Behind the A.D.H.D. Epidemic
October 16, 2013 11:21 AM Subscribe

To be clear: Those are correlations, not causal links. But A.D.H.D., education policies, disability protections and advertising freedoms all appear to wink suggestively at one another. From parents’ and teachers’ perspectives, the diagnosis is considered a success if the medication improves kids’ ability to perform on tests and calms them down enough so that they’re not a distraction to others. (In some school districts, an A.D.H.D. diagnosis also results in that child’s test score being removed from the school’s official average.) Writ large, Hinshaw says, these incentives conspire to boost the diagnosis of the disorder, regardless of its biological prevalence. - SL NYTimes
posted by beisny (152 comments total) 33 users marked this as a favorite

The opening paragraph:
Between the fall of 2011 and the spring of 2012, people across the United States suddenly found themselves unable to get their hands on A.D.H.D. medication. Low-dose generics were particularly in short supply. There were several factors contributing to the shortage, but the main cause was that supply was suddenly being outpaced by demand.

Adderall shortage discussed previously on MetaFilter.
posted by TedW at 11:30 AM on October 16, 2013

Breathe....
posted by mikelieman at 11:40 AM on October 16, 2013 [4 favorites]

I think there is a demographic bomb that is going to go off decades from now when we start to see the long term consequences in adults who have been chronically medicated for ADHD, thanks to the slimy machinations of big pharma and a government that cares for children little beyond some stupid test number that means nothing in real life.

I am not in denial about the existence of ADHD, I just think it is way over-diagnosed nowadays. I'd get multiple opinions before I ever let my kid(s) get that diagnosis.
posted by Renoroc at 11:47 AM on October 16, 2013 [3 favorites]

By Maggie Koerth-Baker of Boing Boing, which, between pictures of bananas, has been really nailing it recently on how to tell good science journalism from oversimplified headline-shouting clap trap. Glad to see her in the Times.
posted by jetsetsc at 11:47 AM on October 16, 2013 [5 favorites]

"Before the early 1990s, fewer than 5 percent of school-age kids were thought to have A.D.H.D." Yeah, during that same time I was constantly getting lectured to Apply Myself and treated like a total bum for not doing my homework and yet everybody seemed to be comfortable labeling me as "a smart kid but no work ethic". Worse, a lot of other kids with similar problems but who didn't score as high on the standardized tests just got lumped in as "bad kids" and thereafter regarded as almost irredeemable.

Lots of issues out there with the current availability of treatment and there are probably a lot of kids who need more adjustment of their routines and less medication. Still, starting it off with "these kids were all totally fine before" makes me think someone either didn't attend a public school or doesn't remember what it was actually like, and how poor the outcomes were for those "fine" kids who didn't do their homework and talked in class and had permanent records as long as your arm.
posted by Sequence at 11:47 AM on October 16, 2013 [103 favorites]

I wish she had talked more about the difference in insurance coverage for ADD/ADHD drugs vs. therapy, which is usually more expensive and rarely covered, but often helpful in different and meaningful ways.
posted by jetlagaddict at 11:52 AM on October 16, 2013 [6 favorites]

Still, starting it off with "these kids were all totally fine before" makes me think someone either didn't attend a public school or doesn't remember what it was actually like, and how poor the outcomes were for those "fine" kids who didn't do their homework and talked in class and had permanent records as long as your arm. QFT

I'm thinking since Common Core and High Stakes Testing are tied significantly to school funding, teacher salaries, and the communal desire to shove kids into the college loan debt machine, instead of being able to be flexible and work with different learning styles, pills are touted as the solution and the only thing paid for.

Anything beyond meds is pretty much not covered by my Cadillac health plan. Hell, I'd pay for it out of pocket as I did for other things if such therapy and retraining for ADHDish kids were available. So I muddle through with a volunteer online support group, trading plans and ideas and doing the hoops required to keep things simpler and get the kids more self-directed towards learning.
posted by tilde at 12:07 PM on October 16, 2013 [2 favorites]

Curiously, parents and teachers are not being labelled with Attention Demanding Disorder and getting properly medicated.
posted by srboisvert at 12:16 PM on October 16, 2013 [31 favorites]

I'm thinking since Common Core and High Stakes Testing are tied significantly to school funding,

Even prior to this, there was this thing called Tracking.

In my public school system that I was in from 7th grade through high school, in a well-funded middle/upper-middle class town, kids got (informally) shunted into various tracks. There was a kid in my elementary school who literally couldn't sit still for more than a couple of minutes (his desk drumming was excellent), and he was no dummy, but he disappeared from all the academic classes I was in in high school. Now, it was a big school, so he could've been in some other section of chemistry or physics, but I don't know. I don't know that there has ever been a time in the US public school system (in general - it is large and contains multitudes) that Back Before Testing or whatever there was this "treat each student as an individual and figure out their best learning style" utopia.

I hope Todd found his way. He was a good musician and a nice kid, and I hope he got the help - medical, academic, etc. - that served him well.
posted by rtha at 12:16 PM on October 16, 2013 [6 favorites]

Ah. Training children for a lifetime's appreciation for Good, Clean pharmaceutical Speed. A better racket than Heisenberg could ever have imagined.
posted by solipse at 12:18 PM on October 16, 2013 [7 favorites]

If you haven't already done so, I beg you to watch "The Trap - Lonely Robot" by Adam Curtis. I've queued up the relevant section; the entire series (of which this segment is a part of) is incredible.

The basic claim is that it is the standardization of psychiatry (creating checklists of symptoms and deliberately ignoring the causes and conditions) that has help create an end result in which over half the population requires medical products to "normalize." The "new normal" is being on drugs.

From the clip:

"What now began to happen is that millions of people, who were being diagnosed by the checklist as disordered, went to the psychiatrist to be medicated. The result was liberation from anxiety on a wide scale.

"But in the process, the checklist became a powerful, and seemingly objective guide for people, as to what should be their normal feelings, and what was abnormal. And a number of leading psychiatrists began to argue that what they were actually doing was creating a static society in which human beings were adjusted by the medication so they fitted to an agreed normal type, defined by the checklist."
posted by phaedon at 12:19 PM on October 16, 2013 [15 favorites]

This thread needs a Trigger Warning.
posted by mikelieman at 12:19 PM on October 16, 2013 [2 favorites]

rtha Good point - and my experiences weren't as public-school oriented as most. Our school refused to track for a number of years and finally did our last year. The High Schools in the area just had a voluntary split for the kids - College or Vocational.

But - there were more resources available, it seems, and parents weren't working three jobs and still on food stamps so there was some time for involvement; if not at school than outside of school through community groups.
posted by tilde at 12:20 PM on October 16, 2013

Were that many Americans always pathologically hyperactive and unable to focus, and only now are getting the treatment they need?

Probably not. Of the 6.4 million kids who have been given diagnoses of A.D.H.D., a large percentage are unlikely to have any kind of physiological difference that would make them more distractible than the average non-A.D.H.D. kid. It’s also doubtful that biological or environmental changes are making physiological differences more prevalent. Instead, the rapid increase in people with A.D.H.D. probably has more to do with sociological factors — changes in the way we school our children, in the way we interact with doctors and in what we expect from our kids.

Really, no sources or rationale for any of these statements beyond "it seems unlikely" to the author? I mean, I'm sure false positives happen (like false negatives), and it's always hard to draw a diagnosis line for things that are more spectrum than black-or-white, but this just seems like idle speculation.

Anyway, I'm all in favour of addressing potential sociological causes of the increase in diagnoses (and differences between diagnosis rates in different countries), but I'm not sure the problem is nearly as simple as "[normal] behaviour has become pathologized".
posted by randomnity at 12:21 PM on October 16, 2013 [11 favorites]

Is it possible ADHD is overdiagnosed? I guess so. But Baker doesn't really offer much in the way of proof, contenting herself instead to go with the old standbys how can this many kids have it? and surely some of these cases aren't legit, right? She adds the new wrinkle of what if schools are pushing this diagnosis to game test scores? But I think without evidence that substantial numbers of people diagnosed with ADHD are anything less than legitimately affected with the learning disorder, it's just another hollow, leading question that ends with unkind skepticism and derision of kids and parents who already have enough to deal with, thankyouverymuch.

Failing anything beyond unsupported skepticism at the increasing preponderance of ADHD, I think the real questions are: 1) if it's being diagnosed so much more often now, does that mean we were missing it before? and 2) if not, what the hell is causing it now?
posted by DirtyOldTown at 12:22 PM on October 16, 2013 [8 favorites]

Let me expand on my comments, "breathe" and "This thread needs a Trigger Warning."

millions of people, who were being diagnosed by the checklist as disordered, went to the psychiatrist to be medicated.

I was one of the kids, born in 67, who they used to figure out what should be on these checklists. I was, I guess 13, in 1980, when I bailed on the prescription meds in favor of just dealing with it and developing coping mechanisms

I was on 250mg of thorozine 2x daily at the time when I said fuck this shit. In retrospect, I'm somewhat surprised at that point I had the motivation to SAY 'fuck this shit'.
posted by mikelieman at 12:24 PM on October 16, 2013 [8 favorites]

Yeah, seriously, I wish ADHD had been diagnosed more in the 80s. Then maybe I would have been diagnosed before age 30. Fortunately, I did pretty well in school anyway, thanks to having the kind of smarts that perform well on tests and essays, and parents who stayed on me and made sure I got my work done. But the perpetual "lunasol would go so far if she would only apply herself" disappointment from my teachers and my parents' (understandable) frustration with why I couldn't just do my damn homework definitely set me up with a lifelong complex about my work ethic and ability to succeed. And once I got out into the working world, things were really hard for me, and I struggled a lot, until I started treatment for ADHD.

I don't want to be overly flip and discount the harm of medicating kids who don't need it. But the thing is, those years in late elementary school through high school are really important for setting up learning and work habits. Many of us with ADHD just didn't develop those good habits or learn those things during that time, and it's so much harder to learn at 35 than it is at 12.

I do appreciate the journalist's even-handed approach to this. It's a lot better than a lot of the other reporting I've seen.

This shocked me, though:

Before I received my diagnosis, I spent multiple sessions with a psychiatrist who interviewed me and my husband, took a health history from my doctor and administered several intelligence tests. That’s not the norm, though, and not only because I was given my diagnosis as an adult. Most children are given the diagnosis on the basis of a short visit with their pediatrician.

I had a similar diagnostic experience as the author - I was referred to a psychiatrist who met with me for two long sessions, gave me a test, asked me a million questions, and had three people, including my mother, fill out questionnaires about my behavior and symptoms. Is that really uncommon?
posted by lunasol at 12:31 PM on October 16, 2013 [16 favorites]

Except in op-ed pieces where people cry foul about overdiagnosis, it seems to be standard, lunasol.
posted by DirtyOldTown at 12:34 PM on October 16, 2013 [5 favorites]

My diagnosing psychologist came straight out and said that the reason adults get the rigamarole and kids usually don't (or at least not to the same degree) is because adults fake symptoms to divert medication and kids generally don't. Not that all adults do, but if you just walked in and they trusted everything you said of your symptoms 100%, they could do it all much faster.
posted by Sequence at 12:39 PM on October 16, 2013 [2 favorites]

There are a certain subset of MeFites for whom "Are we quite sure all these cases of ADHD are even real?" is more than a bit like asking, "C'mon... is racism/sexism even a thing?" Our frustration shouldn't be hard to see coming at this point.
posted by DirtyOldTown at 12:42 PM on October 16, 2013 [27 favorites]

In my experience, the concern about overdiagnosis and abuse of ADHD meds has led to serious barriers to treatment for those who really need it. I don't know what it's like for kids, and maybe it's very different, but for me it involved several appointments over a period of months with doctors in three different specialties, a multi-hour battery of very expensive tests that my insurance didn't cover, a fancy tamper-proof prescription that I had to drop off in person, and a hunt for a pharmacy that actually had my medication in stock. And I get no refills and have to meet a psychiatrist monthly.

The good news is that the medication is really giving me significant help and has improved my quality of life dramatically. Tasks that before seemed like nearly impossible mental battles are now merely boring. I can get dressed in the morning without forgetting what I'm doing halfway through. I don't leave a trail of forgotten valuables (wallet, phone, keys) behind me everywhere I go.

It's important to remember that ADHD is a real thing that causes real problems for real people, and that medication can really and truly help many of those people a great deal. It's not just hysteria and a desire to let amphetamines do the work of parenting. Many people find that getting a diagnosis and medication dramatically changes their lives for the better.
posted by Scientist at 12:45 PM on October 16, 2013 [22 favorites]

If I had a lung condition that made it hard for me to do my job, keep up with my home, or accomplish any of my goals, no one would say a goddamned thing when I took a pill for it. Because the problem is 18 inches higher in my brain, people feel entitled to tell me my real problem is that I'm just an asshole. And that I like speed.

While I appreciate what you say about certain aspects of mental health being a matter of intrusive public debate, I don't think that such debate is entirely without merit. The history of public health is an interesting one. Not too long ago, people used to go to the hospital to die. And not long after that, lobotomies and shock therapy were common treatments for even things like alcoholism. You could even go so far as to say that, just looking at history, one would think we have a long way to go in our understanding the human brain.

Maybe this discussion is worth having. If you are feeling sentimental about social control, I think a more reasonable statement might be, "Leave me and my brain alone" not "Leave me alone, I want my big pharma drugs." I'm not trying to make a claim for over-diagnosis or the non-existence of ADHD or the inefficacy of such drugs. Just that, maybe the public debate over mental health is taking place because we actually care about eachother and are concerned. And to that end, pointing out that the ADHD diagnosis rate in North Carolina is twice that of California is an interesting one. Medicine is part of the social fabric, it is both objective and subjective. Just my opinion.
posted by phaedon at 12:49 PM on October 16, 2013 [7 favorites]

Honestly?

I'm pretty sure we just used to filter kids into shop class. As it stands, there are no longer many high-status low-attention-span lifestyles.

Normative behaviour is changing! but the current class of drugs seem to be Really Gosh Darn Safe so I'm sort of okay with this.
posted by pmv at 12:49 PM on October 16, 2013 [3 favorites]

The problem with saying that ADHD is over diagnosed is that the determination is rather slippery. There are strong indicators but at the end of the day there is no way of being sure because it gets diagnosed via observation by a professional. That doesn't make every determination a subjective fluff statement but it is far from objective truth.

I'm experiencing my own small version of hell with ADHD with a child, so this hits home. It isn't his fault and we are trying to do everything we can to help him but it is unbelievably exhausting. We have used up about every option short of medication, often at great expense and effort and we think we will begin experimenting with medication in the next few months.

In my discussion with practitioners, few parents make this decision lightly. I'm worried that my son will experience long term yet-to-be-known side effects, but I also need to help him cope with day to day basic functioning. Before having some personal experience I held the pompous notion that parents were using pills in lieu of basic life skills. I just don't see it that way anymore.
posted by dgran at 12:51 PM on October 16, 2013 [8 favorites]

lunasol In my and my cohort's experiences, it has started with concerns from school (public and private, elementary and preschool). The teachers and caregivers and parents all filled out at least 15 pages of checklists and health/background/behavior information, and consulted with at least a psychologist in coordination with either a pediatrician or a neurologist. Other interventions were used/recced instead of just drugs and most of us didn't skip straight to drugs. Generally and medical treatment was monitored and tweaked to fit what the kid seems to have needed. But I/we also have a big Hand Bag of Privilege and don't make $10 an hour with 5 PTO days a year (anymore - one of my cohort is painfully unemployed).

Some of us now have access to some tests, measuring style tests, that may or may not bear some resemblance to phrenology, that purport to measure a subject for ADHD based on eye tracking and other movements during the course of a few computer exams. In theory, these are to be used in conjunction with medication and therapy assistance (new and no data among my peer group - only one of us has taken it up and it's too early to tell if this helpful).

With my kids - who both went through the same testing and observation and check lists - it's difficult to pin down how much a med is helping vs a child's maturation and the theraputic work (goals, routines, tasks). Luckily, we've found some what of a balance and now we are riding out the last bit of it - the struggle against doing anything because so much was let slide.

I don't know how much in our case in the children and adults of my household is ADHD and just a "normal" amount of randomness and how much are other problems - physical and mental that certainly don't help any ADHD like tendencies.

Kind of like someone's constantly being treated for a stomach ache and it turns out the problem is their appendix, a low grade infection that just tortures them for a couple of decades and until you happen to pull the damn thing out because you are in there anyway. And then the stomach ache is gone because you had your appendix out (and had never exhibited classic signs of appendicitis) but after babying your gastro system for most of your life you don't know how to act any other way. And every once in a while when your gastro system goes INSANE you don't know if you shouldn't be eating nachos and beer like everyone else or it's just a random stomach issue that will resolve itself.
posted by tilde at 12:51 PM on October 16, 2013 [5 favorites]

This is definitely a sensitive subject for my wife and me.

Our oldest child was labeled as "probably ADHD" by a kindergarten teacher. We had him tested, with borderline results. We did not want to medicate him, so we worked with him and were very careful, and as he matured, he clearly moved away from that, until now no one would ever think to call him that.

Our youngest was something completely other. His nursery school reported severe problems with him pretty much every day, and kindergarten was worse. We moved him to a smaller school for more personal attention, and while they were able to inform us of what was going on with him in a better way, they ended up sending him home midday on a very regular basis. We didn't even think of ADHD as a possibility--it seemed more like explosive rage.

We worked with a psychologist for several months. She diagnosed him as ADHD, with sensory integration issues, and told us that our parenting style would not work on a child with ADHD--he wasn't able to learn what we were trying to teach him. She gave us a number of techniques to use, and we were able to greatly reduce the explosions, but there were still substantial problems, and we were worried about his learning.

So, reluctantly, we started him on Adderall. Experimentation quickly showed that the minimum dose available was enough to take the edge off, enough for him to have control and pay attention (while still being high-energy) but that he burned through it very quickly, even the extended release version that is supposed to last six hours barely lasts 3 and a half. So now, he gets that minimum dose twice each schoolday, and it works. He still has to work at coping mechanisms, but the medicine seems to give him enough control that he *can* work at them, and it's helping even in the off-medicine periods...but he still does need the medicine.

I can't know about other kids on the medicine--maybe for some of them, it's just a quick-fix, an easy diagnosis. But for us, and I'm sure many other families, it's been a rough road, taken step by careful step.
posted by Four Ds at 12:52 PM on October 16, 2013 [24 favorites]

Ugh. BabyHotBot is 10 and had a stroke in utero. Its fifth grade now and the work - the executive function in particular - is starting to bite. Watching her try to focus on schoolwork is clearly torture. We got a neuropsych evaluation and she is smart kid with learning issues. The school is not so much with the help.

We are considering going to a psychiatrist to help with the focus but my wife and I both have personal and family histories of depression and addiction (both of us, all four of our parents) and it seems unwise to add anything to her brain before its fully developed. But she knows she cant go as fast or as accurately as the other kids and she has gotten a stomach ache the last two Sunday nights.
posted by shothotbot at 12:52 PM on October 16, 2013 [2 favorites]

Our oldest child was labeled as "probably ADHD" by a kindergarten teacher. We had him tested, with borderline results. We did not want to medicate him, so we worked with him and were very careful, and as he matured, he clearly moved away from that, until now no one would ever think to call him that.

I don't know...I was also taught to cope and mature, yet now in my late twenties I felt like I just couldn't "cope" anymore and when I took Dexatryne for the first time I honestly felt my life would have been so much easier if I had just taken pills while in college/high school.

I of course understand that it would be better if I didn't have to take pills (and I agree!) but not taking them is like pretending I don't have a problem. It's a confusion of cause and consequence. You take the pills because you are sick, but it doesn't mean that if you don't take them you aren't!
posted by Tarumba at 12:58 PM on October 16, 2013 [5 favorites]

At some point in our history we started screening children for routine vision problems. We set a fairly arbitrary standard that 20/20 vision and started prescribing glasses to those with vision below this standard. Suddenly the number of children being given eye glasses exploded In many cases individuals given glasses attained vision above THE 20/20 standard. These students performed better in academics and sports after they were provided with corrective lenses.

If the NY Times suggested that the explosion of prescription eyewear was the result of over diagnosis. If they hinted at a conspiracy by eye wear manufacturers who had applied industrial manufacturing and plastic to create an abundance of cheap eye wear. If they suggested people should just move closer to the chalkboard or squint to cope; because god forbid we cover the windows to your soul. If they questioned the very existence of poor vision... If they suggested these things, we'd think they were crazy. We'd throw the article in the crank bin.

We ought to treat this article on ADHD the same way. Given the abundance of problems our flawed bodies regularly exhibit, it really ought to be no surprise that our brains are also imperfect and a large number of people may benefit from these medications. How many people needed braces, statins, blood pressure medications, or to wear a knee brace, get glasses, have a sinus surgery, or a wart removed.
posted by humanfont at 1:00 PM on October 16, 2013 [63 favorites]

In my and my cohort's experiences, it has started with concerns from school (public and private, elementary and preschool). The teachers and caregivers and parents all filled out at least 15 pages of checklists and health/background/behavior information, and consulted with at least a psychologist in coordination with either a pediatrician or a neurologist. Other interventions were used/recced instead of just drugs and most of us didn't skip straight to drugs. Generally and medical treatment was monitored and tweaked to fit what the kid seems to have needed.

This is my experience as well, although we still (after almost two years of evals) don't have any formal diagnosis of ADHD or anything else. He's been through several rounds of testing through the school, medical testing (ruling out lead exposure and vitamin deficiencies), and now -- after being on a waiting list for 8 months -- he's starting to see a pediatric developmental specialist who will do yet another round of testing on him.

No one has ever mentioned medication to us, although they will certainly discuss it with us if we ask. It's possible that this is because his needs are somewhat unusual (he's a mish mash of symptoms). Also, he gets all his OT and other therapy (including 1:1 writing help and special instruction in social thinking) through his school at no cost to us. In fact, the pediatric development specialist says that medication probably would not be a good fit for him, because his inattention seems to stem from a 'rich inner life' vs. distractions from external sources.

Prior to my son being born I would have said that ADHD is probably overdiagnosed. At this point, with a 7 year old boy who is so clearly struggling to cope with both his inner life and the external world, I would do just about anything to be able to simply give him medicine and have him be more like other kids.
posted by anastasiav at 1:04 PM on October 16, 2013 [3 favorites]

And ADHD doesn't exist alone either. Sometimes it coexists along side autism spectrum disorder, or other behavioral syndromes and disorders.
posted by ZeusHumms at 1:05 PM on October 16, 2013 [5 favorites]

I like your analogy, humanfont - especially as I've seen as recently as today a stigma against getting glasses (though the objection was it meant the objector was getting old).

20/20 is a nice 'round' number and not everyone without 20/20 is given glasses (especially kids). In our case, once corrective measures were taken, glasses were dismissed full time until the vision had gotten precipitously worse (which had a family tendency behind it as well). Until it got worse, "non medicated, but change the routine like so" was the treatment.

But a really trained eye doc can make that determination - ours is experienced enough that he's made a prediction on when and why the four year old will need glasses (third grade, eight years old, astigmatism).

No eyeballs to measure in ADHD. Though until I know more about those computerized "motion movement" tests, they're on the phrenology shelf for me.
posted by tilde at 1:05 PM on October 16, 2013 [1 favorite]

> I was on 250mg of thorozine 2x daily at the time

For ADHD?
posted by The corpse in the library at 1:06 PM on October 16, 2013 [6 favorites]

I had a friend in high school who definitely had ADHD. He (and his twin brother) were both 5'1", couldn't have been 100 lbs soaking wet, wiry kids with curly hair. It's hard to describe exactly what interacting with them was like - it wasn't like they were just kids who were bored and goofed off. It was very, very different, like you were talking to a human blur who would occasionally pay attention to what you were saying. And 2 minutes later he was talking about Bruce Lee or jumping around or something. This wasn't "trouble focusing," this was more like focus was not possible and you knew he was doing what he could. I consider it amazing that he managed to join the Army, go to Iraq, and subsequently get involved in humanitarian de-mining efforts. (And for the latter I'm immensely proud of him.)

But I think about how my friend was, just in terms of how "hyperactive" barely even describes how much he was up and down, and I wonder if that's what the kids they say have ADHD have going on. Was he just a severe case? Because I do not remember anybody like him from all the kids I knew before and after. I can't reconcile it with what I see about ADHD prevalence.
posted by graymouser at 1:10 PM on October 16, 2013 [2 favorites]

The problem isn't slimy pharmaceutical companies. Or at least not only that. The problem is that ADHD drugs are awesome. I wish I could have a prescription for ADHD meds. Because they're great.
posted by Justinian at 1:13 PM on October 16, 2013 [3 favorites]

Ah. Training children for a lifetime's appreciation for Good, Clean pharmaceutical Speed. A better racket than Heisenberg could ever have imagined.

It seems all discussions about ADHD have to include someone making a wisecrack about giving children speed. C'mon. Try harder.

In 1999 Gabor Mate published Scattered Minds: A New Look At The Origins And Healing of Attention Deficit Disorder. An expert from his website:

In attention deficit disorder the chief physiological problem appears to be located in the frontal lobe of the brain, in the area of the cortex (or gray matter) where attention is allocated and emotions and impulses are regulated. Just as the visual circuits need the stimulation of light, the circuits of attention and emotion control also need the appropriate input: a calm, non-stressed connection with a non-stressed and non-distracted primary maternal caregiver. Stresses on the mothering adult-or disruption of contact with her, as in adoption-predispose children to ADD because they directly affect the developing electrical circuits of the infant's brain. The very chemistry of the infant's brain is affected.

Infant monkeys separated from their mothers for only a few days had in their frontal lobes diminished quantities of dopamine, a chemical messenger important for attention and motivation. (Dopamine is the chemical we are trying to supplement when we prescribe a stimulant such as Ritalin.)

Although there is in ADD an inherited predisposition, a heightened sensitivity, the condition itself is rooted in social factors that have placed nearly intolerable burdens on the parenting environment. It is not bad or unloving parenting that is the problem, but stressed parenting. The erosion of community, the breakdown of the extended family, the pressures on marriage relationships, the harried lives of nuclear families still intact and the growing sense of insecurity even in the midst of relative wealth have all combined to create an emotional milieu in which calm, attuned parenting is becoming alarmingly difficult. The human brain being a social product, so is attention deficit disorder.

It's an elegant explanation, though I have no idea how well this has held up over time. It certainly matches my own experience with ADD and seems to fit within other sociological/environmental theories about diagnostic rates and etiology. I find it more compelling than linking it to the Americans with Disabilities Act and less shop-worn than Evil Big Pharma, Crappy Teachers/Doctors/Parents Who Can't be Bothered arguments.
posted by space_cookie at 1:13 PM on October 16, 2013 [8 favorites]

My son (we're in Australia), who's 7, has had some difficulty at school. Difficulty concentrating, sitting still, expressing boredom at what's going on. The issues with distraction and not being able to sit still are everywhere really, not just at school. He gets tired out reading.

We took him to a doctor, who recommended an occupational therapist. The OT identified issues with his vestibular system (among some other minor things), and started us on a program that involves getting him to spin around on a rotating platform thingy once a day, while getting him to focus and move his eyes between objects.

It has been fantastic, the improvement has been gradual but significant.

But I get the impression, had we been in the US, he would have been on ADHD medication after one visit to the doctor.
posted by Jimbob at 1:19 PM on October 16, 2013 [7 favorites]

DirtyOldTown: "There are a certain subset of MeFites for whom "Are we quite sure all these cases of ADHD are even real?" is more than a bit like asking, "C'mon... is racism/sexism even a thing?" Our frustration shouldn't be hard to see coming at this point."

Here's the flip side. My child got expelled from school last year because, the teachers said, he's CLEARLY ADHD and probably autistic and he cannot come back until he's medicated. HE WAS THREE. HE WIGGLED TOO MUCH DURING STORY TIME. THEIR SOLUTION WAS EXPULSION. (He also licked the floor and convinced all the other kids to lick the floor. Leader among men!)

We are at a different preschool now but the whole experience was emotionally devastating, and we had to go to so many doctors and psychiatrists and testing specialists in the month after the dust-up with the first preschool that it would have been literally impossible for me to keep a job and attend that many doctor's appointments. I don't know what people do whose kids have problems and are single parents, or don't know how to navigate bureaucracy, or don't have health insurance, or NEED their child to stay in daycare or school so they can keep their jobs. They expel two-year-olds from daycare now for biting, did you know?

My neighbor's son has ADHD and the difference medication has made for him is AMAZING. My son has some motor development issues, and the right approach has been occupational therapy ... and age-appropriate expectations. Definitely part of the issue is how YOUNG we are expecting kids to sit still and shut up. And part of the issue is how patchy support for families is, and how dependent it is on having a parent who can push and push and push until their child gets appropriate support and care. In my perfect world, kids with ADHD would be identified young because they have enough access to doctors and early childhood specialists to help their parents identify issues without a crisis required, and kids without ADHD wouldn't be pushed into an ADHD diagnosis to satisfy unrealistic behavior expectations. Both sides of the coin are a problem, and both are solved with more resources into pediatric health care, early childhood education, and family support. A chaotic, patchwork system that fails to identify kids who need services, and misdiagnoses other kids, is not enough.
posted by Eyebrows McGee at 1:23 PM on October 16, 2013 [28 favorites]

It certainly matches my own experience with ADD and seems to fit within other sociological/environmental theories about diagnostic rates and etiology.

So, wait: you're saying that it's the mothers' fault? Because what I read here: "stresses on the mothering adult-or disruption of contact with her, as in adoption-predispose children to ADD because they directly affect the developing electrical circuits of the infant's brain." seems to say that. And there is exactly zero evidence that's the case.
posted by anastasiav at 1:30 PM on October 16, 2013 [8 favorites]

For ADHD?

Yeah. Like I said, they were figuring out the protocols and remember in the late 70's keeping a couple of ludes in your medicine cabinet in case you needed to mellow out wasn't all that uncommon.

The real thing is now they got the protocols all figured out. low dose uppers to just take the edge off. Man, the way I drink coffee, it's not like any real surprise.

Breathe. It ALL begins with a breath.
posted by mikelieman at 1:31 PM on October 16, 2013 [2 favorites]

But I think about how my friend was, just in terms of how "hyperactive" barely even describes how much he was up and down, and I wonder if that's what the kids they say have ADHD have going on. Was he just a severe case? Because I do not remember anybody like him from all the kids I knew before and after. I can't reconcile it with what I see about ADHD prevalence.

It's kinda like how antidepressants can prevent suicide associated with depression, but you don't have to be actively suicidal for them to make a huge difference in your life. The kid jumping around the room nonstop or the kid hospitalized after a suicide attempt are both obviously in need of treatment, but that doesn't mean the ones who are struggling at a less extreme level should be ignored. A lot of the struggles for both depression and adhd (especially the inattentive variety) aren't all that obvious to an outsider, especially in adults who have developed coping strategies. But they can still cause a lot of damage.
posted by randomnity at 1:33 PM on October 16, 2013 [1 favorite]

Sequence: that would make sense. My friend was, without exaggeration, the most hyperactive person I've ever met in my life. I can't imagine that most kids whose parents are told they have ADHD are even a quarter as hyperactive as he was. If a lot of it is "ADD" rather than "ADHD" that clarifies a lot for me.
posted by graymouser at 1:33 PM on October 16, 2013

At some point in our history we started screening children for routine vision problems. We set a fairly arbitrary standard that 20/20 vision and started prescribing glasses to those with vision below this standard. Suddenly the number of children being given eye glasses exploded In many cases individuals given glasses attained vision above THE 20/20 standard. These students performed better in academics and sports after they were provided with corrective lenses.

With all due respect - because I really love your analogy, it made me think - I'm not sure if I totally buy it. I would challenge it in the following way. In today's world, laymen understand how corrective eyewear works. The science is simple, self-explanatory and quite universal. On the other hand, people may claim they know what SSRI's do, but I doubt that many can tell me the benefits of Citalopram over Escitalopram and Fluoxetine. Fine, maybe some people do know why certain chemical compounds work for them and others do not. But does anyone know what their own brain chemistry consists of? Do most visits to the psychiatrist involve an MRI?

This is also evident in the "exploratory prescriptionization" of mental health drugs. Anyone who's been to a psychiatrist knows what I'm talking about. Slow builds, tapering off, cocktails, works for me or it doesn't. I'm not going to call this "quasi-science" but it's definitely not as hard and fast as an eye chart.

Therefore it is your analogy to vision problems that lends the credence to mood stabilizers, reuptake inhibitors, etc. without making any argument proving it so. It is quite possible that people can have fears and concerns regarding the universalization of these drugs while not feeling the same way about prescription eyeglasses.
posted by phaedon at 1:34 PM on October 16, 2013 [4 favorites]

I wish I could have a prescription for ADHD meds. Because they're great.

In the past 6 months I've gone through a ritalin extended release, regular ritalin and Adderall scrip for my hypersomnia. My insurance company won't give me the usual (ar)modafanil (an antinarcoleptic among other things) until I jump through certain hoops, so I'm stuck with this for now. I was looking for an alternative anyway. But it's sort of telling that they're handing me piles of this stuff super easily-- I just explained that I have hypersomnia, a sleep test said it wasn't an issue with my sleep and that armodafanil stops working so well after a year and they give me these class B controlled substances. I was expecting a lot more rigour, I guess, especially since I'm actually using the stuff as a stimulant.
posted by NoraReed at 1:34 PM on October 16, 2013

...yeah, and now that they have the protocols figured out, and the same thing that can help kids get over the hump to where they CAN learn coping strategies... Of course, there's people gaming the system for to just get some uppers to get them through the day....
posted by mikelieman at 1:35 PM on October 16, 2013

This is a depressing, infuriating topic for me. As a scientist, as a pharmacologist, and as a father a lot of the ADHD story is suspect.
First, psychoactive drugs that were invented 60 years ago are virtually never the best choice for an illness. We avoid Thorazine.
Second, methylphenidate was used as an antidepressant until the 1970s. When that panned out, then ADHD was born. Was it all a conspiracy by big Pharm? No. But it was pushed by big Pharm. Methylphenidate is probably as good a blunt instrument for ADHD as it is for depression. (Amphetamines elevate mood).
Third, the diagnosis criteria for ADHD (and most psych illnesses) are collections of behaviors which are overlapping yet given equal weight. They can be vague and they are often inferential or mind-reading. (forgetful - were they forgetful or did something else occur?) This is not science. ADHD feels to me like a retrofitted diagnosis for a fuzzily-defined disease.

I remember my childhood well (back in the sixties/seventies). While I can not say whether those kids who did poorly or had problem behaviors had attention difficulties, I will say that for all my years in a variety of public schools (ten different ones in seven cities and three states) I do not recall witnessing children with hyperactivity problems.

Okay, that is one part of the equation.

My son was diagnosed with ADHD based on behaviors at age three. He is six now. Because of the diagnosis we either have to medicate him to send him to most schools (either public schools or most private).

Is he hyper? Sometimes. With a good teacher and a small class he stays in his seat the whole time and does well on his classwork. When he is set loose (playground) he goes wild.

Does he have ADHD? Maybe. But I believe his diagnosis has made things worse and unless I can pony up private school tuition (not an easy thing) he will be drugged. As a pharmacologist, I am anti-drug. Drugs involve bathing the inside of your body with a chemical to get a particular effect. That's a chancy proposition. The brain is a subtle machine. Psychoactive drugs are a caveman's club. That's an exaggeration and I do believe in using drugs in many situations, but my analogy describes my caution.

Do I believe something like ADHD exists? Yes. If my kid has a 6 on the scale of ten, I've seen others with 9 and 10. (I do believe it is variable for my son. Some days a six, some days a three).

ADHD is probably several disorders lumped together (even attention predominate, hyperactivity predominate, mixed seem simplistic to me).

What we have today is a primitive understanding of ADHD which is defined more by bureaucracy than by realistic treatment advantages.

That's my rant.
posted by dances_with_sneetches at 1:36 PM on October 16, 2013 [22 favorites]

My insurance company won't give me the usual (ar)modafanil (an antinarcoleptic among other things)

Provigil is the bomb. I wish I could get it over the counter.
posted by Justinian at 1:39 PM on October 16, 2013 [1 favorite]

ADHD feels to me like a retrofitted diagnosis for a fuzzily-defined disease

Huh - I've never heard it put like that before.
posted by tilde at 1:41 PM on October 16, 2013

> But it's sort of telling that they're handing me piles of this stuff super easily

Not only does a hypersomnia diagnosis make it easier to get Adderall prescribed, it makes it easier to get it paid for. When I was on an individual insurance plan last year, my insurer didn't pay for my Adderall because my plan didn't cover mental health. But one time, a pharmacist tried to file it anyway, and it went through, and that's when I found out that my plan specifically will pay for Adderall — just not for a mental health diagnosis. If I'd needed it for narcolepsy, they'd have covered it.

(It only worked that one time. But that one time was enough to save $200.)
posted by savetheclocktower at 1:42 PM on October 16, 2013

Much as with the mind-blowingly accelerating portion of the child populace that has serious peanut allergies, perhaps it's worth looking beyond our wariness and skepticism to see if there's something happening to our kids causing this. Perhaps we should spend some more time figuring out how this keeps occurring at such an increasing rate and less time shaming parents and kids who have a verifiable problem.
--------------
Failing anything beyond unsupported skepticism at the increasing preponderance of ADHD, I think the real questions are: 1) if it's being diagnosed so much more often now, does that mean we were missing it before? and 2) if not, what the hell is causing it now?
posted by DirtyOldTown

I think these two are the key insight and the central question.

Allergies, asthma, diabetes, autism, and ADD/ADHD have all skyrocketed over the last couple of decades, and they all seem to be auto-immune problems.

I'd say we are living through a great age of auto-immunity, and that we don't turn around and confront this for political reasons.
posted by jamjam at 1:43 PM on October 16, 2013 [5 favorites]

randomnity: I'm not saying everyone less hyperactive than my friend doesn't deserve treatment; I'm just saying that it's hard squaring my experience with reports about how many kids have ADHD. I knew a lot of kids who were "rambunctious" and high energy, but they weren't in the same league with my friend's ADHD. It makes more sense if a lot of the real problems are "inattention" rather than "hyperactive" - because if you knew my friend in high school you'd hesitate to label kids hyperactive.
posted by graymouser at 1:44 PM on October 16, 2013 [1 favorite]

> I remember my childhood well (back in the sixties/seventies). While I can not say whether those kids who did poorly or had problem behaviors had attention difficulties, I will say that for all my years in a variety of public schools (ten different ones in seven cities and three states) I do not recall witnessing children with hyperactivity problems

It used to be much easier to deny education to kids with disabilities. Pesky Section 504, throwing off all our good anecdotes.
posted by The corpse in the library at 1:45 PM on October 16, 2013 [7 favorites]

Because of the diagnosis we either have to medicate him to send him to most schools (either public schools or most private).

Just FYI: you legally cannot be compelled to medicate your child in order for them to have access to public school. Also, public schools in the US are compelled by law to provide needed therapies to children which will enable them to have equal access to education.
posted by anastasiav at 1:47 PM on October 16, 2013 [3 favorites]

This may or may not be an ADHD anecdote, I honestly don't know. But I was/am bright, creative, the kind of student who aced tests without studying -- but also highly emotional, and not very good at focusing attention for longer than a few minutes at a time unless I'm really engaged.

Sometime in the late 70s my parents took me to a child psychologist. One session. All I recall was having to strip down to my underwear and walk a straight line in front of doctor and parents, which was humiliating and upsetting and of course I cried.

The psych prescribed some kind of pill, playing outside more, and karate lessons to build up hand-eye coordination and self-esteem. (Self-esteem was the answer to EVERYTHING.) Nevermind that I did not want any of those things.

-- Heat, humidity, and direct sunlight make me EXTRA CRANKY and twitchy and nervous, and I was in Florida. Of course I didn't like playing outside, most of the time. (I now suspect I have summer SAD.)

-- In lieu of karate (because of my age, and being averse to what I considered violence) I was put into judo classes. Which mostly consisted of older and larger and better-coordinated people, and was full of yelling and discipline and competitiveness and being sweaty and did fuck-all for my self-esteem or anything else. Music lessons instead would have been great (and were, in my teens).

-- The purpose of the pills was to "keep me quiet" according to a conversation my parents had with the psych a few weeks later. There were no more pills after that.

I hope most kids who need it are getting better mental health care than that.
posted by Foosnark at 1:47 PM on October 16, 2013 [1 favorite]

That's my rant

If that's your rant, then it gets raves!

Thank you for articulating my actual feelings so much better than I ever could.

I think that it's a class size thing. The smaller the class, the harder a kid needs to work to 'game' the teacher. Now that the teachers are all focused on the Core Curriculum implementation details, unless you REALLY need help, they just don't have time for the ones who can stay out of trouble.

Dosing kids can increase the fraction that can stay out of trouble.

Lather, Rinse, Repeat. Always Repeat.
posted by mikelieman at 1:48 PM on October 16, 2013

If I had a lung condition that made it hard for me to do my job, keep up with my home, or accomplish any of my goals, no one would say a goddamned thing when I took a pill for it. Because the problem is 18 inches higher in my brain, people feel entitled to tell me my real problem is that I'm just an asshole.

This got me thinking - another area of life you see a similarly framed debate is when it comes to food and the public's mistrust of GMO's. Make food tastier and more plentiful? Sure! But "internal" changes to "Mother Nature," fear of long-term consequences, etc. For many, it's a different playing field and can be like a holy line that shouldn't be crossed. I think brain drugs are treated much the same way; obviously in that they don't fall into the same category as splints and eyeglasses.

I believe in eliminative materialism. Which is to say that scientific knowledge typically replaces whatever pop quasi-religious ideas that preceded it with a better explanation. It's just that, making pills and declaring them cures doesn't necessarily make them so. We could (and probably very well are) in the beginning stages of understanding how to medicate the human brain.
posted by phaedon at 1:48 PM on October 16, 2013 [2 favorites]

As a middle-school teacher, I have two minds on this.

1. We expect kids to sit still and be quiet *way* too much. The emphasis on standardized testing and the loss from our economy of many jobs that pay decently and aren't part of the "information economy" have fueled an ever-greater emphasis on skills that you have to sit still for. Which is kind of understandable. We need to prepare people for the jobs there are.

Except that you can teach kids a lot about math and reading and writing without requiring so many repetitive worksheets and drills. And in fact they'll learn better if the material is hands-on and developmentally appropriate.

2. But. I taught in a school with a lot of low-income kids who came from stressful environments. A lot of them had a really hard time with self-control. Like, there were easily ten kids in *each* of my 25-student classes that could merit an ADHD diagnosis. And I don't think they were all born that way - like all neurological states, a mix of genetics and environment affect a kid's development. In this case, the environment was full of trauma and the kids adapted developmentally by developing hypervigilance. A lot of them probably also had PTSD.

I wished they I could have given them a more supportive environment with counseling and space to move and social-skills coaching. But I didn't have many resources. And so for many of these kids medication made the difference between succeeding and failing in school. And getting a diagnosis and medication was So. Damn. Hard. for their families, many of whom relied on state-run healthcare that was so overcrowded that the appointments they needed to get medication refills were delayed by months.

So in conclusion, we need to look at the complex underlying causes of the behaviors that lead to ADHD diagnosis and think about how transforming the environment can help. But we also need to accept that some kids need medication.
posted by mai at 1:49 PM on October 16, 2013 [17 favorites]

Self-esteem was the answer to EVERYTHING

UP WITH PEOPLE!
posted by mikelieman at 1:49 PM on October 16, 2013

I like that thought, mai. Some of ADHD is PTSD in kids. I'll tell you this, if I had seen a present day zombie movie when I was a kid, I'd still be hiding behind my parents' couch. Movies with monsters that looked like broccoli were enough to leave me traumatized for days. So, in conclusion, zombie movies cause ADHD.
posted by dances_with_sneetches at 1:57 PM on October 16, 2013 [1 favorite]

I had a meltdown over my Comp Sci homework because I couldn't complete it, and my mind was acting like a sieve.

It also brought back all sorts of memories over my schooling, and all the bad memories associated with it. Like, being kicked out of daycare as a preschooler. Or, getting F's on all of my schoolwork in 1st Grade. Or, having to do schoolwork in a room in elementary school, isolated from the other kids, because they distracted me too much. Or nearly having to be held back in 7th Grade, because I couldn't keep up with the homework. Or, having my step-father yell at me for hours at a time because I continually brought home bad grades. I eventually just ripped up my report cards instead of bringing them home. Or, having to spend my summers in high school in summer school, having to catch up, instead of having the time off to relax and recharge. Or, barely graduating from University because I finally switched to a major I didn't really care for (Communication Arts instead of - you guessed it - Comp Sci), just so I could get through and graduate.

Surprise - I got diagnosed with ADHD, formally, as an adult. Turns out I was also diagnosed as a kid, but my parents didn't want to treat me for it - and also didn't tell me about it. And I'm medicated for it now, after trying many different combinations, with a mixture of Concerta and Lamictal. Yes, it's probably overdiagnosed. But, it's also underdiagnosed. When I was a kid in the '70's, it wasn't diagnosed in girls. My life might not have changed with access to medication. My life may have gotten worse. Or, my life might have gotten better. I just wish that they would have attempted it.
posted by spinifex23 at 2:00 PM on October 16, 2013 [9 favorites]

> What we have today is a primitive understanding of ADHD which is defined more by bureaucracy than by realistic treatment advantages.

That's my rant.

I'm the first person to admit this, and if later breakthroughs indicate that my best treatment option would not be a mixed amphetamine salt but rather X, Y, or Z, I'll accept that as progress and start taking a new kind of pill.

Until then, as we're navigating the fog, we have strong evidence that a large group of people are helped by these drugs, blunt tools though they may be. The fog doesn't prevent us from drawing a rough outline around the people whose lives we've made better.

Joseph Bazalgette thought that a vast system of underground sewers would solve London's problem with cholera outbreaks. Prevailing opinion was that disease was spread through "miasma," or foul air, and so he thought that containing the stench of urban life was the key to preventing future outbreaks.

London's sewerage system was a massive success despite the fact that the miasma theory gets the causation completely wrong. We, as humans, knew that we'd stumbled onto something, even if we didn't know exactly what. Same with scurvy and lemons — for a couple centuries we had no knowledge of vitamin theory, yet we knew that fresh lemons warded off scurvy. We went from wandering aimlessly in the dark to wandering toward a dim light in a certain direction.

In your case, I think you're very poorly served by a rigid school policy. I do hope that you find greater freedom to avoid treating your three-year-old with the blunt instrument of medication. But blunt instruments can still be useful for many people.
posted by savetheclocktower at 2:00 PM on October 16, 2013 [10 favorites]

re: PTSD

Seeing Jaws at the age of 7 DIRECTLY fucked me up for at least a year. Anecdata, but given the way these things seem to work, "you're going to need a bigger boat"
posted by mikelieman at 2:00 PM on October 16, 2013

But I get the impression, had we been in the US, he would have been on ADHD medication after one visit to the doctor.

Well, for what it's worth, your impression is wrong. It's not your fault. The New York Times in particular loves to stir up shit about ADHD, I guess because it's good for page-views. But it's bullshit and it's dangerous and hurtful and (as someone with a personal stake in this from a variety of angles) it makes me too angry to even post coherently, so I'm not going to try. I'll just say that, in this as in most things, you should not get your information from the Times -- or at least not from the Times alone.
posted by The Bellman at 2:01 PM on October 16, 2013 [5 favorites]

Alpha children wear grey. They work much harder than we do, because they're so frightfully clever. I'm really awfully glad I'm a Beta, because I don't work so hard.
posted by ZenMasterThis at 2:02 PM on October 16, 2013 [9 favorites]

I think that it's a class size thing. The smaller the class, the harder a kid needs to work to 'game' the teacher. Now that the teachers are all focused on the Core Curriculum implementation details, unless you REALLY need help, they just don't have time for the ones who can stay out of trouble.

Oh, FFS.

Please, come have dinner at my house, where the class size is three and my child cannot -- CANNOT -- stay in his seat for more than a bit or two, and then needs to jump up and do something. Or, perhaps you can console him at bedtime, when he's telling you about what a hard time he's having making friends because the other kids won't play foursquare with him (all the rage at the moment) because he can't keep it together long enough to play an entire game. Or, maybe you can get up with him a couple times in the night, because he tends to wake up and want to check out Wikipedia articles about dinosaurs, because that's what he's thinking about.

One of the canonical questions for parents while their child is undergoing diagnostics is "Are you ever afraid your child will suddenly dart out into traffic?" That's my kid. He's 7, an age when he should be gaining more independence. But it's impossible for me to have him even walk alone across a quiet parking lot, because of his tendency to walk out in front of (fortunately slowly-moving) cars.

ADHD doesn't only affect school work. It affects family, sleep, the child's ability to be able to be age-appropriately independent, and even their ability to build necessary social bonds with other kids. It's not just about "gaming the system". In my house it's about safety, and the ability to simply be a civilized person around other people.
posted by anastasiav at 2:03 PM on October 16, 2013 [32 favorites]

humanfont: "Given the abundance of problems our flawed bodies regularly exhibit, it really ought to be no surprise that our brains are also imperfect and a large number of people may benefit from these medications."

I absolutely support better access to medication and other supports for mental health conditions. However, and I say this as someone who's taken antidepressants for much of my adult life, I'm a lot more hesitant to put my child on a psychoactive drug than to give him eyeglasses. There's first the issue that whenever a child is exhibiting problematic behavior, even seriously problematic behavior, chances are pretty good that he'll grow out of it in six months. Second, children's development is wildly uneven, especially in the early childhood years, and a kid who's well behind his peers in self-control at 6 will most of the time be on target at 10, whether you intervene or not. Third, medication that causes changes to the brain is a much harder question than correcting vision or setting a broken arm. I think it's a doubly difficult question when you're talking about a child with a developing brain, a developing personality, and a limited ability to make these decisions for him or herself. I mean, we really weigh whether to give our little ones benadryl for seasonal allergies because it makes them mopey and dopey! That's an easy decision to make for myself: I know how miserable allergies make me vs. how benadryl makes me feel. But that's a lot harder decision to make for someone else, especially a child with limited language ability.

Which isn't to say medication isn't appropriate for children. But it is a weightier decision, and diagnosing things like that in children is often more difficult than in adults because children grow and change and develop so fast. (And again the answer is, more resources and support. Sigh.)
posted by Eyebrows McGee at 2:09 PM on October 16, 2013 [3 favorites]

I think my comment is being taken out of context. First off, please take note again that back in the late 70's I was diagnosed, correctly, and had a bad course of trial-and-error medication over the years, resulting in me making the choice at the age of about 13 to just deal with it -- holistically. And while I sometimes think maybe a script for adderall might help take the edge off, I find I'm productive enough with a steady supply of good coffee.

So, let's all agree, for those kids who need the meds, they NEED THE MEDS. No questions there.

But I don't the discussion of how overprescription happen, and that there are sociological aspects, in combination with overloading the teachers.

The kids in the 'margins' just got a whole lot larger, and when they 'act out' ( because you know, they're not dumb, and understand that you're wasting their time with a lot of the pointless stuff... ) there's a well known path of least resistance to 'resolve the issue'. ( NON ADD/ADHD kid being disruptive in class... )
posted by mikelieman at 2:14 PM on October 16, 2013

graymouser: ADHD is often used as a catch-all, but a lot of us don't actually have the H. I just... drift, personally. I have the memory of a goldfish, normally, and difficulty sitting through an entire television program, but mostly that means that I putter around on the internet instead. I was never that hyper, but I was fussy about weird things, I also have sensory issues--I could concentrate better when barefoot, for example. One of the major things aside from meds that's helped me is using my computer and smartphone to basically be my memory. Record stuff immediately, don't trust the brain, the brain is treacherous. I'm not perfect at it, but it's been helpful. The non-hyperactive kind is generally referred to as "inattentive".

Yeah. I had a conversation with a mom I know about her eight-year-old daughter who was recently diagnosed as ADHD-inattentive and between that and conversations here on metafilter, I'd guess that there's something similar going on for me. The entirety of my childhood when I had to have the TV on to do my homework (and an adulthood where I can't write without likewise having the television on, or music going, or so many tabs open on my web browser that I can't see the names on them). The fact that I can't estimate time for the life of me, that I'm always late, and losing things, and all those nights when I was a kid when I'd get stuck hoping from one World Book entry to the next and end with them all pulled out around me in a mess. The books I read under the table, and the obsessive focus on obsessive interests, the way my brain turns off and goes quiet when I stay up late reading about the history of happy meal toys, or whatever, for hours and hours. How my grades would be great only when I cared and otherwise my teachers didn't know what to do with me. How I did wonderfully in graduate school and college but not so well at all in high school. Reading my books under the desk during geometry. Going home and writing 50,000-word fanfiction instead of doing my homework.

(Oh, and the high correlation between that and dyslexia, the fact that I had to tattoo "L" and "R" on my arms to tell them apart, the fact that I frequently transposed or reversed letters all through elementary school yet no one ever said anything because I was in G&T classes and liked reading but there's clearly things going on for me spatially.)

I somehow managed to stay functional through school--I'm guessing because I was well-behaved and quiet and did really well when I loved something and did passably, grade wise, when I didn't. But adult life where I have been able to use the coping mechanisms I've developed for all of this and tailor my schedule and tasks to my interests has been so much better. I think of how much worse it must be for kids like me today, when there's more standardized testing (I remember the unique hell of that, when you couldn't draw or write anything on the back of your test booklet but just had to sit there) and less recess and less library time and less music and art, things which always made my brain feel better, more calm. And I just think, what we're expecting of kids is too much. I don't know that I "really" have ADHD or I'm on the fringe edge of normal but I know that the office lifestyle and the school lifestyle that's meant to prepare us for the office lifestyle doesn't work for me and never really did and I wonder how many kids (and people) are out there who would be fine if they just . . . had more liberty over their lives.
posted by PhoBWanKenobi at 2:22 PM on October 16, 2013 [26 favorites]

Well, for what it's worth, your impression is wrong. It's not your fault. The New York Times in particular loves to stir up shit about ADHD,

No doubt there's a huge amount of exaggeration - but when I read stories like the one someone above spoke of, of a 3-yo being expelled for not being able to sit still, then there's something messed up going on.
posted by Jimbob at 2:24 PM on October 16, 2013 [2 favorites]

My son is about to turn five at the end of this week. He'll start ADHD meds at least part time shortly thereafter. At our pre-school's, special education's, and pediatrician's recommendation it is likely the best course of action for him. That will be on top of his special early-intervention pre-school, his speech one day a week, and his OT two days a week.

In less than one year he will be expected to be writing in a journal - in kindergarten. That isn't a 'by the end of kindergarten' goal, like when I went to school, that's a week one goal. Right now he can't sit through Harold and the Purple Crayon without squirming. He can't sit through a movie. He can't sit through dinner. He can't go to the bathroom without forgetting that that was what he was doing and getting distracted on the way - sometimes that also means that mid way through dinner he's stripped down to take a bath and play with bath toys instead of use the toilet... which when he remembers - he really needs to use! (I'm glad he has good bladder control)

My wife and I are his parents. It is our job to help him - to be his advocate. He doesn't like getting distracted, or being unable to finish his meal, or being unable to sit, or having to constantly move. He can't sit through writing his own name. I repeat. He can't sit through writing his own name. There are four letters in his name O-W-E-N.

Now we'll saddle on top of that the OT, which includes some interesting muscular stuff. It takes my Son two pieces of paper (and a lot of direction) to write four letters in a scrawl which only those that know him can translate. In his case, the ADHD exacerbates the need for OT, and the need for OT makes the ADHD harder to handle. So how do we medicate a five year old? He hasn't even had the time to develop yet... and that's the problem - he almost can't develop without something. He is stuck, stuck in his very awesome imaginative brain, in a world where how much toothpaste you use isn't important but the neat invention he's come up with is.

My wife and I are his parents. We need to be able to help him be able to learn and not stifle his creativity. So, if his growing team of specialists let us, we'll medicate the school days of the week and let him get his wild on on the others (until he lets us know that he'd rather be mellow all the time - and likewise, if he'd like to give school a go without meds, we'll try to accommodate that after he tries them with meds... but as parents, I want my son to have the designation, because the designation is the only way that he'll get the support he needs so that others can see just how special a kid he is.
posted by Nanukthedog at 2:36 PM on October 16, 2013 [14 favorites]

Unless someone can marshal some evidence that children can get PTSD from watching a scary summer blockbuster, can we stop making light of a real, debilitating disorder? Thanks.
posted by MisantropicPainforest at 2:37 PM on October 16, 2013

What do we need ADHD treatments for, when we have this fine prison system?

Seriously, studies have been done that show the percentage of prison inmates with ADHD is around 40%. That's right, 2 out of 5 prisoners have ADHD.

Complain about overdiagnosis if you want, rant about drugging kids if you want, complain about how this is all just a problem with modernity it the school systems or parents I'd you want. Just remember, one way or another we WILL deal with those people who have ADHD, and if the schools won't, the prisons will.
posted by happyroach at 2:42 PM on October 16, 2013 [7 favorites]

I don't think I'm making light of the real, potentially debilitating disorder I have been diagnosed with when I point out that the psychology and motivation of children are complicated and that not treating each one as a unique individual patient and trying to 'commoditize' treatment regimes and subsequently extending the established models to potential patients to whom it isn't appropriate.

Kids have ADD. Kids have ADHD. Kids have them AND OTHER ISSUES. If you don't work on everything ( meds + strategies for living ) , do you get anything resolved?
posted by mikelieman at 2:45 PM on October 16, 2013

The arguments that people often present to explain their belief that ADHD/ADD is overdiagnosed, and that people just want to get high, and all the usual rubbish and tomfoolery, sound very very similar, and are similarly ugly, to the arguments presented by people who think that those who suffer from chronic weight issues are just lazy overeaters with no self-control.

It's very frustrating.
posted by elizardbits at 3:04 PM on October 16, 2013 [24 favorites]

rtha: I hope Todd found his way. He was a good musician and a nice kid, and I hope he got the help - medical, academic, etc. - that served him well.

Hey, I was a Todd. Grades deteriorated from straight As to straight Fs as I started skipping school to work on my own music, got shunted into a "dropout prevention" school downtown, composed/arranged for all the school stage productions, and flunked/dropped out anyway.

Was unmedicated and struggled tremendously as I studied music on my own, carved out a niche career, and tried to be a responsible adult (HAHA). Finally got (re-) diagnosed and medicated five years ago. I felt like I knew I'd had a quad-core processor the whole time, but had been proudly limping along on one really fast core, which was prone to overheating and shutting down, and couldn't handle modern multitasking without locking up.

To put it another way, this fake, unnecessary drug abuse allows me to cheat at life and gain an unfair advantage by performing such herculean mental feats as "answering phone calls sometimes", "paying my bills on time", and "having a business meeting and remembering more than 0% of what was discussed". Bipolar II still kicks my ass at hilariously inopportune times, but my wife likes being around me a lot more when I don't zone out every 30 seconds, and I no longer have to choose between my career and personal life.

Maybe I'm just being optimistic, but I bet you Todd similarly had a bear of a time in his early 20s, grew up, sorted his head out, and is now in the same boat (even if it's a sailboat in a hurricane). Haters can go eat a butt.
posted by jake at 3:07 PM on October 16, 2013 [22 favorites]

The arguments that people often present to explain their belief that ADHD/ADD is overdiagnosed, and that people just want to get high

I don't think people want to get high; I think that ADHD medication helps people perform better whether or not they have ADHD. Go to any top tier competitive university program these days and use of these meds is absolutely rampant. It's like doping in high level bike racing; the people who don't do it are disadvantaged.

That doesn't have much to do with little kids of course.
posted by Justinian at 3:35 PM on October 16, 2013 [2 favorites]

These threads are always crazy because ADHD is one of those things where everyone feels that their opinion is an informed one. We all have opinions on related topics like laziness/willpower, the difference between can't and won't, are-things-being-unnecessarily-medicalized and so on. I don't want to stop anyone from talking, but I would encourage you, if you haven't yet done any serious reading, to at least check out something like (PDF warning) this, which is just the first thing I found by Russell Barkley that seemed like a serious explanation.

Barkley's model for understanding ADHD is potentially a lot better than the one you have in your head right now, especially if you don't have any particular step-by-step, where-does-it-come-from kind of explanation. And if you have ADHD yourself you might find it really eye-opening, not to say mind-blowing. I definitely did. He's describing his own initial insights here (he's sort of The ADHD Guy from what I understand) and it's all very satisfying in that "Ohhhh that fits, I get it I get it" kind of way.
posted by a birds at 3:44 PM on October 16, 2013 [4 favorites]

another reason ADHD threads are always kind of nuts is that it attracts ADHD folks who do stuff like spending 45 minutes writing and rewriting a short two-paragraph comment
posted by a birds at 3:48 PM on October 16, 2013 [21 favorites]

I really, really hate the "cheating" metaphor for any mental drugs, because it's not a zero sum game. If a lot of people have access to drugs that improve their lives, that's fucking great. We need to figure out how to prevent self-abuse and addiction and mitigate side effects. I feel like a lot of the whole "well people are using them who don't need them" talk misses that in favor of bullshit moralizing. I see this in threads about antidepressants, antianxieties, ADHD meds, antinarcoleptics and painkillers. Powering through medical conditions stubbornly doesn't make you virtuous and meds don't make you weak. If you feel like people on these meds aren't diseased enough to use them, there's prolly a problem with how you think of diseases.

There is definitely something to talk about related to whether certain regimented social structures marginalize and possibly medicalize certain types of brains so that they have to receive treatment in order to fall in line with the social order, and I think that's the real issue at hand: not the doctors, the parents, the kids, the teachers or any other specific group but the societal structures and the way medicalization can seem like the only choice. That's when the meds become harmful and coercive and that isn't a problem that's solved by saying "gee we're overdiagnosing".
posted by NoraReed at 3:59 PM on October 16, 2013 [5 favorites]

The idea that I think taking medication is cheating should be obviously wrong to anyone familiar with my posting to metafilter. My problem isn't that some people are taking Modafinil and other drugs to help themselves, my problem is that other people aren't allowed to do so.
posted by Justinian at 4:06 PM on October 16, 2013

Here's the flip side. My child got expelled from school last year because, the teachers said, he's CLEARLY ADHD and probably autistic and he cannot come back until he's medicated. HE WAS THREE. HE WIGGLED TOO MUCH DURING STORY TIME. THEIR SOLUTION WAS EXPULSION. (He also licked the floor and convinced all the other kids to lick the floor. Leader among men!)

Heh, made me smile to see something like this in here.

I am that kid. I was kicked out of catholic school at the end of 1st grade for being "too weird". They were convinced i had to have something like that, but didn't want me back even if it had been figured out.

I ended up getting diagnosed with ADHD, but none of the stimulants helped. After going through a few shrinks i got diagnosed with aspergers... And here we are. I went through a few shitty medication regimens that didn't do shit or caused other weird problems, but eventually got to something that kinda worked.

Here's what i really want to ask this thread though.

First of all, have you ever met anyone as an adult who actually said "yea, i was just a bit weird but i got funneled into the system because they didn't want to deal with me and ended up on medication that was horribly detrimental to me and fucking sucked". Because while i've met maybe one or two people who thought that, they were often the ones who'd go off their medication and fly off the rails and end up right back on it. Right along there with my friends who are bipolar, or have other issues like that. The vast majority of people go "jesus christ i'm finally able to feel in control of my own shit and get stuff done why the fuck didn't this happen sooner".

And second, what a piece of shit this article is. it doesn't really qualify anything it says. It just harps on and on at "and doesn't this seem a bit suspicious? doesn't this seem wrong?" If you're going to claim somethings fucked up, provide some freaking proof. Don't just go "this doesn't look right to me". I absolutely agree with what was said above with relation to that reaction vs the similar ones to sexism and such. "I don't buy it so it doesn't exist" and "It's being blown way out or proportion" aren't really arguments you get to make. Even if you are a person who would be effected by what you're railing against, your personal experience cannot be universal.

You know what the person who wrote this sounds like? the fucking antivaxers. "THIS LOOKS SUSPICIOUS TO ME SO SOMETHING MUST BE WRONG!".

Ok, get some proof on your side. Or shut up.

Really, everything said here and here x1000.
posted by emptythought at 4:12 PM on October 16, 2013 [9 favorites]

You know what the person who wrote this sounds like? the fucking antivaxers. "THIS LOOKS SUSPICIOUS TO ME SO SOMETHING MUST BE WRONG!".

I listen to conservative talk radio in the car, just as a safeguard against being too happy. This shit is all the hosts do, all day every day. I'M NOT SAYING XYZ, TOTALLY NOT AN XYZ-IST, BUT IT KINDA MAKES YOU THINK, HUH? JUST THROWIN' THAT OUT THERE.

Fucking just want to punch
posted by jake at 4:18 PM on October 16, 2013 [5 favorites]

I deactivated my account a while back, because it was a distraction (this will make sense momentarily), but I've reactivated it specifically to post this comment. It may or may not be interesting to anyone here, but to tempt you: it spans four generations, and is an anecdotal response to the question of where all the ADHD kids were prior to the 90's. I'm skipping a lot of details, so you'll just have to trust me.

---

My daughter and my son -- fraternal twins -- have both been diagnosed as having ADHD, one of the combined type and one of the inattentive type. It was a long path, involving thoughtful intervention from educators, physicians and both parents.

For my son, his January 2013 diagnosis resulted in a stronger focus on coping mechanisms already being implemented, plus a significant diet change[1] that has transformed the quality of his life, a remarkable turnaround that occurred within the first week[2].

Nevertheless, this comment really starts with my daughter.

My daughter's diagnosis was ADHD inattentive; she's eight years old, her diagnosis is less than two months old. She was already experiencing problems that one might attribute to laziness, carelessness or simple stupidity, but her brother's diagnosis combined with some insights I gained during his assessment set her on a course for assessment.

As much as I hate to admit it, I was the main impediment blocking her diagnosis at first; I felt my son's behavioral problems were a much higher priority, and her teachers said my daughter was "a pleasure, but kind of spacey at times." I often said "she's just like I was, it's how kids are, she'll be fine when she's older, we just have to help her get through school." The very things my mother was told about me, over and over. More on that later.

So what about the prior generations?

Well, in 2010 I started a journal. Like most things I've tried to start over the years, I didn't stick with it, but I did get four entries. In one of them, I make a joke about my daughter's inattention and other similarities to me, and joked about us being ADHD, which I ended with "Heh."

A few years later, going through the process of my son's diagnosis, one doctor outlined the typical childhood of ADHD inattentive type...and it was like hearing my own biography. That's when I stopped laughing and started paying attention. More than a year later, I have a strong case for my own ADHD inattentive type, and am pursing my own assessment. Even without the diagnosis, the experience has been transformative.

Why has it been transformative? Well, I'd spent 40 years believing I was a strange, fucked-up person who just couldn't apply myself, couldn't be fully present in relationships, couldn't finish anything without procrastinating until the deadline was imminent, and so on...and that's just how I am. Which, of course, is still true. But with a name to put on my experience, suddenly I had reason to believe I wasn't the only person in the world like me. It gave me the ability to assess my own coping mechanisms -- hard won over a lifetime, and occasionally thought of as faults rather than ways to cope -- and all the ways I'd failed to achieve my goals over the years. It gave me knowledge from outside, from others who experienced it, new tools to try. Now I'm operating as if I have it -- even without the diagnosis -- and things are much better for me. I'm still struggling, but at least I can see a light at the end of the tunnel.

So why wasn't I diagnosed ADHD?

Well, my parents didn't have much money, and I had the inattentive type, which means you're only causing problems for yourself, and everyone else thinks you just don't apply yourself. Remember, I didn't think my daughter had a problem; I fully expected her to do what I did, just muddle through and feel like crap the whole time. I'm sure it was similar for my mother.

In fact, I know it was.

After my son's diagnosis, I talked to my mother about her own history. My mother was the youngest of a very large and poor family, and she lost her father at a young age. Her mother also kept her out of elementary school most days, to "keep her company" and because my mother was having "convulsions" for an undiagnosed reason until age 12[4].

She doesn't really buy into ADHD as a thing, and she doesn't really know anything about it, but the things she shared with me about her own youth align perfectly with the prototypical ADHD inattentive kid: The trouble paying attention. The poor grades. The feeling of being in a fog, and suddenly waking up with no memory of what had happened. The always feeling stupid because she just couldn't pay attention long enough to learn anything.

Once she started high school -- and was allowed to attend regularly -- she was shocked to discover that she wasn't stupid, and that she could learn, and she did so. As my mother, she's always been forgetful and unfocused and ditzy, and shy around strangers. Just like me. And my daughter.

Why wasn't she diagnosed as ADHD?

Well, her father was a musician and signpainter (highly creative) who didn't have much education, who spontaneously eloped when his girlfriend was forbidden to marry him, often traveled to find steady work, was wanted by the police at one point (so never returned to his home state), had to steal some of his kids out of an orphanage[5], and eventually medicated himself to death as an alcoholic when she was still very young.

That didn't leave my grandmother in a position to do anything fancy like worry about her daughter's mental health; she was too busy carrying hot water up a flight of stairs to a shared bathroom so the kids could have a hot bath once a week (that's more than one person a day, in a family as large as theirs was) and other such stuff that poor people choose to go through instead of working hard and raising their standard of living. But I digress.[6]

Short version: my daughter, my mother, my grandfather and I all share specific traits that line up with ADHD inattentive as it is currently defined. My grandfather ended up a poorly-educated ne'er-do-well criminal who drank himself to death. My mother ended up being kept out of elementary school, having persistent self-esteem issues, and not even trying for college. I ended up struggling through school, constantly berated by instructors for not living up to my potential, having persistent self-esteem issues, and dropping out of college. My (son and) daughter are getting the support they need because we finally recognize that this is the way some kids are, and that they can't help it, rather than simple laziness or stupidity.

Hope that helps inform the discussion somehow.

[1] prior to his diagnosis, caffeine was not a significant part of his diet; he now consumes a regimen of caffeine via tea multiple times a day. He also no longer consumes carbohydrates in the morning, and limited carbs for snacks and lunch, with the carb calories replaced with additional proteins and vegetables.

[2] prior to his diagnosis, his karate sensei refused to let him attend class unless one parent was on the premises to deal with behavior issues, and his teachers were experiencing multiple frustrated outbursts of anger on a daily basis. In the first four weeks of his revised diet, he received student of the day 3 weeks out of 4 in his karate class, with a night-and-day transformation in his ability to focus physically and mentally. Similarly, his teachers noted an immediate and obvious improvement, and our first post-diagnosis, post-diet-change teacher conversation regarding his poor behavior was requested three months later, whereas before the conversations were occurring weekly (and sometimes daily.) In both cases, the instructors had not yet learned of his diagnosis or diet changes; they were simply responding to my son's behavioral changes.

[3] somehow I'd gotten it into my head that caffeine was a terrible, horrible thing, so I was avoiding it on purpose. Now I embrace it.

[4] my mother was told she had convulsions, but her memory of it was that she'd be sitting there, and suddenly a whole bunch of time would have passed and she wouldn't remember any of it. I experienced the same thing, and so does my daughter, but neither she nor I were ever told "convulsions" were involved. I suspect her mother just kept her out of school because it was easier than dealing with her difficulties with attention and focus in school.

[5] this comment is long enough without relating this story, sorry!

[6] yes, sarcasm.
posted by davejay at 4:28 PM on October 16, 2013 [30 favorites]

another reason ADHD threads are always kind of nuts is that it attracts ADHD folks who do stuff like spending 45 minutes writing and rewriting a short two-paragraph comment

Oh my god yes. You have no idea how long I spent writing that comment.
posted by davejay at 4:35 PM on October 16, 2013 [4 favorites]

Actually, I know exactly how long: a bit over an hour and a half. Yikes.
posted by davejay at 4:35 PM on October 16, 2013 [9 favorites]

a birds: "another reason ADHD threads are always kind of nuts is that it attracts ADHD folks who do stuff like spending 45 minutes writing and rewriting a short two-paragraph comment"

Yep. I have stuff I want to say, but I am wary of how long it will take me to write it and hit send.
posted by desuetude at 5:13 PM on October 16, 2013 [1 favorite]

Davejay, what information led you to restrict your son's intake of carbohydrates?
posted by Joe in Australia at 5:24 PM on October 16, 2013

For all of you who have contributed anecdotes to this thread, I wanted to let you know that it's super helpful to me, both as a parent and as a (university) teacher. I really appreciate your willingness to share your stories. I have gained many insights from reading MetaFilter, and beginning to understand at least a little bit other people's inner lives---which are very different from mine---is enlightening.

So, thanks everyone!
posted by leahwrenn at 5:26 PM on October 16, 2013 [4 favorites]

So, wait: you're saying that it's the mothers' fault? Because what I read here: "stresses on the mothering adult-or disruption of contact with her, as in adoption-predispose children to ADD because they directly affect the developing electrical circuits of the infant's brain." seems to say that. And there is exactly zero evidence that's the case.

Argh. I had put in an extended explanation in my original post but decided against it in favor of lunch.

Keep in mind that the quote I used is a description of the book - a small piece of lengthy blurb if you will.

Scatter Minds is about how caregiver attunment/attachment patterns in infancy and childhood impact neurological development and influence extent to which a genetic vulnerability to ADD becomes Actual ADD. There may a million reasons why a child experiences disruptions in the quality of caregiver attunment/attachment...but overwhelming stress on families, mothers especially, is a significant factor. That's what I meant when I said my experience matches this.

We already know that childhood stress, trauma, neglect, abuse, lack of emotional sustenance etc. play significant roles in the development depression, anxiety disorders, substance abuse etc. This particular book explains how and why those same issues contribute to the development of ADD. A central theme of the book is that modern parenting is extremely difficult and that the rapid rise in ADD and other mental health problems are, in part, a consequence of significant pressure on families - mothers in particular. I had hoped that overall, the excerpt I used adequately clarified this, but I can see how it comes off as Blaming Mommy.

The reality is that parents can only absorb so much pressure without it negatively impacting their relationship with their kids and their kids' development. This pressure can be in the form of poverty or economic insecurity, long work hours, lack of support/help, domestic violence, a parent's own struggles with ADD, depression, substance abuse...and on and on.

In his book and in subsequent interviews, Mate's explains that his stance is not Let's Blame Mommy. He often uses parental, caregiver and maternal attachment/attunementt interchangeably. That said, he acknowledges that mothers continue to do most of the heavy lifting when it comes to caring for infants and small children. He also states that newborns' attachment behavior seem to indicate early preference for mom and, at least in the early weeks/months, might be more sensitive to disruptions in that relationship than to others. The other claim is that infants ultimately gravitate towards the caregivers most attuned to their emotional and mental states/needs if one is available. I'll leave it up to folks better versed than I in child development to weigh in on the accuracy of this.

In the book he does not state adopted kids have higher rates of ADD. He states that if ADD is as genetically determined as folks seem to think, concordance rates should be higher than 50-60% in studies of twins who were adopted by different families.

He argues that stressful and often traumatic circumstances animating the adoption decision, the adoption process and the quality of the adoptive home might explain these concordance rates and may explain why one twin may develop ADD but the other does not - despite a shared genetic vulnerability. Also, he's using Canadian stats and in that particular section seemed to focus more on babies adopted after several months with their mother/primary caregiver and babies who cycled through multiple homes before finding a permanent, loving home.

Still, this was one book written some 14 years ago. It's an argument I find compelling, but it's one theory about ADD amongst many.
posted by space_cookie at 5:34 PM on October 16, 2013 [4 favorites]

Honestly, both sides of the ADHD argument depress me at times. I'm diagnosed as having ADHD, and have many of the classic symptoms of such - but it's something that I never ever dare to mention these days since I don't manage it with medication. Especially since I hang around with very academic and scientific-minded people, I get so much pushback for that as exemplified by many of the comments in this thread - ranging from accusations of being anti-science (I'm a medical researcher!) to patronizing comments of "well you know it'd be easier if you just popped a pill". This is even though I avoid medication for my ADHD for a very valid reason - my diagnosis of ADHD is also co-morbid with ASD, and mood-altering drugs have very unpredictable and uncharacteristic effects on me as they're really calibrated for neurotypical people and don't jibe well with my brain. I even avoid common recreational drugs in social contexts despite being an university student very much subject to social pressure - even caffeine! - because they end up reacting with me in ways that people very much do not socially expect. But for some reason, my method of managing my ADHD with my own mental strategies and tricks is seen as less valid, ineffective, and old-fashioned compared to medication - I understand it doesn't work for everyone and that medication has been a huge boon, but sometimes the overwhelming counter-response can leave me feeling less than respected.

Beyond that, I'm a disability rights activist and very much in favor of neurodiversity, and what depresses me about both sides of the ADHD argument is that they both come from the very ableist premise that mental deviations are ultimately a scourge and deviation from an acceptable norm. I sometimes get very distressed by the whole "rags to riches" phenomena of storytelling around mental disorders/deviations and medication where a person, pre-medication, was a complete failure with absolutely nothing and then suddenly, they take a pill and become functional. It reinforces the whole culture of stigma around mental disorders and intolerance of non-neurotypical people by diminishing the validity of neurodiversity - and is indeed a very self-damaging form of internalized ableism that I've had to actively work to unlearn. While certainly, my ADHD has negatively impacted me in some affairs, I do appreciate some of the cognitive features it has granted me - I love the energy, the flexibility and quick switches in thinking, the ability to dive into my own leaping trains of thought when I'm in downtime. That ADHD is so negative in the real world at times is more indicative of our way our society is structured (the many comments about the school system are apt here) rather than any individual failing, and I'm disappointed that the individual is always blamed and held responsible to change rather than the system's inability to accept and integrate neurodiversity.
posted by Conspire at 5:48 PM on October 16, 2013 [9 favorites]

Yeah regarding PTSD and adhd- it's funny that people still have this concept of either genetic or environmental variables being the cause. Really when you start looking at epigenetics it's starts being more interesting how trauma and various exposures could predispose offsprings/grandchildren to hyper-vigilance as well.

Meaning even "genetic" predisposition might actually be epigenetic in nature, meaning it's still environmental just in the parents or grandparents.

This is a paper about evidence of this in rodents.
"BACKGROUNDThe concept of developmental programming suggests that the early life environment influences offspring characteristics in later life, including the propensity to develop diseases such as the metabolic syndrome. There is now growing evidence that the effects of developmental programming may also manifest in further generations without further suboptimal exposure."

Sorry it's blocked. Essentially so far it's apparent that epigenetic alterations caused by the environment can alter the offspring as well. So saying "Four generations of these traits means genetic" is really not exactly the case, the actual genes for these diseases are rarely pinpointed because often they are epigenetic in nature. Which means they are very reactive to environmental variables but mostly in prenatal and early childhood periods when there is the most sensitivity. Some of these patterns become self reinforcing-- a trauma in a mother might cause poor functioning and a willingness to deal with an abusive partner and alter the childs genetic functioning through both family factors and epigenetic changes and theoffpsring might then, being altered and having learned the family coping mechanisms be more likely to be stuck in abusive patterns and reinforce those epigenetic variables across many many generations.

It's really fascinating stuff because really it implies we should be doing more to ensure family stability, resources, and supports in addition to understanding a few generations might still have traits resulting from specific environmental variables. But of course human's adapt so it's really complex since some people have adapted to survive better in unstable conditions which were the norm for long periods in their genetic history.

I'm a huge fan of environmental enrichment. The thing I wonder about is how will the meds effect the epigenome across the generations? Which tactics will lead to best fitness across the generations?

I guess what I'm trying to say is "predisposed to add" could simply mean any thing in your epigenome including chemical exposures your parents went through or trauma that altered the epigenome. It's hard to have these conversations without posting ten bazillion studies about truamas/environmental effects on biology and mechanisms of alterations passed on to offspring and grand offspring.

All I'm trying to say is if you define trauma as damage of either physical or emotional origin-- it's basically all trauma. Make human conditions better. Unfortunately better is complicated. We haven't really developed a manual of how to provide for human welfare nor to we really direct policy based on the extensive research done on this topic,which is unfortunate.
posted by xarnop at 5:51 PM on October 16, 2013 [2 favorites]

To make that shorter- make environments match individual human needs.
posted by xarnop at 5:52 PM on October 16, 2013 [3 favorites]

First of all, have you ever met anyone as an adult who actually said "yea, i was just a bit weird but i got funneled into the system because they didn't want to deal with me and ended up on medication that was horribly detrimental to me and fucking sucked".

Well I was misdiagnosed as bipolar and was put on medication that made me legitimately crazy and almost killed me. Does that count?
posted by elizardbits at 5:56 PM on October 16, 2013 [5 favorites]

Also I think it's insincere to say "adhd people need meds". When the system is set up for neurotypical people, yes they do. However we could design programs that did not require the same workload, that matched strengths to specific types of work adhd types might be skilled at, changed the expectations, and worked with kids where they are. In addition creating an education system and workforce that matched people strengths to training programs and jobs really fit their skill sets. I know, I know, but capitalism. Yeah. There's that. I'm just saying the only thing meds benefit adhd is keeping them in the workforce at jobs that pay enough to live a decent life. However--- if we did a better job of creating a workforce as if people mattered and everyone belonged in a job with a living wage--- they would not HAVE to take the meds to survive.

"Have to" is relative to the choices we make as a society that essentially force them to.
posted by xarnop at 6:00 PM on October 16, 2013 [4 favorites]

(Aaand I should add, for people who like the meds and gain a personal benefit it should be fine for them to take them.)
posted by xarnop at 6:02 PM on October 16, 2013

Lots of people like to point at the school system as the cause of ADHD. I can see the temptation. All the sitting still, the worksheets, the lining up. Of course it makes kids squirmy. I would have totally bought it, until I had my son.

My son came out the chute a bright, curious blur. I decided to homeschool him starting in Kindergarten. I used an ecclectic approach, with unit studies and creative alternatives to workbooks. We studied Greek myths with Lego, we did math while baking, we studied writing in the supermarket, we acted out the rotation of the planets around the sun. My son was free to run and climb and read and collect rocks and pretend with his friends. But he struggled every day because he could not pay attention. He could not pay attention to me, or to his books or to "i before e except after c." He was restless, always moving, always talking. He walked in circles, and tripped over his own feet. Just trying to sit and read together was a major production.

Our doctor refused to evaluate until he was 6. When he turned 6 we started the process. I know I've probably talked about this before. During our initial interview with the doctor my son crawled up and down and over and under the exam table like a demented weasel, despite my attempts to corral him. I always felt like such a bad parent in those days. Nothing I said stuck.

Eventually the doctor recommended Ritalin, and I had to think really hard about it. I was so afraid it would take something away from him. But we tried, and within an hour I could see him settle, like swirling water calming in the basin. It was a revelation. There was a boy in there!

We homeschooled for another 8 years and every time someone at a homeschool gathering would start on about how school causes ADHD I would point at my son and say "then what caused his?" Over the years there were times when we tried to go without medicine and it just isn't possible. He would be licking the floor and smearing butter in his hair...at 10. He absolutely knows that his brain feels better on the meds.

It turns out that he also has ASD and a nonverbal learning disorder. He did go to public high school, and was able to receive special services there. He now goes to Landmark College, which is one of the only colleges designed for people with ADHD, ASD and LD. If you know a teen with special learning needs, you should have them check it out.
posted by Biblio at 6:49 PM on October 16, 2013 [7 favorites]

My daughter has an ADD inattentive diagnosis. Medications have not helped (two versions over the six years with dosage adjustments within), so I proposed stopping medication at the outset of this academic year. Things have gone poorly, but I view accommodations as more important than medication. Recently, for the accommodations, we were forced to do a reevaluation, and we found in IQ testing (she was too young the first time around for this) that her processing speed is extremely low, like 2nd percentile. This explains a lot on the slow/spacey responses, and with the rapid math difficulty. The other areas are normal if not high.

That to me seems to bring her away from the attention realm and to just needing to work around this low level processing problem to develop her ability. The treatment prescribed though, is medication alongside accommodations.

My problem all along and continuing at this point is that there is very much a trial and error approach being taken with prescription for her and very little actual assessment other than grades, which are dependent on all kinds of stuff out of our control, such as reliable teacher prompts, social situations, timing issues with gathering materials from the locker, etc.

I get that trial and error may be necessary, but let's be scientific. Why not medicate and run well-designed tests for measurable improvement, completion of banks of tasks/question, being attentive to some controlled presentation, and so on?

Then, when I look to literature (which I am unqualified to do, I accept), I am finding that some studies show long term academic outcomes are similarly low for medicated and unmedicated diagnosed groups. These findings make me skeptical which creates friction over my denying my child the medication others feel she so surely needs.

I find the approach inept and the field relatively opaque about how they are going about this, but maybe it is just me not appreciating this early moment in the development of knowledge around these conditions. It also may be that this is more complex than I am appreciating as an uninformed person.

We're on the third medication and watching closely. The meeting over the accommodations is coming, and hopefully we can secure something that will cancel out her specific disability.

Thankfully, we have managed to keep her interested in school, curious about the world, and not damagingly self-conscious about it all. What a kid!
posted by zangpo at 6:51 PM on October 16, 2013

Davejay, what information led you to restrict your son's intake of carbohydrates?

His doctor's advice (the one with all the ADHD experience) as a first step; effectively his position is that most undiagnosed ADHD people end up self-medicating with stimulants like caffeine, nicotine, cocaine, etc., depending on what they've stumbled on that works for them, and for a kid caffeine is the safest non-prescription option by far.

As an aside, he suggested that mornings and lunches with protein and vegetables and such, but no or low carbs, has also been helpful at helping kids' moods stay more even and stable, which makes it easier for them to manage their emotional state.

Gotta run, but feel free to memail me if you want to chat more about it.
posted by davejay at 6:59 PM on October 16, 2013

Funny...I *wish* I could get a diagnosis for adult ADD...
posted by littlejohnnyjewel at 7:02 PM on October 16, 2013

littlejohnnyjewel - Why?
posted by Salamander at 7:06 PM on October 16, 2013

Much as with the mind-blowingly accelerating portion of the child populace that has serious peanut allergies, perhaps it's worth looking beyond our wariness and skepticism to see if there's something happening to our kids causing this. Perhaps we should spend some more time figuring out how this keeps occurring at such an increasing rate and less time shaming parents and kids who have a verifiable problem.

But what do I know? I'm just someone who failed out of college, got diagnosed and treated for ADD, then made Dean's List seven times in a row.
posted by DirtyOldTown at 12:01 PM on October 16 [27 favorites +] [!]

But isn't that what the article is recommending we do? I don't see the 'shaming' of parents or kids here, at all.

I really feel as if threads on topics like ADHD and obesity don't do well on metafilter precisely because people are primed to take offence. Which I understand, but it's a shame. How can we have a dialogue about things that effect entire societies if people start from the position that their personal story is under attack?
posted by Salamander at 7:18 PM on October 16, 2013

(I'm promising myself at the outset that I won't spend an hour and half on this).

I'm recently diagnosed, as a result of my son - at age 7 - getting diagnosed. Getting there was three years of hell as we dealt with a series of increasingly inadequate educational settings (including most of a year in a private school that was supposed to be prepared to handle kids with challenging behaviours), incredibly long wait lists to get him assessed, and then a rough period of getting his medication adjusted to the right level.

It helps an unbelievable amount. But it's not the end of the journey - it now (hopefully) allows us a window to help him learn the coping skills and strategies he is going to need the rest of his life. Because his ADHD isn't travelling alone.

As for me, the dawning realization that I also had this and getting on a medication trial with the help of the first physician in my life who took me seriously about my statements about how "wrong" I felt was a huge relief. The moment on my commute into work the morning I started on meds that everything came into focus was stunning; my mind stopped racing, my anxiety dropped, and for the first time in about forever I felt competent and like I was able to contribute. This is after a life that from all outside measures looked successful and happy, but on the inside I was chewing myself up and several rounds of treatment for depression had never touched that sense of "wrongness" the way that being treated for ADHD did.

I coped for a long fucking time on my own, and as a result I'm finding I have very little sympathy for folks who say it isn't real or it is a condition created by Big Pharma. Taking the meds is a first step - now I have to go back and re-examine the coping strategies I've developed over a lifetime and see if I can't develop some better, healthier ones.

Yes, ADHD is a vague and fuzzy set of overlapping symptoms. So are the diagnostic criteria for depression, anxiety, autism spectrum disorder, and a whole host of other mental conditions. We don't have nice clean blood tests or ultrasounds for this stuff. I suspect that we will eventually see that we are talking about a wide range of different conditions that we currently label as one thing because our diagnostic skills aren't advanced enough yet. That doesn't mean we throw our hands up and say it isn't real; it's reason to dig deeper still because we have folks who have certain conditions being mis-diagnosed with others and as a result being mis-treated. Imagine how much fun it is to be diagnosed with depression, take your anti-depressants and get therapy, and all the time wonder why you still don't feel better or right or "fixed." It's not a lot of fun and likely leads to other problems.

Is it being over-diagnosed right now? Quite probable. Are some doctors too quick to medicate? I would have no problem believing that (hearing people are having kids as young as three being evaluated/diagnosed floors me because no one we talked to here in Canada was willing to even think about exploring ADHD treatment for my son until he was six, minimum - before that, you just can't separate out kids being kids from something else). I've seen doctors way too quick to whip out the prescription pad for depression, anxiety, and everything else. Meds aren't right for everyone. Do some folks seek out ADHD meds for non-therapeutic reasons? Sure. Same thing happens with painkillers and tranquilizers and probably lots of other prescription meds. These are controlled substances for a reason.

This whole area - of developmental disorders, of mental health issues - it all needs a lot more research and development and clinical understanding, absolutely. But here's the big thing - these are still health issues. These are still disabilities (and that's a tough word to apply to yourself). However, these are not moral failings on the part of people who have them, whatever form of treatment they seek.

Remember that when you want to suggest that people are "gaming the classroom" or are being lulled into a sense of false dependence on Big Pharma for our "troubles" that don't really exist. For those of us who've run through the gamut of diagnostic testing and work to get here and are feeling "right" for the first time in our lives (or are seeing our children finally make some progress in academic settings and have a chance to develop the skills they will need as adults), our work didn't end with getting on the meds. It just started, and for the first time I'm feeling like I have a shot at being the person I want to be, rather than feeling like an utter failure who has been able to somehow fool everyone into thinking I'm something I'm not. I've put enough shit on my shoulders about being a some kind of morally defect loser already, thanks. I don't need yours too.
posted by nubs at 7:20 PM on October 16, 2013 [3 favorites]

I was an ADHD kid. Made me better in school for sure, but I just remember by artistic side dying when I went on medication. The system was definitely not good and bringing out my talents, but i understand that that's quite a pipe dream to have a system that caters to each individual students' talents and inclinations.
posted by GoneWhere at 7:23 PM on October 16, 2013 [1 favorite]

I really feel as if threads on topics like ADHD and obesity don't do well on metafilter precisely because people are primed to take offence. Which I understand, but it's a shame. How can we have a dialogue about things that effect entire societies if people start from the position that their personal story is under attack?

Speaking for myself, I would love to have that conversation but it seems all too often that it starts with the question of “Does ADHD even exist? Or is it just that you have poor habits/are lazy, etc”. And I’m not speaking solely of Metafilter, but other conversations I’ve been in (including with my parents). It’s pretty hard to be dispassionate about a topic you live with every day when the first thing you have to do is defend that yes, such a thing exists and here’s my proof. The people with the condition are being placed into a situation where they have to justify themselves and that the condition is not the result of a personal failing.

When the conversation starts that way, it’s hard to move past the personal. And when you’ve had to do it a fair number of times, it becomes a default behaviour as soon as the topic arises - which might be completely unfair to the person who is attempting to engage in the conversation in good faith, who is coming to the table from a presumption of this is a real problem that we need to engage in serious dialogue about.

It`s really made me appreciate how people from a variety of disadvantaged or non-mainstream perspectives can be made to feel under assault before the conversation really begins, and how that can lead to alienating allies or potential allies as well. Which I realize I may have done with my little rant above.
posted by nubs at 7:39 PM on October 16, 2013 [1 favorite]

Remember that when you want to suggest that people are "gaming the classroom" or are being lulled into a sense of false dependence on Big Pharma for our "troubles" that don't really exist.

Where does the article say that? Where has anyone in this thread said that?

The article is about over-diagnosis of ADHD, particularly in children. It raises pretty valid questions about the differing rates of diagnosis a) between US states, b) between the US and other countries, and c) now and in the past.

I don't see a single claim that ADHD doesn't exist. I may have missed a comment somewhere, but the article doesn't claim that.

As an analogy, I suffer from chronic depression and have spent years tweaking my daily dose of antidepressants. Obviously, I do not think depression is 'made up', or that medication is the easy way out. On the other hand, I absolutely do not think that the diagnosis and treatment of depression is as black-and-white as the diagnosis and treatment of, say, myopia (which I have also suffered badly from since birth). Am I worried about the increasing number of children and teenagers being diagnosed with depression? Yes. I welcome our society having more open discussions about how depression is diagnosed, and why the rate differs from one country to another, and why its diagnosis is on the upswing.

The people with the condition are being placed into a situation where they have to justify themselves and that the condition is not the result of a personal failing.

Okay, sure; I can see how that would get old pretty quickly, and I can understand why people are sensitive about it. I just don't think this article is asking anyone to do that, and if we start from a position of defensiveness, the discussion is doomed.
posted by Salamander at 7:49 PM on October 16, 2013 [2 favorites]

This is a difficult thread for me. I was one of the people who railed against the increase in ADHD diagnoses and the amount of kids on meds. You can find variations on this article, by the way, going right back through the mid 80s; this is not a new issue. I worried (and I still worry) about the long term physical effects of taking daily ADD meds for years on end. Nobody seems to know what that will do to your liver or kidneys; there's been enough time now for a longitudinal study or two but I don't know if one has been done. That was one of the reasons I chose not to medicate my own child with ADHD. In retrospect, that was probably not a good decision.

Like a lot of other people in this thread, I have a child with ADHD, born in 1991, who was diagnosed at age 8, finally, after years of increasingly serious trouble in school and at home (it's perfectly normal to be called in for a frantic meeting with your kid's teacher and all the other grade teachers and the principal and whatever school counselor or psychiatrist they can find every single year within four weeks of the first day, right? Right? It's perfectly normal to have a kid who climbed to the top of the refrigerator at 10 months, right? He's just active and if he chooses to eat dinner under the table instead of at it it is simply because he is creative. And so on. Actually, with a few modifications, it was really okay most of the time. He was and is a charming, beloved, somewhat troubled force of nature.) In his case the ADHD is combined with a rare form of learning disorder called a visual perception disorder, a certain amount of ODD (that is oppositional defiance disorder) and a small host of other issues that nobody understood then and I don't think much does now.

They suggested medication; I resisted. He had an IEP and school aides and a variety of other help but when he got to middle school, it was not enough. For one thing, they took away his IEP and said he was just stupid. I yanked him from that school and put him in a private hippie school where he was promptly suspended. In desperation, we tried medication: Straterra, to be specific. For the very first time in his 13 years, he did his homework. He also became suicidally depressed which understandably terrified me and the school. So I took him off the meds and had a big fight with the current psychologist. Let me just say here that being a single mother is not easy and psychologists who look at you and say, well, if you really cared about your son you would clearly homeschool him are not helpful. Sure, I said, I'll quit my job and do that - we can have classes in our spacious cardboard box under a bridge. I took him off the psychologists too at that point.

Things went from bad to worse in high school. I will gloss over the next few hellishly bad years except to say that one of his evaluations said, quite accurately: "He will soon start to self medicate if he hasn't already; likely to end up in the criminal justice system." I got angry at this then - I spent a lot of time being angry with dismissive psychologists and actively hostile school administrators. Nobody wants a kid like mine in their school; if they can just get them to drop out then it's so much less disruptive and their test scores will improve. That's bitter and cynical, yes - and our experience. Well. This story, by the way, has a happy ending for now: he is as I write this, doing really, really well, which is something that a couple of years ago I would never, ever have thought I would be able to say. He's working at a restaurant, where they love the fact that he never stops moving and is content to put in 60+ hours a week. He has an apartment and a girlfriend and I think he is going to actually be okay. He is still unmedicated and he is still a force of nature - having him in your house is kind of like inviting a large, friendly force 5 tornado to dinner.

In 20/20 hindsight though and even though I really did fight and advocate for him, I wish I had been more open minded about medication when he was younger. I wonder all the time if that could have made a difference. I wish I had found out about more resources and pursued them harder; I wish those resources had really existed then - I wish a ton of things; parental guilt* that never entirely stops. I also wish they would stop writing these articles. Is it over diagnosed? Quite possibly. Does that make it any less real and any less difficult? OH HELL NO.

* You know what I'm not guilty about? His early childhood. Up thread somewhere someone was talking about maternal trauma and lack of attachment causing this. Uh, sorry, sure we were not wealthy but that child never spent more than four hours away from my side until he was almost three years old. He wasn't allowed to watch scary movies; he was hugged and cuddled and kissed and never spanked and I read aloud to him every single night of his life until he was about twelve.
posted by mygothlaundry at 7:56 PM on October 16, 2013 [11 favorites]

I am uniquely qualified to talk about this. I have strong positive and negative opinions about my diagnosis, the many different treatments I've gone through (both medicinal and therapeutic), about the firsthand accounts of misdiagnoses so many of my peers said they had to deal with (during the late-80s early-90s Ritalin boom), about how much I have benefited from finding a drug that works for me and about how I am a different person when I'm on it right down to my core personality traits and how scary that is... but wouldn't you know it's the end of the day and my Adderall's worn off and I can't seem to put the right words in the right order.

PARENTS OF ADHD CHILDREN -
PLEASE LISTEN TO THEM
Children and young adults lack so much autonomy in their treatments and also the experience, the frame of reference, and the vocabulary to let you in on what they're goimg through.

At the same time, so many well-meaning parents are so blinded by hope and desperation that they're missing out on what's going on in their own house. If you're medicating your kid, pay lots of attention. Note what's different and what's not. These drugs are hard core.
posted by elr at 7:56 PM on October 16, 2013 [7 favorites]

Hey -- if anyone's still around, I recommend watching at least the first bit of this Youtube video if you're interested in (what I consider the best explanatory theory of) how ADHD works and what it is. Honestly I wish I had gotten here at the beginning of the thread with this, I'd rather have seen 80 comments about that than the article linked up top.
posted by a birds at 8:01 PM on October 16, 2013 [4 favorites]

Where has anyone in this thread said that?

Here and here I guess the precise quote is àbout gaming the teacher, apologies for not being completely precise.

Anyways, I guess my tone is off for this discussion as I`m being defensive. So I`ll just take myself away from the keyboard.
posted by nubs at 8:02 PM on October 16, 2013

It's terrible to say but I sometimes DID use my real disability to game my teachers. And sometimes my parents too.

But so did my friend with cancer and so did my friemd with heavy allergies and so did my friemd who was pregnant and so did a LOT of my friends who weren't really having their period that day,but I assure you, ADHD is as real as all those other things. Mischievous kids will be mischievous.
posted by elr at 8:10 PM on October 16, 2013

Anyways, I guess my tone is off for this discussion as I`m being defensive. So I`ll just take myself away from the keyboard.
posted by nubs at 8:02 PM on October 16 [+] [!]

I apologize, nubs; I didn't mean to imply that anyone should leave the discussion, and I'm not the one to make that call anyway.

That's two comments from the same poster, though, and even then I'm not even clear what he's saying about ADHD drugs.
posted by Salamander at 8:19 PM on October 16, 2013

Cool I just wrote another really long comment and erased it and then I'm starting again.

ADHD discussions are heated because it's a moral issue. ADHD kids "can't" do their homework, but they can play video games for 3 hours on end? They can do their homework sometimes if someone's standing over them with a whip. How is this different from laziness? So if many/most cases are misdiagnoses, that really leaves those particular people with little explanation other than that they are just lazy and lying about it. Heated discussion ensues.

I keep recommending this guy Barkley's books and that video lecture above, and it's funny because his explanation of ADHD is really that it is simply and solely a problem with lack of self-regulation. This sounds like the kind of thing that could be "someone's fault" and part of an accusation rather than an explanation, but he then goes into a really, really satisfying amount of detail about

what kinds of self-regulation he means
how they work to govern behavior
when, how, and even why they develop
how ADHD affects each (in a causal chain, not as a blob) and why other disorders don't

He even throws in what's basically a guess--but in my opinion a brilliant and insightful one--about the evolutionary origins of self-regulation as a trait in humans, and how it came to be that we devote such a huge amount of our brain to it.

I tortured myself throughout my childhood and adolescence with self-inflicted accusations of laziness, ignoring/rejecting 3 different ADHD diagnoses as "excuses" and so on. Other people in this thread have said they got similar treatment from others rather than from themselves. So, morality issue, are you a good or a bad (lazy) person. Emotional topic.

To me all of that accusatory emotional stuff was only possible because my understanding of ADHD included a description of my behavior, but not anything resembling a cause. Like I said above, "You have a disorder that makes you unable to do your homework" did not work for me. "It's a problem with your executive function" wasn't enough either. Now, having a lot more detail about the thought processes involved and (crucially) the origins and purpose of those thought processes, I don't see it as a moral issue at all. Also here's another link to the video I've been talking about.
posted by a birds at 8:56 PM on October 16, 2013 [5 favorites]

I am quite old, at least in MF terms. So I didn't get diagnosed as ADHD until I was in my forties (the psychiatrist said after ten minutes with me, "oh you're a textbook case. Can you go get your wife now. I'm sure we have much to discuss"). I can't even get through all the posts on this thread without switching between a couple web forums, checking on the cats, switching the music.

I am almost finished with a fantasy novel I've been working on for a few years now. Half a chapter and it's done, ready for a brutal round of editing and polishing. And to force my self to write those last few thousand words, words that I am sure Scalzi or Stross could pound out in a morning I will have to have at least another four days, make sure I have an incense stick burning, music playing, with still check the Interwebs about 15 dozen times per 500 words, etc. etc.

I do not take meds. Everything but Adderall elevated my blood pressure and/or heart beat. Adderall was the greatest I ever felt in my life but the salts were killing me - horrendous dry mouth. My wife said, "Oh, just go back to being you." I drink a lot of diet soda, I try to keep up on exercise, and a few other coping mechanisms. None of these remotely bring the clarity and drive that Adderall did but I survive.

I used to be on an international ADD forum. It seemed that those not living in the US or Canada were indeed having an extremely hard time getting the meds that came so relatively easy to the rest of us. Some of those people I'll never forget, their struggle was so acute and relief was not coming their way.

I see that I have started every paragraph with "I". That's driving me nuts as well but that's another story entirely. Godspeed and good luck to all those that suffer under the broad ADHD banner. I think there are far worse conditions to have but this was is a bitch. It has fucked up my life in ways beyond count and I really truly hate it, except for the hyper-focus. That is my one mighty weapon and it really truly is a thrill when it kicks in.
posted by Ber at 9:23 PM on October 16, 2013 [1 favorite]

1) if it's being diagnosed so much more often now, does that mean we were missing it before?

60s/70s kid here. A few months ago I found most of my old report cards, going back to 1st grade. I brought them to my next shrink appointment to show my doctor something in particular (unrelated to ADHD), but as he got about halfway through the pile he kind of laughed and said, "Well, this certainly confirms the ADHD diagnosis." It was really eye-opening to be able to go back and read all the comments with a new perspective. I don't know what they could have done at the time, but even the acknowledgement that there might be some cause other than my bad attitude would have probably saved a lot of people a lot of heartache.

"Yeah, during that same time I was constantly getting lectured to Apply Myself and treated like a total bum for not doing my homework and yet everybody seemed to be comfortable labeling me as "a smart kid but no work ethic".

See also: "Does not live up to her potential."
posted by Room 641-A at 10:32 PM on October 16, 2013 [7 favorites]

I wasn't diagnosised as a kid because girls didn't have have that.
posted by HMSSM at 10:38 PM on October 16, 2013 [16 favorites]

A few things on the NYT piece...

First, if the ADA created "upsides" to an ADHD diagnosis that contributed to increases in diagnostic rates, it would be helpful to know the numbers on how many families know that ADHD is covered under the ADA, know what resources are available if their kid gets diagnosed, and the percentages of families that actually avail themselves to resources like extended test taking times and quiet study places. It would also be helpful to mention what resources schools are and are not required to offer kids with ADHD. According to a disability rights attorney I know, there's lots of confusion about what schools must do to accommodate ADHD kids. This article is the first I've heard of access to extra tutoring as an ADA benefit or accommodation, I'm not sure schools have to provide it. If one going to claim "upsides" please be more inclusive and precise about what those are.

Also. She writes: The No Child Left Behind Act, signed into law by President George W. Bush, was the first federal effort to link school financing to standardized-test performance. But various states had been slowly rolling out similar policies for the last three decades. North Carolina was one of the first to adopt such a program; California was one of the last. The correlations between the implementation of these laws and the rates of A.D.H.D. diagnosis matched on a regional scale as well. When Hinshaw compared the rollout of these school policies with incidences of A.D.H.D., he found that when a state passed laws punishing or rewarding schools for their standardized-test scores, A.D.H.D. diagnoses in that state would increase not long afterward. Nationwide, the rates of A.D.H.D. diagnosis increased by 22 percent in the first four years after No Child Left Behind was implemented.

....From parents' and teachers' perspectives, the diagnosis is considered a success if the medication improves kids’ ability to perform on tests and calms them down enough so that they’re not a distraction to others. (In some school districts, an A.D.H.D. diagnosis also results in that child’s test score being removed from the school’s official average.) Writ large, Hinshaw says, these incentives conspire to boost the diagnosis of the disorder, regardless of its biological prevalence.

Okay. But how does this happen, in reality with real parents and real kids? It seems to me that in order for this to come about, a statistically significant number of teachers and schools would have to alert a statistically significant number of parents of low performing kids to a possible problem...and alert them in such a way that these parents agree that something is amiss and decide to take their kids to doctors or mental health professionals..who then diagnose ADHD and write prescriptions in significant enough numbers that schools experience or perceive benefit.

Or. Is it she saying that this is a confluence of these factors? My interpretation this is that changes in FDA regulations for permitting direct consumer marketing gave the public at large new - but not always accurate - vocabulary and framework for understanding and approaching certain types of problems and behavior in kids. The inclusion of ADHD in the ADA normalized the condition and made it easier for parents to get help for kids struggling in school. When states began linking student performance to school funding, ADHD - already on the tip of everyone's tongue - became a common scapegoat or release valve for schools' anxiety about low-scoring kids. Since GP's (unfortunately) diagnose in large numbers and don't always use more accurate diagnostic instruments available to MH specialists, they tend to over-rely on parent teacher reports and assumptions about possible ADD. Still, that's a lot of speculation.

I'm not saying the article is flat out wrong that there is an correlation between "incentives" and diagnostic rates...just that it's sloppy, poorly argued and with too little concrete evidence to support it.

It's fine and all that she says Hinshaw's research "winks suggestively" at these correlates....except that general-audience journalism about mental health disorders is littered with thousands and thousands of suggestive winks. The NYT is especially bad on this front, much as I hate to say it. It muddies discussion waters considerably, unnecessarily politicizes an already fraught arena and does little to expose good research to a wide audience, or help people who struggle with actual mental health problems.
posted by space_cookie at 10:53 PM on October 16, 2013 [2 favorites]

PARENTS OF ADHD CHILDREN -
PLEASE LISTEN TO THEM
Children and young adults lack so much autonomy in their treatments and also the experience, the frame of reference, and the vocabulary to let you in on what they're going through.

This is the #1 thing i think, and the #1 shitty aspect of my memories of being young. I had absolutely zero autonomy in my treatment, and most of the time it honestly felt like i had less autonomy or consideration of my feelings than the average kid.

It will, until the day i die be a scar on my relationship with my mother. She knows it too. I know she did her best, and i don't place the blame solely on her for that as it feels like society in general stacks the deck against non neurotypical kids.

But fuck if it didn't feel like i had broken out of jail or something when i broke away from my family, moved out, and quit taking constant daily doses of medication i had been forced to take since i was 8 or so.

Well I was misdiagnosed as bipolar and was put on medication that made me legitimately crazy and almost killed me. Does that count?

...I'm sorry, really. I kinda feel like shit now. I guess i got into "sith deal in absolutes" mode there. It's just that even via the internet i've only heard a couple stories like this. But i've heard shitloads of both of the problematic promoted "rags to riches" stories, but mostly just "oh yea i figured out what the fuck was going on and now i take a low dose of adderal/antidepressants/etc and it's not like it's 100% gone but it's way easier for me to deal with you know, life". That's definitely the story of a lot of people i know, met, or have talked to.

And the premise of this article, and a lot of people i've argued with who are vehemently for this over-medication premise and generally anti-medication are pretty much sharing a fence with the people who disbelieve that adhd and other neurological conditions really even exist.

So yes, that counts, i'm sorry. It's just that it's one of those situations i really feel gets painted on a sign and used a club by a side that can be quite shitty in these types of discussions.
posted by emptythought at 11:48 PM on October 16, 2013 [1 favorite]

That's two comments from the same poster, though, and even then I'm not even clear what he's saying about ADHD drugs.

That's me. I had to step away and feed the family ant do things, and never got back to the discussion.

I thought that I was clear enough. If you need meds, take meds. Myself, I take a hell of a lot of caffeine, because as a kid during the doctors' attempts to medicate my ADHD, due to the timing as they were developing the protocols -- I experienced a lot of flailing around tweaking the meds and it wasn't a good scene, so I bailed out on the meds at about 13 and went with caffeine + coping strategies.

Now, re: Gaming.

I wasn't referring to gaming meds. I was referring to the natural tendency of any system to be gamed.

The kids are gaming the teachers for more independently directed time ( while they're doing boring shit, I'll work on my book... ) and the teachers are gaming the administration.

A trend is that ADHD kids are really bright. So they get 'bored easily'. Which means that they can tune out most of the time and still keep up. So they then realize how they can maximize the time they're doing the things they want to. So, since they're not causing trouble, an overloaded teacher might not notice -- for example -- that the kid didn't memorize their multiplication tables. Which is fine in third grade, but every time they have to pause 10 seconds to work out 5 * 7, they're setting themselves up for a whole lot of hurt in calculus.

The teacher CAN'T care. They're overloaded, and just doesn't notice that the kid is 'faking it', or 'gaming HER'. Not for meds or anything, but just to stay under her radar.

That's how it was IN THE 70's.

Now add to the teacher's workload the Core Curriculum shit. Add to the student who already knows that their time is being wasted the additional pointlessness of Core Curriculum activities, and the issue we had got worse, and then add to that the upswing in 40 years of the diagnosis and treatment.

Now, the thing here is that if the teacher's overloaded, and in their experience the kids who take the ADD meds cause less grief, what do you think their going to lean towards, EVEN IF THE KID DOESN'T NEED THE MEDS.

So we have a few distinct groups here:

1) ADD/ADHD kids who need meds + coping skills.

2) ADD/ADHD kids who don't need meds, but need continuous work on skills. ( me, unless you consider caffeine a med, and I do... )

3) Kids without ADD/ADHD who are just disruptive to a classroom.

Oh, and why the knee-jerk reactions to both this and obesity? Same basic reason. Comfort Zones. This comes back to that whole Zizek/Ideology/They Live/"Put on the sunglasses. I'm not putting on those fucking sunglasses. Put on the sunglasses!" The moment there's pressure on someone's ideology ( again in Zizek's usage ) there is intense pushback.
posted by mikelieman at 12:35 AM on October 17, 2013

So, I guess the point there was: ADD/ADHD kids have been falling through the cracks for a long time, as long as they weren't disruptive and didn't outright fail the quizzes and exams.

With the trend to diagnose with a broad brush, and the increased class sizes, and the increased workload, those cracks just got a whole lot bigger, and now there's a whole lot more kids at risk of falling through those cracks. And I suspect since the teacher's are so overloaded there are NON-ADHD kids just skating by, doing good enough, not really learning, and never getting the basic educational foundation they're going to need.

And the teachers actually KNOW they're not delivering that basic educational foundation. They know that the kids they got from third grade don't know their multiplication tables. But since they don't have time to spend a day or two making the kids drill until they're proficient, they just keep moving forward with new material so they stay on schedule. ( That's the part of the teachers gaming the administration ).
posted by mikelieman at 12:41 AM on October 17, 2013

I have a really bad luck with ADHD threads, I always arrive way too late. In any case here is my $0.02.

Caffeine is an interesting thing. For me it really was the closest thing that came to a stimulant when I was not taking Ritalin (long story). The downside is (besides the fact that I have blood pressure issues) is that of course your energy levels will go up and down the whole day if you use high, short-acting dosages (espresso shots, energy drinks...). In hindsight, I should have used black tea (as davejay said) or mate or something like that.

As for the generational thing, well, yeah. My dad has a pretty strong case of ADHD, I myself have ADHD and two of my other siblings have it too.

I've read Scattered Minds not long ago and really liked it, especially the different perspective it offers. It also fits into other things I've heard about attachment.

sigh I have so much more to say but this is enough for now I think.
posted by KTamas at 2:51 AM on October 17, 2013

Yeah what frustrates me is that we have huge amounts of resources on what causes adhd. We already know that for example we could be addressing poverty,food insecurity, and income instability for people in general and especially for pregnant women and mothers. We could address outdoor air pollution. We could address housing instability, roach/mold/mice and other problems in old buildings including measuring indoor air pollutants in products we build housing and household products from. Nicotine and other substances used during pregnancy as well. We are failing to address the health needs of families from a perspective of the relationship between poverty and access to needed services. AND we are failing to incorporate into our health system the reality that health needs involve more than just someone willing to hand out prescriptions. Family wellness involves multiple domains of stability and services to meet those various domains. And knowing what we do about epigenetics and how environmental factors impact not only ourselves but our children, we need to get serious about providing supports (not shaming/lecturing) for people prior to getting pregnant, during pregnancy, and during the early years of children's lives when they really need emotionally stable parents available. This means more maternal leave policies and financial supports for mothers, and more access to stress relieving supports such as massage, yoga, exercise for families in general. There are SO MANY things we can be doing.... and looking at the issue of attention deficit as an issue that occurs because of "genes" is not really validated by science. There are some diseases that are caused by specific genes, this is not likely one of them.

This is something that occurs in people who have themselves or their parents/grandparents/etc been exposed to unhealthy conditions. And we can fix that if we get serious about looking at what we know and enacting policies that actually meet human needs for attachment, love, bonding, nutrition, exercise, play, nurturing, and more across a spectrum of domains. What's more "bad lifestyle choices" are themselves usually the result of bad conditions. Helping people build positive behaviors means respective how their current coping mechanisms ARE currently serving them and helping them find alternatives that meet those needs but with less side effects or more long term benefits. In essence, it means opening doors by providing more resources, support, and tangible help with the process of change rather than shaming them for how they are surviving difficult circumstances on their own.
posted by xarnop at 4:29 AM on October 17, 2013 [2 favorites]

I guess what I'm thinking is if we're going to use science, why not use science to create environments that meet human needs, rather than using science to create people that can endure the worst crappiest environments a cheap uncaring society feels like providing without manifesting any negative symptoms whatsoever?
posted by xarnop at 4:59 AM on October 17, 2013 [1 favorite]

if we're going to use science, why not use science to create environments that meet human needs, rather than using science to create people that can endure the worst crappiest environments a cheap uncaring society feels like providing without manifesting any negative symptoms whatsoever?

The only thing I can imagine is that terraforming is expensive and this way the Gammas won't need really high oxygen levels on whatever shithole they get dumped on?
posted by mikelieman at 5:27 AM on October 17, 2013

See The Underground History of American Education by John Taylor Gatto, Chapter 7, The Prussian Connection. Maybe it's not the kids, but the schools that are sick.
posted by bukvich at 7:05 AM on October 17, 2013 [1 favorite]

I have edited a paragraph from a seemingly unrelated article. Click through to see the original.

Making Life Easier for Those With Attention and Focus Issues

ADHD does more than make life difficult for people by offering them plenty of challenges. Scarcity of attention, lack of ability to remember and shifting focus saps them of the tools they need to get ahead. You can't swim far if you're always treading water. You can't use time in school or work wisely or make a plan to acquire marketable skills, or build your skill set if you're always thinking of and distracted by internal mental "revving"and/or external distraction. But it gets worse. Other studies have shown that reduced bandwidth (or "decision fatigue") results in loss of self-control (this is true for non ADHD and ADHD people alike). Many of the characteristics we ascribe to those with ADHD — poor impulse control, lack of motivation — as explanations for their poor performance may actually be the result of lack of mental bandwidth caused by ADHD.

And I agree 20001/2% with letting the kids be in the discussion of issues that affect them - whether or not it's about ADHD. It's a good rule of thumb, and at least in my family, discussing each kids' issues honestly and openly as age and situation appropriate is useful. Each of the kids don't know everything going on with each other (usually just a thumbnail sketch) and we let them help but not nag each other.
posted by tilde at 7:16 AM on October 17, 2013 [1 favorite]

See The Underground History of American Education by John Taylor Gatto, Chapter 7, The Prussian Connection. Maybe it's not the kids, but the schools that are sick.

I referenced that book in a letter to our children's school principal. FWIW, I loved it so much when I read it online, I had our local, independent bookstore order me one special so I could have it on the shelf for the moment I could just pull it out and go, "By any chance, are you familiar with *this*?"
posted by mikelieman at 7:20 AM on October 17, 2013

We already know that for example we could be addressing poverty,food insecurity, and income instability for people in general and especially for pregnant women and mothers. We could address outdoor air pollution. We could address housing instability, roach/mold/mice and other problems in old buildings including measuring indoor air pollutants in products we build housing and household products from. Nicotine and other substances used during pregnancy as well. We are failing to address the health needs of families from a perspective of the relationship between poverty and access to needed services.

xarnop, can you talk a little about what your background is? Because the vast majority of children I know with an ADHD diagnosis come from families that have none of these things. In fact, we're an attachment parenting family, and I know at least one other AP family in my son's school who have a child whose issues are more severe than those my son experiences.

I'm not disagreeing with you that it would be lovely and good for families and children to address those things. I just -- even after reading all your comments in this conversation about three times -- I come away with the feeling that you feel like ADHD is something that only happens in broken, impoverished families, when that certainly is not the case.
posted by anastasiav at 8:37 AM on October 17, 2013 [2 favorites]

Well I believe "impoverished" is a matter of what the needed health variables are. I was raised in a wealthy home that was low in warmth and parent/child interaction because my parents were both working and stressed and busy a lot and they each had some ongoing trauma issues of their own that they clung to hard work ethic to cope with, having endured parental death and poverty in their early childhoods.

The depression occured in this country about three or four generations ago, enough for it to be relevant in terms of epigenetic imprinting.

My background is that I'm adopted, and was placed for adoption at birth into a family with good resources and wealth, but that was low on resources for a special needs child-- i.e. an infant not breastfed grown in the womb of a woman with high levels of grief/trauma/child abuse and having panic attacks and likely some mild partial siezure activity actively throughout the pregnancy.

I have also placed an infant for adoption and the lack of literature on how this seperation effects infants and mothers available when I was making that decision or coping with my own health issues and the health issues in my family concerned me so I turned to reading extensively all I could find about maternal attachment, prenatal development and early childhood development-- the variables that affect it, and how to better assist mothers in being empowered to nurture and support their children in healthy ways that respect the dvelopmental and attachment needs of children.

Environmental enrichment does not cure attention deficit, however there are some treatments that might work better than meds, like for example: neurofeedback

I have devoted my life to ensuring children are better cared for than I was- environmental enrichment is more complex than just being nice to your children and having money, it takes work to identify the needs of people who can't talk or even know really what their needs are, and of course there is some guesswork involved. Emotional well being, bonding and interaction with parents, status with family and peers, support from others, these kinds of variables play a large role in immune health and emotional and cognitive well being. Blaming parents for not being able to provide every single thing is not the direction I want this to go, it really does take a village and we need to help families be connected to a variety of resources that help them understand and meet the needs of their children.

I've been in school taking courses in biology/psychology/and human development for many years now, but it's slow going being a single mom myself and trying to ensure I still spend a lot of time with my son (and also dealing a lot of other complex life issues). Neurofeedback gives me A's in school but it's expensive as crap, and I'd really like to see options like this given on insurance for accessible rates, especially since some people like myself can't tolerate a lot of pharmaceuticals.

What I've found interesting is the nature of how I can look at my biological family and see how those who were exposed to the most trauma developed worse health, and I believe that worse health can be passed on to offspring (and grandchildren). I don't expect anyone to take my word for it, it's just food for thought and anyone interest should read the literature on it themselves and formulate their own opinion.

To me: income is not the deciding factor of a "poor" environment for children. There is emotional poverty, nutritional poverty, air quality poverty, toxic exposure, emotional abuse, and many many variables that can make a situation not meet a child's needs or actively harmful to them. Anything happening in the prenatal period and in the mothers history can impact this even if she has money or stability at the time of pregnancy.
posted by xarnop at 9:29 AM on October 17, 2013 [2 favorites]

Raising my hand as one of the late diagnosed inattentive crowd. Brought up in a "There can be nothing wrong with any of us, ever" Scottish presbyterian family ("But what about Uncle ____'s drinking, or ____'s depression, or …?" 'shutupshutupSHUT UP!'). Amazed my family didn't notice the glorious gravitational pull that windows had on me, the annual 'lazy kid' report card, the early riser, the never knowing when to stop eating, the non-linear conversations, the tuning-out in crowds greater than 4 …

So, years later, with a chunk of medication and meditation behind me, I'm learning to relate to people and situations better. The biggest and most difficult part is accepting and forgiving myself: I'm neither lazy nor stupid. I'm just tuned to a different scale. While I'm getting more and more okay with this, DirtyOldTown's comment reminds me that there is still a stigma. I work in a regulated profession, and if I were to meet a particularly literal tribunal, technically, my aerobatic brain could get me kicked out of the profession. Hence the sockpuppet, which I hope to be able to drop some day.
posted by A Friend of Dug [sock] at 10:21 AM on October 17, 2013 [1 favorite]

I was raised in a wealthy home that was low in warmth and parent/child interaction because my parents were both working and stressed and busy a lot and they each had some ongoing trauma issues of their own that they clung to hard work ethic to cope with, having endured parental death and poverty in their early childhoods.

Interesting; that describes my upbringing (except for the wealthy part, more like lower middle class) and I was just having a conversation about this last night.

I had a simple enough theory: if ADHD is genetic, that means at least one parent is going to have it, and so the challenges of the children are going to be exacerbated by the challenges of the adult parent. Thus, the "low in warmth...stressed...busy" parenting style might not be the cause of things, but the symptom of it -- that, yes, of course kids with ADHD have at least one parent like this, because that parent is where they got the ADHD from.

Proving it is hard, and I have nothing to offer except an anecdote from the person I was speaking with. She dated a man who was adopted, and whose sister was also adopted from a different set of parents, from birth. They were raised by the same parents at the same time in the same environment. Neither parent had ADHD, he doesn't have ADHD, but his sister has severe ADHD.

Anyway, it's something to think about.
posted by davejay at 11:28 AM on October 17, 2013 [2 favorites]

I had a simple enough theory: if ADHD is genetic, that means at least one parent is going to have it, and so the challenges of the children are going to be exacerbated by the challenges of the adult parent. Thus, the "low in warmth...stressed...busy" parenting style might not be the cause of things, but the symptom of it -- that, yes, of course kids with ADHD have at least one parent like this, because that parent is where they got the ADHD from.

This is a great point. It also could potentially be both a (partial) cause and a symptom - in which case diagnosis/treatment of the parents (and people who will be parents someday) would be a very good thing, and we should be worrying about underdiagnosis at least as much as overdiagnosis.
posted by randomnity at 11:49 AM on October 17, 2013 [1 favorite]

Right but as I'm adopted extrapolating fromm my story and yours isn't very helpful. There is actual real research done on this specific topic and I think that should be weighed. The research on adoptees is helpful and I can post some of it or memail you some if you'd like. Essentially the research I've read is that it's very complicated and individual what is protective or harmful but parenting has some effect. There are parenting styles and behaviors that have a protective effect. Epigenetically altered mice by abuse or chemical damaged offspring do better if adopted by healthy mothers, however depending on the type of damage they may still be altered compared to mice who are both born from and raised by healthy mothers.
posted by xarnop at 12:34 PM on October 17, 2013

The argument that Halloway and Ratey have expressed on the genetic front is that ADHD is something that people can have a genetic predisposition for, but that the expression of that predisposition depends greatly on environmental factors. As I recall, their environmental concerns have more to do with exposure to heavy amounts of electronic entertainment than with parental attachment.
posted by nubs at 12:42 PM on October 17, 2013

My kids were both parented in the AP style and one has ADHD and the other has Anxiety. I think it's a crapshoot.

Also, I don't think that kids with ADHD are inherently smarter than other kids. I can't find anything to back that up. Kids who have higher IQs do have a hard time with ADHD, because people are more likely to see them as lazy when they don't achieve their potential.

I have also never met a teacher who would pass a bunch of underperforming students on because she had to follow a schedule and please the administration. There are a lot of flaws in our education system, but I don't think overloaded teachers trying to get everyone in their class on meds and social promotion is what we ought to be looking at.

Besides, why would you want a whole classroom full of kids on speed? Adderall works to get the brain's attentiveness levels up to baseline. In ADHD kids, this means calming down and focusing. If you have a kid with normal attention, what will the meds do? Crank them up. That seems counterproductive.
posted by Biblio at 1:40 PM on October 17, 2013 [3 favorites]

anastasiav: "can you talk a little about what your background is? Because the vast majority of children I know with an ADHD diagnosis come from families that have none of these things. "

ADHD rates of diagnosis are so much higher in impoverished schools than in wealthy schools that my state actually tracks it (and several other defined disabilities of various sorts) and you get notified if the rates at one of your schools is dramatically out of line with statewide population. It is a known problem that children are labeled "special ed" in impoverished schools at higher rates than in wealthy schools; there are a variety of reasons for this, including: the ability of wealthy parents to provide supports for "low-level" disabilities without involving the school; the cultural difference between middle-class teachers and poor students that leads those teachers to see certain behaviors of the poor students as signs of a disability when in fact it's a cultural difference; greater exposure to lead paint and other neurotoxins in poor neighborhoods; nutritional differences; different access to specialists who can provide a "better" diagnosis; etc.

I am not a public health person so I can't tell you what the rate "should" be. But as a school official, we expect to see a certain amount of difference in disability rates between wealthy and poor students due to neurotoxin exposure (my county has the highest rate of lead exposure in the country, so children in unremediated housing stock get a LOT of exposure), nutritional deficiencies, and the greater home and family instability that children in poverty usually experience, which can cause permanent damage. But we also know there is a diagnosis problem, where black boys in poverty are something like five times as likely to be diagnosed with a disability as white middle-class boys, and we have to watch and track that and if there's an unexplained cluster, we work both with the health department and with our internal structure, to see whether this is a public health issue or whether this is a racism/classism issue. Do you have a teacher who's just sending every rambunctuous boy to the office repeatedly and recommending an evaluation? An evaluator who finds ADHD in every child she examines? That kind of thing happens, people are human, sometimes they make mistakes, and sometimes they suck, and sometimes all they have is a hammer so every problem is a nail.

But yeah, something like 9% of students have ever been diagnosed with ADHD, but among children below the poverty line the rate is around 11%. That might be a difference we expect to see if there's an environmental component to ADHD, but it might also be a sign that cultural factors and expectations and classism play a role in some diagnoses.
posted by Eyebrows McGee at 2:24 PM on October 17, 2013 [7 favorites]

My take: I'm not convinced about ADHD, but I am convinced that the Germanic school system is precisely the least-useful place to install young, developing minds for 12 years. Little wonder kids haven't been paying attention for centuries - the whole thing is just boring as hell.
posted by turbid dahlia at 4:16 PM on October 17, 2013 [1 favorite]

....From parents' and teachers' perspectives, the diagnosis is considered a success if the medication improves kids’ ability to perform on tests and calms them down enough so that they’re not a distraction to others. (In some school districts, an A.D.H.D. diagnosis also results in that child’s test score being removed from the school’s official average.) Writ large, Hinshaw says, these incentives conspire to boost the diagnosis of the disorder, regardless of its biological prevalence.

Talk about a giant leap. It is equally plausible that more frequent/higher stakes testing uncovers more kids with ADHD who would have otherwise gone undiagnosed because even today the symptoms are not well understood outside of certain circles.

nubs: "As I recall, their environmental concerns have more to do with exposure to heavy amounts of electronic entertainment than with parental attachment."

Again, symptom rather than cause. You don't notice that your kid has ADHD when they're outside all the time because they're either gone or dead tired. Only when they're at home where you actually notice that they have the TV on while they're texting their friend and reading a blog and putting together a puzzle.

Too much exposure to tabbed browsers, for example, doesn't cause ADHD behavior, it enables it. Back before computers multitasked, you wouldn't have known I was ADHD if you only saw me in front of a computer. It enforced a single stream of activity with few context switches by its very design, thus masking the condition in that particular circumstance. Now, I can have 130 tabs open in Firefox and another 75 open in Chrome and you can watch me flit back and forth as my attention wanders. It's gone from actively suppressing the symptoms to actively enabling them. It's no wonder that it would be more recognized when there is more opportunity to observe it in today's world.
posted by wierdo at 6:21 PM on October 17, 2013 [4 favorites]

Renoroc: "I am not in denial about the existence of ADHD, I just think it is way over-diagnosed nowadays. I'd get multiple opinions before I ever let my kid(s) get that diagnosis."

Quick question: how many opinions would you insist on getting if a doctor told you your child had diabetes?
posted by Deathalicious at 12:43 AM on October 18, 2013

Diagnosing diabetes is a lot easier than diagnosing disorders of the brain.
posted by Justinian at 1:10 AM on October 18, 2013 [2 favorites]

My feelpinion, worthless and controversial as it is, is that human civilization has survived, flourished, done amazing things, brought us up to this point, without having been impacted by the seriously high percentage of the population whom statistics tell us have this affliction. That doesn't mean it's not real. That doesn't mean the experiences of people with the affliction are not real. But either numbers have skyrocketed due to an external cause that should really be the focus of our attention, or survival and progress and happiness has been possible despite it.

I've got a lot of things going on. I've been diagnosed officially with depression and anxiety, unofficially (ie. by a counsellor) with Aspergers. Based on a superficial self-analysis of my behaviour, ADD or ADHD are probably up there in my psyche as well. But point me to a fucking "normal" person, amongst all of us, amongst the whole of humanity. Good luck. If everyone is abnormal, maybe perspectives need readjusting.
posted by Jimbob at 1:21 AM on October 18, 2013

Now, I can have 130 tabs open in Firefox and another 75 open in Chrome and you can watch me flit back and forth as my attention wanders. It's gone from actively suppressing the symptoms to actively enabling them.

Does this actually negatively impact you in any way? Does it actually matter? I get stressed when I've got more than 6 tabs open. Maybe I'm OCD or something, better head off for some meds.
posted by Jimbob at 1:23 AM on October 18, 2013

Above, a birds linked to this video as a primer on ADHD, and I'm going to strongly second it. For anyone in this thread who genuinely and sincerely doesn't thing ADHD is a real thing, please take the time to watch it -- you'll learn a lot.
posted by davejay at 8:57 AM on October 18, 2013

actually it is useful even if you're very familiar with it, as a refresher
posted by davejay at 8:58 AM on October 18, 2013

wierdo: "Now, I can have 130 tabs open in Firefox and another 75 open in Chrome and you can watch me flit back and forth as my attention wanders. It's gone from actively suppressing the symptoms to actively enabling them."

Jimbob: "Does this actually negatively impact you in any way? Does it actually matter?"

Yes, the inability to stay focused on what one's supposed to be working on does actually negatively impact one and does actually matter. "I have a lot of browser tabs open" may sound trivial; "I have half a dozen books I'm actively reading at a time, partly because I can never find the one I intend to read and so start a new one; I haven't filed my tax return because when I try to find my receipts I get distracted by all the other stuff and the next thing I know it's four hours later; my partner thinks I don't care about them because while they're talking my attention keeps flitting off onto other things; and I'm not sure how I'm supposed to be taking this new medication my doctor prescribed because I was distracted while she told me verbally about it and the printed information the pharmacist gave me is around here somewhere, maybe in this pile of papers, under... ooh, here's that article I was looking for last week, now I can read it!" is not trivial.
posted by Lexica at 3:52 PM on October 18, 2013 [3 favorites]

ADHD runs in families. ADHD is also correlated to lower wager and higher incidents of bankruptcy. It seems we should expect that poor kids are more likely to have ADHD. The important thing IMO is do the children who receive medication experience improve quality of life and educational success vs. those who are diagnosed but not treated or treated with other therapies.
posted by humanfont at 4:10 PM on October 18, 2013

Jimbob, basically what Lexica said.
posted by wierdo at 4:38 PM on October 18, 2013

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