no single cause; 5.9% of youth & 2.5% of adults; safe & effective meds
July 28, 2021 3:33 AM   Subscribe

"The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder" is a scientific review of studies about attention-deficit hyperactivity disorder, published in the September 2021 issue of Neuroscience & Biobehavioral Reviews. (DOI link, full PDF, 30 pages, open access article licensed as CC-BY.) "Our aim is to provide current and accurate information about ADHD supported by a substantial and rigorous body of evidence." Findings start: "The syndrome we now call ADHD has been described in the medical literature since 1775."

The summary of findings includes:
  • People with ADHD often show impaired performance on psychological tests of brain functioning, but these tests cannot be used to diagnose ADHD.
  • Neuroimaging studies find small differences in the structure and functioning of the brain between people with and without ADHD. These differences cannot be used to diagnose ADHD.
  • ADHD is rarely caused by a single genetic or environmental risk factor but most cases of ADHD are caused by the combined effects of many genetic and environmental risks each having a very small effect.
  • The stimulant medications for ADHD are more effective than non-stimulant medications but are also more likely to be diverted, misused, and abused.
  • Non-medication treatments for ADHD are less effective than medication treatments for ADHD symptoms, but are frequently useful to help problems that remain after medication has been optimized.
The Discussion section includes:
Epidemiologic studies have taught us that ADHD occurs around the world, but we know little about how culture affects the expression of ADHD symptoms or the response to treatment. Because most research about ADHD is based on Caucasian and East Asian samples, we must be cautious in generalizing our assertions to other groups. In addition, far more research pertains to males than females. We also need to learn more about ADHD in older adults. Future research into ADHD should examine more diverse samples from a wider range of cultural contexts.
posted by brainwane (56 comments total) 69 users marked this as a favorite
 
[This may be a bit of a fraught discussion. Whether you have ADHD or not, please remember the MetaFilter community guidelines when you comment, such as speaking for yourself (not others), and being sensitive to context.

If you'd prefer a thread explicitly centering commenters with ADHD, and commenters who otherwise struggle with executive function, this one just started 2 days ago.]
posted by brainwane at 3:33 AM on July 28 [11 favorites]


I think they are underestimating the percentage of people affected. The gender and age statements are also concerning.
posted by interogative mood at 4:37 AM on July 28


Thanks for posting this, brainwane! Don't have time to check it out immediately but will definitely check it out and would never have found it otherwise.
posted by Bella Donna at 5:29 AM on July 28 [3 favorites]


I'm glad to see explicit expression of the very valid concern about possible cultural differences... so many times I read or listen on a topic in cognitive (or other) psych, and it sounds so global-north-centric in the most oblivious way.
posted by Sheydem-tants at 5:36 AM on July 28 [9 favorites]


ADHD occurs in 5.9 % of youth and 2.5 % of adults.

I am happy to see ADHD normalized, and not stigmatized, in the media. But I would also like to see far fewer throwaway comedy lines or invocations for dramatic effect.

Like, some days I really consider asking my doctor about an ADHD evaluation -- it's serious. And then a character on TV who is merely forgetful or distracted will say, "Oh, it's just that ADHD!" with a knowing grin, which makes light of it.

The line between acceptance and dismissal is not a clear one!
posted by wenestvedt at 6:11 AM on July 28 [9 favorites]


My partner and I talk about the social construction of psychiatry a lot, and it seems maybe a bit too coincidental that the first description of ADHD occurred around the same time that capitalism was being discussed in the Western milieu. It's either this year or the next when Adam Smith codified this into The Wealth of Nations.

Which isn't to say that ADHD / ADD doesn't exist. But rather the pathologizing of the cluster of symptoms we call ADHD / ADD and its subsequent treatment aligns so well with the idea of increasing production by the citizen masses:

"The man whose whole life is spent in performing a few simple operations, of which the effects are perhaps always the same, or very nearly the same, has no occasion to exert his understanding or to exercise his invention in finding out expedients for removing difficulties which never occur. He naturally loses, therefore, the habit of such exertion, and generally becomes as stupid and ignorant as it is possible for a human creature to become. The torpor of his mind renders him not only incapable of relishing or bearing a part in any rational conversation, but of conceiving any generous, noble, or tender sentiment, and consequently of forming any just judgement concerning many even of the ordinary duties of private life... But in every improved and civilised society, this is the state into which the labouring poor, that is, the great body of the people, must necessarily fall unless the government takes some pains to prevent it."

An Inquiry into the Nature and Causes of the Wealth of Nations
(1776), Adam Smith

Pair this with one of the results of this review, "[studies] of economic burden show that ADHD costs society hundreds of billions of dollars each year, worldwide" and there's a kind of explicit nod towards why we stigmatize and then subsequently pathologize human inclinations by institutional means if they don't accord to the values by which modern nation states organize themselves.

I wonder sometimes if the ideal of a 'renaissance' philosopher who delves into various fields and theories isn't just a kind of heroic-ideal of someone with ADHD/ADD whose various interests happened to align with what was valued by their society at that time or by descendant societies, and the vast majority of the human populace whose interests didn't "contribute" to a nation's GDP were stigmatized instead. And the modern evolution of that into a chronic illness may just be a practical, life-saving bandage for those whose behaviors are devalued to such an extent that society would rather they not survive by denying them access to healthcare (which costs $), food (which costs $), and so on. They are, after all, failing in their contract with the nation state who provides security and protection and rule of law in exchange for a productive, regularly reproducing citizenry whose (focused and efficient) labor is a precious resource.

Contrast this to a society in which basic needs like healthcare, food, housing, and so on are provided for. I imagine a society like that one might actually pathologize more behaviors as anti-social, like any of those that lead to completely unnecessary harm to others and society (eg the CEO/shareholder dynamic, pollution, greed, etc) and ADD/ADHD may be less a chronic illness and more just another phenotypical set of personality quirks for people who aren't viewed only for their (exploitable) productive capacity.
posted by paimapi at 7:35 AM on July 28 [71 favorites]


Very much what paimapi said!

Diverse ecosystems are healthier than monocrops, and neurodiversity is healthier than everyone trying to cram their brains into the same way of being.
posted by aniola at 8:03 AM on July 28 [7 favorites]


I do not think I have anything like this. But it's telling that I really only know about ADHD from various tropes and jokes in media and common parlance. It's a real condition but it's also something I'm almost completely ignorant about. I'm going to do some reading about it.
posted by SoberHighland at 8:11 AM on July 28 [4 favorites]


Diverse ecosystems are healthier than monocrops, and neurodiversity is healthier than everyone trying to cram their brains into the same way of being.

Agreed - at the same time, speaking as someone who has ADHD and struggled with it at times, I don't view my taking medication or working with strategies to manage it better to be me joining the monoculture. I'm still diverse, I still perceive things differently, there are strengths to it, but there are also deficits. Getting on medication has allowed me to actually start working towards some long-term goals I've had for my life, as opposed to just thrashing along as best I could. It's not just being neurodiverse, the deficits can cause real problems in all areas of life - relationships, and addictions (there are some unhealthy habits I had/still have that are the result of me just trying to self-medicate, but it's taken my years since my diagnosis to really recognize and address some of them - and my bad habits are very minor comparatively speaking).

The name is part of the problem, because it's not really Attention Deficit (I can hyperfocus with the best of them, on shit that really doesn't matter) - its a deficit in executive function, which includes things like planning and prioritizing, working memory, task initiation (which is a particular problem for me, but each person with it is different in terms of where those deficits are, along with respective strengths). It's really hard to function in any life if you can't get started on things you need to do, much less the things you want to do.
posted by nubs at 8:23 AM on July 28 [34 favorites]


It’s not usually thought of as a chronic illness, but I dig your post, paimapi.
posted by lokta at 8:39 AM on July 28 [2 favorites]


I adore this tweet from @mspowahs...
ADHD is the most poorly-named affliction ever. like hi do you have a profound physical inability to accomplish your goals specifically because they're your goals and also the thought of your friends not liking you makes you want to die? you may have Trouble Sitting Still Disorder
posted by lloquat at 8:56 AM on July 28 [63 favorites]


These are the kinds of accommodations one needs to make if one wishes to interact with the world. She would be understandably pissed off if someone came along and diagnosed her with Vertical Projection Deficit.

Agreed - I am near sighted and have astigmatism - my glasses are an accommodation so I can effectively function. As soon as the issues needing accommodation is related to our brains, however, a lot of labels get applied, not all of good, helpful, or useful. I just take exception to the use of the word "attention" in this case (leaving aside deficit for the moment), because it's about a lot more than that - "executive function" has helped me explain it better with family & friends.
posted by nubs at 9:18 AM on July 28 [2 favorites]


Certainly, I empathise hugely. I suspect we each have our own difficulties with a paradigm that is flawed almost beyond usefulness, after a lifetime of there being no way of even describing the situation at all. I feel a considerable fightiness that I try to suppress but that leeches out occasionally, and hope I didn't get any on you.
posted by Grangousier at 9:32 AM on July 28 [1 favorite]


Until society starts rewarding my renaissancical multifarious genius and/or capitalism is overthrown in favor of universal basic income and whatever else, I do need actual tools that enable me to live in the society & circumstances in which I find myself. Medication helps me do that. So does society at large recognizing the reality of, and refining its understanding of, ADHD.
posted by MiraK at 9:35 AM on July 28 [17 favorites]


Grangrousier - not at all - I think we are both very much in a similar place with the problematic concept of what this is, and finding different ways of working with/through it. I have what is working for me right now, and am hoping to share thoughts/experiences without trying to claim that my approach is the "way" and I hope I'm not coming across like that. I too have my days where I lose my patience with it all. Hugs and empathy!
posted by nubs at 10:11 AM on July 28


MiraK, as someone who is currently medicated and in search of therapy, the necessity of the tools that helps people survive is a concept that I'm acutely familiar with. But I think it's helpful to envision a better world for people like you and me because it helps us recognize the things that we as individuals, our social networks, and society-at-large need to understand in order to manifest such a reality.
posted by paimapi at 10:12 AM on July 28 [1 favorite]


Maybe it's covered in one of the studies within the lit review, but I was disappointed not to see any mention of dyscalculia and the overlap with ADHD, as they both involve working memory issues (and both can be difficult to diagnose in adults who have developed lots of coping mechanisms. Like meeee.)
posted by desuetude at 10:29 AM on July 28 [5 favorites]


have my first appointment today with someone who might eventually prescribe me meds for the first time after 30+ years of trying to get by with coping mechanisms alone

like on the one hand it would be great if there were a societal shift towards recognizing our unique gifts & normalizing accommodations for our difficulties

really really great

on the other hand... you know the thing where you're hungry but there's some kind of insurmountable complication in the logistics chain of feeding yourself so instead of eating you lie on the floor for several more hours continuing to be hungry? that is not a problem I want society to adapt to, that is a problem I want to stop having
posted by taquito sunrise at 11:14 AM on July 28 [36 favorites]


Which isn't to say that ADHD / ADD doesn't exist. But rather the pathologizing of the cluster of symptoms we call ADHD / ADD and its subsequent treatment aligns so well with the idea of increasing production by the citizen masses:

As someone who was diagnosed with ADHD as a child, and then told I didn't need anything because "it's not a problem for girls", and then diagnosed again in grad school, I've been seeing the current ADHD boom and it reminds me of how 1950s housewives took Miltown when the real problem was their shitty husbands and the patriarchy. Maybe the real problem is shitty jobs and capitalism.

I mean, Pre-Ritalin Grandma looks like me at work, but Ritalin doesn't solve the problem of how once you finish chopping the goddamned potatoes there are more potatoes and more potatoes and more potatoes after that and no one ever thanks you for the potatoes you did chop and it really wouldn't matter if they did and there are always still more potatoes and chopping potatoes is kind of pointless anyway because death is inevitable and time wipes everything away.
posted by betweenthebars at 11:43 AM on July 28 [21 favorites]


Just dropping in to reinforce that ADHD is often associated with anxiety and depression. I've been diagnosed with ADHD since childhood, and grappling with the other two since COVID. This is the most intersectional I've ever been.
posted by TheHuntForBlueMonday at 11:45 AM on July 28 [11 favorites]


some kind of insurmountable complication in the logistics chain of feeding yourself so instead of eating you lie on the floor for several more hours continuing to be hungry

OMG yes this. Earlier today I spent several hours (several. hours.) at my desk clicking around in an infinite paradox/loop of "can't get coffee because no clean mugs" and "can't do dishes because must start working" and "can't start working because no coffee" (and hidden under that, "bad mother because no clean cups" and "your ex-husband was right to call you useless at life").

Of course the real problem was "forgot to take meds after I woke up" but it took me several. hours. to figure that out and fix it, y'all. FUCK.

This is the sort of routine everyday experience that makes me look askance at folks who try to "normalize" ADHD. This is a disability! It shouldn't be considered normal and acceptable for anyone to live like this. We aren't going to become happier by accepting the fact that yes, we must continue to expect to lose many hours of our day to utter bullshit that takes two seconds to solve for someone who doesn't have this disability. This is not a societal issue. This is a problem in our brain function. Emphasis on problem! Emphasis on our! Emphasis on brain function! It IS a deficit, god damnit. It's not shaming anyone to call this a deficit because it's not shameful to lack normal functioning in any part of our mind or body.

> but Ritalin doesn't solve the problem of how once you finish chopping the goddamned potatoes there are more potatoes and more potatoes and more potatoes after that and no one ever thanks you for the potatoes you did chop and it really wouldn't matter if they did and there are always still more potatoes and chopping potatoes is kind of pointless anyway because death is inevitable and time wipes everything away.

This is confusing because AFAIK nobody has ever diagnosed ADHD by the criterion of "do you feel pissed off about how nobody ever thanks you for chopping potatoes?" and nobody has ever claimed that Ritalin makes other people thank you for it. ADHD is real. ADHD itself is not a problem originating in society. It's a brain problem inside oneself. It can coexist with other societal problems but that doesn't mean ADHD is itself the societal problem.
posted by MiraK at 11:50 AM on July 28 [39 favorites]


"The syndrome we now call ADHD has been described in the medical literature since 1775."

That's pretty fascinating, but I wonder if it could be traced back further? For example, I've never tackled the entirety of Robert Burton's Anatomy of Melancholy, but I wouldn't be surprised if there's something like it in there.
posted by Saxon Kane at 11:51 AM on July 28


As someone who was diagnosed with ADHD as a child, and then told I didn't need anything because "it's not a problem for girls"

This is why I'm concerned that the consensus statement makes specific claims regarding how many women and adults are affected vs males and kids.

I also caution folks against assuming that these numbers are a ceiling and not a floor. I've seen in my own family that the moral panic around pills and over diagnosis has resulted in many relatives delaying seeking treatment. I've watched as they eventually overcome their fears (usually because their kids got diagnosed at insistence of teachers and they saw how effective the medication was), then suddenly they get tested, treated and its like OMFG if only I'd done this years ago.

Finally I think that it is wrong to equate this as something that is only a problem because of our modern, capitalist society. Those with ADHD, especially suffer higher rates of accidents when doing physical activities and tend to make decisions that have adverse long term consequences. These symptoms would have had adverse life consequences regardless of the era.
posted by interogative mood at 12:03 PM on July 28 [11 favorites]


some kind of insurmountable complication in the logistics chain of feeding yourself so instead of eating you lie on the floor for several more hours continuing to be hungry? that is not a problem I want society to adapt to, that is a problem I want to stop having

I have a chart for that.

But I absolutely want society to adapt to that. I want there to be fruit trees on every block. And nut trees. And wild garlic. And so on. And so forth. Feeding myself should be as simple as going for a walk, and saying "ooo, that looks tasty".
posted by aniola at 12:31 PM on July 28 [7 favorites]


society adapts, I stop having the problem
posted by aniola at 12:32 PM on July 28 [7 favorites]


and everyone else benefits, too
posted by aniola at 12:32 PM on July 28 [1 favorite]


But I absolutely want society to adapt to that. I want there to be fruit trees on every block. And nut trees. And wild garlic. And so on. And so forth. Feeding myself should be as simple as going for a walk, and saying "ooo, that looks tasty".

I like this and would appreciate this but if I can't get up & feed myself when there is plenty of food two rooms away in the kitchen a nut tree outside is not going to help

like society adapting far enough to help me would require a button I could push to send a volunteer to bring me a dinner to the floor I'm stuck on, & inevitably the button would be in the other room where I'd left it & therefore functionally as far away as the moon
posted by taquito sunrise at 1:48 PM on July 28 [21 favorites]


"This is not a societal issue. This is a problem in our brain function."

It's both things. People have all sorts of different abilities, and to a large extent the amount to which those functions/dis-functions cause problems in our lives are mediated by what kind of society we live in. I may only have the vaguest idea of what day or time it is, but it's our society that demands minute-precise scheduling and links the ability to attain the basic necessities of life to those schedules. And it's a societal narrative that says I'm lazy or inconsiderate or worthless* when I struggle with time-keeping.

Society creates the conditions that determine what human abilities are normative and the values that determine how people who are unable to conform to those norms are treated. (Including determining whether your dis-function is valid enough to get access to medical treatment.)

*this is not true, no person is worthless
posted by radiogreentea at 2:14 PM on July 28 [9 favorites]


I think that it is wrong to equate this as something that is only a problem because of our modern, capitalist society.

QFT!

Until society starts rewarding my renaissancical multifarious genius and/or capitalism is overthrown in favor of universal basic income and whatever else, I do need actual tools that enable me to live in the society & circumstances in which I find myself.

QFT also!

I like this and would appreciate this but if I can't get up & feed myself when there is plenty of food two rooms away in the kitchen a nut tree outside is not going to help

QFT some more!

I mean, obviously, yes, we should all do what we can to improve our environment (social and physical), because ADHD is a lot like asthma/Type II diabetes/depression/polycystic ovarian syndrome. Yes, prevalence is going up, let's look at our surroundings. Is greed at the root of the pollution that affects poor kids more than rich kids? (Duh!) Is it a coincidence that richer ZIP codes have fewer diabetics, better access to healthy food, and fewer for-profit dialysis clinics? (Hell no!)

But that investigation is going to be complicated and in the meantime, people still need help. "Just fix the system!" has its heart in the right place, but people need antidepressants, albuterol, insulin, and birth control pills to keep functioning in the meantime. They need expert consultation as well.

ADHD is still treated like fake news by a lot of armchair experts; you wouldn't believe how many people I've met who fully acknowledge autism and depression as real, but proudly proclaim ADHD a fad diagnosis. Even actual experts have historically overlooked it in patients who were not white males. Incidentally, those patients are also the populations who are used to hearing that misogyny and racism aren't real issues because if we just got rid of capitalism all those other problems would resolve.

I mean, good lord, yes, the rat race hurts us in all sorts of ways. As a woman, I'm often expected to multi-task the world's problems on top of my own. As an ADHD patient, I'll give you three guesses how well that tends to work out. The first two guesses don't count.
posted by armeowda at 2:18 PM on July 28 [10 favorites]


Maybe the real problem is shitty jobs and capitalism.

Hahahahahah.

I suspect I might have AD(H?)D, but I have a lot of things worked out, coping strategies, knitting, etc. over the years to compensate. I don't really want to get diagnosed with anything where people tell me I have to take medication (I can't swallow pills for shit) and frankly, it's not really what I consider to be a problem if you let me handle things like I need to handle them. Which is to say, DON'T MAKE ME FUCKING SIT STILL AND STARE AT YOU FOR AN HOUR WITHOUT SOMETHING USEFUL TO DO, something my office has zero sympathy about. I've debated getting diagnosed so I could ask for accommodations of uh, some kind, but given the nature of my office, that's probably not a great idea on many levels. I also don't want to add that to the long list of black marks on my record already.

Though the rejection sensitive dysphoria does sound like A Thing. I've been given so much crap since age 5 or so that yeah, I got the issues with regards to being bitched out about how I interact with humans, friends who ghost, etc.
posted by jenfullmoon at 2:36 PM on July 28 [4 favorites]


society adapts, I stop having the problem

This is a ludicrous statement, and in addition it is invalidating years of work people have done to get ADHD recognized as a real health condition and real disability. ADHD is not like patriarchy or racism. It does not originate in society, therefore it is not solved by changing society. People with ADHD are not (or not only) "misunderstood geniuses" or "eccentric vagabonds" or "absent-minded professors" or whatever the fuck else - we also experience real deficits in the ways that our own brain works which result in real impediments to our ability to live our lives.

Even on our own without society ever factoring into the equation we experience these deficits. It's a health condition, like a headache. It's a disability, like chronic migraines. It doesn't stop being a problem when society adapts.
posted by MiraK at 2:44 PM on July 28 [26 favorites]


society adapts, I stop having the problem

Society adapting will not address the problem of me apparently being completely unable to move any project from the state of "here's an idea I'm excited about" to "I have made a thing happen".

I feel like this is a parallel conversation to ones that have been had and continue to be had in the autistic community. Yes, my life would be a lot easier if more people understood autism better. At the same time, better understanding won't do a thing in terms of helping me overcome autistic inertia and managing to shift from doing Thing A to doing Thing B, or helping me deal with my executive function having gone to shit due to pandemic/perimenopause/other factors.
posted by Lexica at 4:56 PM on July 28 [17 favorites]


I think we need to be a little careful in being quite so sure that if society just adapted in some vague but positive way, people with ADHD would be just fine and dandy without treatment.

In pre-capitalist agricultural societies, executive function was irrelevant for most people because they didn't get to do any deciding anyway, it was summer so everyone weeds for 12 hours a day.

What we've created is a society where exceptional executive function is highly rewarded and good executive function is required to do most jobs (in particular ones that are well paid). In that sense, sure, if we removed all the choices from people's lives we'd remove the disadvantage that people with ADHD have but I don't think that's what people mean when they blame society.

Let's say we all move to fully automated luxury space communism. Great, we all get conceptualise and work on our own projects (of whatever kind) all the time. Except that many people with ADHD won't be able to because, untreated, their condition will completely paralyse them.

There are conditions like anxiety and depression where there is a much stronger case to make that the peculiarities of modern society trigger them in susceptible people much more frequently than in the past but I just don't think that generalises to every other possible condition or trait.
posted by atrazine at 5:25 PM on July 28 [25 favorites]


This is a total just-so a friend and I came up with after reading about donkey racing, but we wonder if some neuroatypicality fitted well with working animals. Which seems like it would earn your share of subsistence agriculture.
posted by clew at 5:58 PM on July 28


misunderstood genius
eccentric vagabond
absent-minded professor

great with animals

Could you please not? There are plenty of people who work with animals who are still impaired by ADHD and other forms of neurodiversity.

Your very entertaining just-so story implies that ADHD is a made-up disorder that didn't exist in the good old days of subsistence farming, and also implies that people with ADHD or other neurodiversity would be miraculously cured of our impairment if only we would make more suitable lifestyle choices. It's insulting on top of being wrong, whether or not that's your intention.
posted by MiraK at 6:53 PM on July 28 [16 favorites]


I don't really want to get diagnosed with anything where people tell me I have to take medication (I can't swallow pills for shit)

jenfullmoon (or anyone else with similar apprehensions), FWIW there's at least one non-pill ADHD med: Daytrana Patch. I can't personally vouch for it, but like so many other things, I learned of its existence here on MetaFilter.

As always, thanks for posting, brainwane.
posted by Iris Gambol at 9:22 PM on July 28 [4 favorites]


Just want to say that I am very uncomfortable with the conversation about the social model of disability being shut down as attempted above. Very few conditions are equally disabling in all contexts, and if we aren't going to try to understand those contextual effects I'm not clear what else there would even be to understand.

In particular, as a variously neurodivergent person with an ADHD diagnosis, I am keenly aware of the ways my functioning is specifically impaired by the "attention economy" and the unprecedented resources that contemporary society devotes to capturing and misdirecting my limited attentional resources. (I am also keenly aware of the ways in which contemporary society makes some aspects of my condition way less disabling, for example by making it relatively feasible to make a living without needing to muster the executive function to leave the house or deal with any supernumerary humans.)

There are at least three distinct things in play here -- the underlying neurodivergence, the disability caused by that neurodivergence in a particular context, and the conceptual framework used to categorize ADHD as A Thing rather than many little things or a subset of a bigger thing. All of these, but especially the last two, are inseparable from historical context.

I don't have the resources to pursue this thought all the way, but could it be that the coincidence of modernish capitalism and a modernish idea of ADHD arising at similar times arises from a particular narrative of the self that took hold around this time, in which it began to make sense to speak of "attention" (mutatis mutandis) as a thing that selves have?
posted by Not A Thing at 10:41 PM on July 28 [18 favorites]


Very much agree with Not A Thing. Am in a position to have seen how different socio-economic settings affect the same people in radically different ways, and this is leaving aside radically different worldviews. Have experienced the same thing myself

I'm really uncomfortable with the way Metafilter seems to aggressively shut down every avenue for discussion that diverges from whatever the most forceful commenters decide should be the orthodoxy on any given topic.
posted by doggod at 3:29 AM on July 29 [7 favorites]


A friend of mine who isn't a mental health expert but who (like me) deals with ADHD and who (unlike me) writes regularly about gymnastics, wrote this excellent piece yesterday about ADHD and Simone Biles.
posted by Navelgazer at 4:33 AM on July 29 [2 favorites]


It's difficult not to react strongly to arguments that say ADHD is purely contextual and ADHD is not a deficit or a disorder at all. I don't regret arguing against them because these are damaging ideas.

Context is an integral part of understanding ADHD, of course it is, and I don't think anyone here has tried to shut down nuanced arguments about context which don't pretend that environment/society is the only context that matters. In particular, the reason why I personally react strongly to "it's a socially constructed problem!" is *because* of the context of ADHD being so recently recognized as the valid neurobiological condition that it is, and the context of such a large part of society still opposed to recognizing it as such.

So many people's lives have been made difficult by arguments that ADHD is fake and/or purely socially generated; it seems rather tone deaf for people who want to argue for context to ignore this aspect of the context.
posted by MiraK at 5:23 AM on July 29 [10 favorites]


We are all speaking from our own experiences, which are very likely as difficult as yours, if not more so. I, personally, have been dealing with this shit, by myself, for fifty years, which is quite possibly longer than you've been alive. It's just that we've come to different conclusions, and would like to be able to compare those different conclusions without being told we're bad people who are doing it wrong.
posted by Grangousier at 5:32 AM on July 29 [4 favorites]


It's just that we've come to different conclusions, and would like to be able to compare those different conclusions without being told we're bad people who are doing it wrong.

But the conclusion some of you seem to have come to IS that my conclusion is wrong. You're saying ADHD is 100% socially created & 100% socially resolved - which necessarily implies that neurobiological causes do not exist and need not be treated. YOURS is the view that doesn't make room for anything but your one & only chosen possibility of what ADHD is, what causes it, and what will cure it. If that is not your view then my disagreement is not with you.

I, personally, have been dealing with this shit, by myself, for fifty years, which is quite possibly longer than you've been alive.

This is uncalled for, jesus, how condescending can you get. If you can boast about your age, you can act it.
posted by MiraK at 6:30 AM on July 29 [7 favorites]


Mod note: Hi friends. Let's please keep the temperature in check here. There is room for both things to be true, that ADHD is a real brain thing with real effects and people can get treatment that helps, and also that some things about how society's organized make it more of an issue than it might be in other circumstances. People with ADHD can and do have both views, even holding both at the same time. This is supposed to be a place where we have have discussions that include nuance and not flatten everything to 100% right/wrong. Please don't get into attributing extreme positions to other people in the discussion which just ends up escalating needless fights; instead let's aim for a discussion where people speak for themselves and bear in mind people can have different views or different emphases and still have a respectful conversation.
posted by LobsterMitten (staff) at 6:43 AM on July 29 [15 favorites]


I think the problem here is that you have to use a lot of executive function skills when you're at work, when you're at school, and when you deal with society in general. And so it's easy and understandable to feel that society could be the cause of the problem. The reason a lot of us with ADHD get very angry when people try to ascribe societal causes to our disorder is that we have issues with emotional dysregulation. .. ok, sorry, yes, this is one of the (very annoying) symptoms of ADHD, but there's another reason, which I can only describe with an annecdote of how it feels to have ADHD

Have you ever been on a zoom call where the audio keeps cutting out and the video keeps stalling? How did the conversation you were trying to have go? Imagine every conversation you ever had was like that. I mean, you don't have to wait through the glitches because you don't notice them, but you do miss all of that content. Your friend thinks you don't want to talk to them, or you're bored, or you're just not interested in them. So you try harder to listen to them, but trying harder has no effect. Imagine trying to make and keep friends like this. This hurts. Over years this causes social anxiety and social avoidance. This has nothing to do with modern society, this is basic human interaction that's impaired. This isn't going to be a problem for your teacher or your boss. It is an enormous problem for you.

Ok I have one more example: In college, long before I had any clue I had ADHD, and before the internet was ubiquitous and before cell phones existed, I would try to go to the library to cut down on distractions so I could study (and I found the stuff I was studying interesting, and I had a lot of personal motivation to learn about my class materials). I would find myself reading the spines of the books, trying to guess what year they were written based on the typography, or maybe I would end up picking up the books and reading them, forgetting what I was at the library for. I would try sitting in a karel where I couldn't see any books, but my thoughts would involuntarily and imperceptibly shift to random ruminations and waste most of the time I had alotted to get work done. There was literally nothing but my own brain to distract me, but when you have ADHD your perpetually-bored brain is such an expert at distracting you it doesn't need twitter. Although, now that I have meds, I can read 5 posts on twitter and then actually close the tab and get back to whatever it was I was intending to do (at least on my good days), so, that's nice.

If we want to help people with ADHD, we would make it easier to find a good psychiatrist and cover healthcare costs for everyone, and we would educate more GPs on what ADHD actually is so they don't dismiss patients based on their own misconceptions. And, yeah, it would also help to end racism and poverty (if you're white and wealthy you're more likely to get help, if you're not you're more likely to be disciplined). But we should keep in mind that the reason these things would help is that they would get more people access to treatment. Because the treatment is what we really need.
posted by antinomia at 7:49 AM on July 29 [16 favorites]


I was diagnosed with ADHD two years ago, at 33. I'd always had a feeling that something was going on in my brain, but wasn't quite sure what. I'd been dealing with anxiety, forever, and had been diagnosed with it for at least eight years by that point. I'd looked up many mental health disorders online, trying to figure out what might be the one going on in my head. Several checklists pointed me toward ADHD, and it seemed plausible, so I set up appointments to try and figure out if it was the case.

The diagnosis changed my life. I had an answer. An actual, clinical term, with a definition that I could look up. There was research! There were reasons. It wasn't just me being the worst of all time.

I was tired of feeling like the smartest and the most stupid person in the room at the same time. It wrecked my self-esteem, and made me feel like I wasn't worthy of being a member of society.

I do take medication. It was a recommended treatment option, and I figured it was worth a try. It wasn't a magic cure-all. But I can absolutely tell that it does help me focus. It didn't cure my ADHD, but it made it easier for me to remember some of my other coping strategies and workarounds. I'm still me, but I can think more clearly. The hamster wheel moves a little more slowly.

Anyway, I'm still rambling, because of course I am. I recently discovered the YouTube channel, How to ADHD. The creator, Jessica McCabe, did a really excellent TED talk about her experiences with it. She talks quite a bit about the stigma surrounding ADHD and medication. She takes it, and it's helped her immensely.

Medication isn't for everyone with ADHD. However, it's really effective for many of us that have ADHD. It's another resource that I can use, a tool in my kit. I'm glad there are a lot of tools available for those of us with ADHD. There's a lot going on, and what works for some doesn't work for all.

But we're not faking it. Sometimes, meditation and mindfulness and planners aren't enough. We are worthy. We deserve the chance to explore all available treatment options. And, for the love of everything, we're not making it up.
posted by PearlRose at 7:59 AM on July 29 [13 favorites]


Oh man, thank you, Navelgazer, for Sarah Rasher's Simone Biles piece by . Every so often I go through a "but do I really have ADHD?" phase, but there were several spot-on descriptions in there that rang so true. And remembering that the days when I do do well are the days I take my meds first thing in the morning, right when I wake up.
posted by danhon at 1:36 PM on July 29 [2 favorites]


What is there for adhd if amphetamines no longer work? Amphetamines saved my life 25 years ago, but don't seem helpful anymore. They:

a) increase sexual thoughts in an unwanted way,
b) cause me to hyperfocus on things that are rarely significant / useful, which feels great at the time but not so much later,
c) cause anxiety if I forget to eat -- and since they suppress my appetite, I have to eat before I take them, and
d) don't quite fit in 24 hours (if I take them immediately when I get up I won't reliably sleep until 18-20 hours later.
posted by lastobelus at 1:47 PM on July 29 [4 favorites]


But the conclusion some of you seem to have come to IS that my conclusion is wrong. You're saying ADHD is 100% socially created & 100% socially resolved.

No, as far as I am concerned, that is not at all what I am saying (and what I understood others on this side of the debate to be saying, either).

What I would say is that there seems to be a strong, though perhaps unquantifiable, contribution to the severity of sympoms and to how problematic they are by a very wide range of environmental factors.

I grew up in a place with at least 3 concurrent socio-cultural models, with different economic frameworks, and then moved & lived in a 4th. In a couple of those, most of my challenges were utterly negligeable; while they were very hard to deal with in the 3rd and the 4th was virtually unliveable for me to the point where every 2-3 years I would come completely unravelled.

This is not just about race, or poverty, though obviously such stressors are more likely to contribute to all kinds of mental struggles; it's about radically different lives in their minutiae - how authoritarian your environment is, how arbitrary demands and rewards for all daily activities, how clock-bound you are expected to be, how much inherent structure your daily life contains vs arbitrary structures, how much community there is around you and if there is someone or several someones available to pick up your slack and vice versa (is your avilability taken advantage of when it is there within a framework of fairness and justice, so can you feel like you are giving as well as receiving when your chips are down - which can be quite often? In a society where you have nothing to give because everything is atomized, on the clock, and people get services for money there is much less given-and-take you can engage in, both giving and receiving), and so much more.

Two notes:

1. I think most people in this thread, on both side of this divide (or non-divide? I'm getting the feeling people talk as though the two positions in this debate are held much more fervently than they ruly are) have ADD/ ADHD - so it's not that those of us arguing for environmental contributions have the luxury of being neurotypical as opposed to the others.

2. This whole thread feels very ... American. Or maybe western? Not sure, but in my country for example, ADD/ ADHD doesn't exist diagnostically, and I reckon that there must be quite a few others where that is also the case. My country uses ICD-derived coding for billing, but diseases and conditions are included selectively in our standard, and ADD is not. There is some hope that ADD as well as CPTSD will be included in my country's standard with the ICD 11, but that is far from certain and even once it is, it will be decades before it will percolate down to providers and patients.

What this means is that there is no hope in hell that we will ever benefit from the pharma-solutions to this, and it is beyond upsetting to be constantly shut down by US contributors whenever other solutions are explored, or even if we just want to shoot the shit a bit mentally exploring other avenues. I'm happy you guys have found something that works for you, but there are millions around the world who never will, and as our lives have become increasingly Americanized over the decades, the frameworks we had in place - some of which made our lives infinitely more bearable - have vanished.

So I'd like some aknowledgement of the fact that not everybody lives in a rich country with what is ultimately rather good healthcare and accommodations, and those of us whose experience differs are still allowed to have conversations, try to find solutions that are workable for us, and maybe even daydream about scenarios where some of our issues might be easier to bear.
posted by doggod at 1:56 PM on July 29 [12 favorites]


That's really interesting, doggod, and I wonder if you'd be willing to speak more about:

> at least 3 concurrent socio-cultural models, with different economic frameworks, and then moved & lived in a 4th. In a couple of those, most of my challenges were utterly negligible; while they were very hard to deal with in the 3rd and the 4th was virtually unliveable

I'm curious about what types of differences in socio-economic models were so impactful to your experience.

-----------------

BTW I'm really sorry for coming across as if I am invalidating people's experience & interest in exploring a social model of disability. I fixated on one set of words (society adapts, problem solved!) and attributed that to everyone who was speaking of environmental factors. On reflection & reread my impression was wrong. We're all on the same page that it's both/and, not either/or. Sorry for misreading & misattributing.
posted by MiraK at 3:16 PM on July 29 [6 favorites]


MiraK, I don’t have the bandwidth to be disciplined & evidence-producing, so I’ll go with one somewhat woolly ramble, for want of a better word.

There’s a risk that all of this sounds too idyllic, and clearly there were tons of issues, but on the whole and with exceptions the systems worked quite well to smooth a lot of what now might stand out as glaring deficits and dampen even inner struggles some of the time (though there were other things leading to mental difficulties).

For one, even though I grew up in a town, the situation was very ‘it takes a village’ – and everybody was part of the village. Drawback – everyone was in each other’s business, and as a kid that’s often not what you want. But if you were out at -10 degrees Celsius without a hat because your parents didn’t notice and you didn’t think to bring one, there was bound to be someone to send you back indoors, or even give you one. If you got lost, someone would bring you home, you didn’t need to panic. If you ended up far from home at lunch time, you’d get fed somehow, somewhere. And when your RSD kicked in, there were enough people around you for one of them to notice, step in and sooth you.

We had many social connections as a family, and many people involved in each other’s lives, solving problems for each other, jumping in at a moment’s notice to help. etc. Didn’t have the energy/ mental bandwidth today to sort some food for yourself or the family? Good chance someone had some spare and you could pitch up there, and then return the favour another time when you were more on the ball. Didn’t know how to do something – or couldn’t do it? There were bound to be several people around who could help you/ do it for you, while you in turn would be called on to do something at some point for someone else, in a never-ending ring of reciprocity.

And there were so many ways in which you could be of service to others! Impromptu child minding, help, helping with cleaning, cooking, coming over for a chat, having someone over for a chat, mowing, gardening, fruit picking, pickle-making, offering a cup of coffe, procuring stuff, repairing stuff, teaching someone something, listening to their problems & giving advice, putting them up if they were in a pickle, if you had a car taking them places, helping with wine-pressing, etc, endlessly, provided these were mostly spontaneous and not too often too rigidly time-bound.

And everyone had quirks and weaknesses, you just planned around them.

In part, this set-up was due to some very specific socio-economic circumstances: the country was extremely poor, things were scarce, there was no entertainment beyond what you got from yourself and people around you (no tv, no internet, very few organized shows etc), the economy sucked so most jobs were quite rigidly 4-8 cause there wasn’t all that much to do anyway, and a lot of people were first or second generation urbanites with active links to village culture, which had much stronger inter-personal and generally social connections.

So for many of us, adults and kids, you experienced two different worlds in one day: the structured ‘public’ life at work/ school, (structured at least in terms of schedule), and the much more free-flowing time away from imposed schedules. Seeing what life is now for people with much more atomized lives that are planned out for 12, even 16 hours/ day starting at incredibly young ages, with a flood of rigid tasks, deadlines, demands and a fraction of the help that was so much more available in the community, I am surprised that we don’t all capitulate.

In addition to this, we spent a lot of time in the country (as children and adults). Life here seemed like it was from a different planet. Lots of off times, but with so much to grab your attention! Fantastic for entering into a sort of state of flow, drifting between working, daydreaming, socializing, playing as wildly as you will, seemingly in perfect accord (mostly) between yourself and the requirements of the world around you. Needed food? You often could literally pick something up from next to you. And when these more languid rhythms needed to be broken, the need was obvious and naturally emerged in the foreground of your mind – rain coming, the sun setting or rising, cockerels crowing, dog whining, cows coming home, chicken getting loud, the hay needing to be mown, weeds growing, etc. It all made sense and easily floated to your attention. You could easily hyperfocus on the useful and you had your reward with everything you accomplished, instantly. 12-hour days and more, with everybody pitching in - but at the end the hay was in, the lot was free of weeds, etc. It was incredibly hard and tough on the body and it made for a simple life, but in terms of mental equanimity it was pure luxury, provided that there was no additional hardship.

I’m not going into the many differences between cultural groups – I grew up in a place with many ethnic groups with quite distinct attitudes and behaviours around certain issues – for example, I was frequently uncomfortable when visiting friends from group x, which had much more rigid expectations for behaviour, scheduling, etc. But that turned out to be good training for the future 😊

What we have gained since then is a significantly higher standard of living in terms of goods and greater overall life expectancy because of advances in medical treatments. Including mental health – there were many challenges beyond those which come with ADD and primitive or even non-existent treatment options in many cases.

I experienced this mostly as a child, but also a good chunk as a (young) adult and for me it made a huge difference to the whole way in which I stand in the world. I’ll single out 2 things:

1. The fact that time was flexible. Time was, in fact, a different thing. Not something that hits you like a mallet 24 times a day – just something that flows, sometimes barely there, like you are living in infinity, sometimes bunching up and quickening, bringing with it excitement, action-readiness, adrenaline, in response to obvious external circumstances (nightfall, rain, sunshine, someone visiting). Most days had both kinds of time. This brings to mind Robert Sapolsky's Why Zebras don't have ulcers.

2. The fact that time chunking and demands more generally were not arbitrary and you were not alone to face them. At the end, there were rewards - and often the activity itself was inherently peasurable because it seemed to flow naturally. Even when it was hard.

I repeat that this is a somewhat rosy rendition of what was going on; there were a lot of other pressures that were not great for people’s mental health, some of them coming from the very closeness with others that was so beneficial in other ways. But for me the ADD experience specifically was somewhat different and I’d say easier to carry outside of places/ situations where expectations are extremely rigid.

There'd be much more to say, but this is quite rambly as it is.

BTW, MiraK, thank you for being so gracious!
posted by doggod at 4:34 PM on July 29 [31 favorites]


doggod, that is fascinating and accidentally gives me really good leads on understanding how I like to exist in my life, so thank you so much for taking the time to put all those thoughts together.
posted by lauranesson at 5:55 PM on July 29 [1 favorite]


doggod, i find resonances in your experiences. What little time i had living with westerners was when my ADHD-ness even became something worth commenting. Thankfully i was already a full adult with working experience etc so it didn't do much on my self-esteem but it did lead me to reflect on the accommodations i had more naturally, when growing up, even when living away on my own in my own country compared to outside.
posted by cendawanita at 7:55 PM on July 29 [3 favorites]


My goodness. I think quite a lot of my WTF reaction can be explained by how utterly alien your experiences sound to me. I've never lived like that, doggod. I thought people who spoke of their childhoods or vacations this way were making it up (benignly, due to nostalgia goggles). Thank you for writing all of that out. We really don't know how half the world lives, do we?
posted by MiraK at 3:16 PM on July 30 [1 favorite]


I've got a 10 yo who's being investigated for possible ADHD, and these issues have been much on my mind lately. I would like to thank all of you for your thoughts and the various interesting links in the FPP and comments.
posted by Harald74 at 7:12 AM on July 31 [3 favorites]


doggod, thank you so much for such a vivid and thoughtful comment.
posted by umbú at 7:23 PM on August 6


doggod, flagged as fantastic.

While not minimizing the benefits of greater access to advanced medical care, you have made very, very clear how much you (= plural: you and the other humans who live in your country) have lost, as a culture in which time made room for people with ADD and other "quirks and weaknesses" yielded to Americanized ideas of time as "something that hits you like a mallet 24 times a day."

And I say this as a 56-year-old woman in the United States who was diagnosed with ADD 20 years ago.

I'm so used to my US peers' skepticism ("You don't have any attention problems! You love to sit and read!") that it's hard for me to rein in my defensiveness when someone else with ADD presents their framing of the experiences that they've had in an entirely different society. But your evocative word picture deserved, and received, more than a reflexive reaction from me. I will be thinking about it for a while.
posted by virago at 9:15 AM on August 7 [1 favorite]


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