 2000, 2002; Mattay et al., 2000; Mehta et al., 2000)."

They didn't explicitly compare to people with ADHD doing the same tasks, but it seems to be pretty well established that amphetamines and methylphenidate do bring ADHD symptoms under control much more than placebo. Again, not my area of the literature, though.
posted by en forme de poire at 9:21 PM on March 29


So saying that "stimulant medications would also improve the quality of life for someone without ADHD" is not really true. It isn't true at the same dose levels, and it's not true in the same ways.

People without ADHD who take the doses you are talking about don't necessarily report euphoria either. You're comparing therapeutic doses with recreational doses. Of course they will have different effects!

But in any case you're drawing an implication the opposite of what I intended. I didn't imply that if everybody has improved quality of life then no-one should be prescribed amphetamines, I said that whether or not your quality of life improves isn't what prescribing amphetamines should be based on, it should be based on whether your need it to function normally or not.

Which seems an important difference, since it specifically addresses the problem en forme de poire brings up.
posted by Justinian at 9:58 PM on March 29


If, every time we ask "But what about boys", the response is, "...but girls!" then we will never do anything about boys. That's not equality, that's just negligence.

The difference between stims and alcohol/pot is nobody wants a classroom filled with drunk or stoned kids. There are some conflated interests going on.
posted by effugas at 12:12 AM on March 30


The difference between stims and alcohol/pot is nobody wants a classroom filled with drunk or stoned kids

Nobody wants a classroom full of punding kids busily taking apart their desks either.
posted by en forme de poire at 2:08 PM on March 30


If, every time we ask "But what about boys", the response is, "...but girls!" then we will never do anything about boys.

The point of bringing up girls is that the rate of under- or over-diagnosis of ADHD may depend heavily on gender. That's not ignoring boys' issues. That in fact does not even contradict the idea that diagnosis is mediated heavily through gender; if anything it supports it. The problem is when people make a statement like "ADHD is over-diagnosed" when they really mean "ADHD is over-diagnosed in boys", perhaps even underdiagnosed in girls. Those are different problems and solutions for one are not necessarily going to solve the other.
posted by en forme de poire at 2:18 PM on March 30 [5 favorites]


Is "punding" a typo or has language left me behind again?
posted by Joe in Australia at 2:24 PM on March 30


punding
posted by en forme de poire at 2:26 PM on March 30 [1 favorite]


Well, that's just great. I had better start documenting my dialect before it dies out altogether.
posted by Joe in Australia at 7:11 PM on March 30


Apparently, kids in (much of) Europe are far less frequently diagnosed with ADHD and given medication than kids in (most of) the US. So are US kids being overdiagnosed, or is it that kids in Europe are, in fact, being underdiagnosed and undertreated?

Another option this doesn't really seem to consider: what if for some, or various reasons it is occurring more here than other places? Similar to how there's more autism and MS in the pacific northwest US than as i remember, anywhere else in the world?
posted by emptythought at 7:39 PM on March 30 [2 favorites]


I said that whether or not your quality of life improves isn't what prescribing amphetamines should be based on, it should be based on whether your need it to function normally or not.

Which seems an important difference


Huh?

From where I'm sitting, that looks an awful lot like no difference at all. A newfound ability to function normally is an improvement in quality of life, is it not?

Improving quality of life is, and should be, the goal of just about all medical treatment.
posted by Sys Rq at 9:39 PM on March 30 [2 favorites]


I think the issue is that "improving quality of life" could be seen as a superset of a lot of different aims, including both "raising deficient abilities to normal" but also "inducing a feeling of competence, well-being, and/or happiness."
posted by en forme de poire at 9:59 PM on March 30


Kind of like an antidepressant does?
posted by Sys Rq at 5:06 PM on March 31


Right, and if someone is depressed, that would be part of the criteria for treating them successfully, but for ADHD it might be sort of peripheral to the main issues.
posted by en forme de poire at 3:43 AM on April 1


An interesting fact about ADHD is that there is a different test in the United States than there is in Europe, in Europe the affliction actually has a different name as well and goes by the name of a "Hyper Kinetic Disorder" and only describes what people understand as a more serious version of ADHD.
posted by lartinos at 7:25 PM on April 18


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