If the authors life is not being impacted by his ADHD then he does not have ADHD. The clinical diagnosis for a mental illness is that it impacts your life in a negative way. His attention deficit does not impact his life in a negative way, therefore it’s not a disorder.
The author frankly does not know what he’s talking about. And, clinically, he does not have ADHD.
I have a mood disorder (NPSLE). I am on permanent disability and I have been hospitalized several times.
Even though I know my disorder comes with a gift, and rather unappreciated gift because I do consider myself neurodivergent, I also know at times I want to die at my own hands. And I also know it makes me unable to work.
I think the threshold for where we think some Neurotype is affecting our life has been lowered dramatically.
Please make your substantive points without crossing into personal attack. That's always important, but especially when the topic is as sensitive and emotional as this. Certainly you're welcome to share your own experience—that's important, and what you've said about it here is important. We just need it to come without swipes and putdowns towards others.
Edit: we've had to ask you before about breaking the HN guidelines (https://news.ycombinator.com/item?id=30570715). If you wouldn't mind reviewing them and sticking to the intended spirit of the site, we'd appreciate it.
The criteria specifies that
"There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning."
I don't see this as being the same thing as ADHD being a NEGATIVE. It's like saying that being short is a disorder because it interferes with picking fruit from tall trees, and being tall is a disorder because it interferes with your ability to be a jockey. While both of these are true, it's ultimately condescending to frame either of these as a "disorder" simply because both aspects negatively interfere with one lives in certain contexts.
The diagnostic criteria does not rule out that one can be an exceptional A+ student which still has their symptoms interfere with school functioning if they're for instance repeatedly sent to the principals office for disrupting classes. Simply the very fact they have an issue that other children typically do not typically have, wipes away all consideration of their positive merits, and justifies a rather insulting label. To me, this is reflective of the typical feeling superior to those who are atypical.
>I think the threshold for where we think some Neurotype is affecting our life has been lowered dramatically.
Undoubtedly, but this doesn't in itself justify not lowering the threshold.
"There's too many kids being diagnosed with ADHD."
Um, just maybe those kids would really like to not be made to feel absolutely worthless in life because they have struggles with their attention that was previously written off as them being naughty or not trying hard enough?
Don't get me started on what a horrendous environment a school can be to someone who might just operate a little bit differently.
Being short can be a disorder. It just so happens that picking fruit from tall trees by itself isn't considered by society to be a very necessary & important activity, while "social, school, or work functioning" is. Adults who remain too short to do things that are considered necessary & important for adults to do would almost certainly have a negative disorder of some kind.
That criteria sentence from the CDC website is overly broad. If you watch more technical talks [1] on ADHD they go into much more detail about what ADHD is exactly and why it affects almost everything very severely (it has a specific impact on executive function, which cuts across a lot of behavior). It's not just a wishy washy way of describing a category of dysfunction.
If the DSM-V definition is overly broad, and the truth behind ADHD is different, is that not fairly alarming?
Currently 9.4% of children are diagnosed with ADHD[1], but we don't diagnose 9.4% of the population as having a disorder on merit of being very tall or very short. In fact, with ADHD, we're also not also counting the opposite of ADHD as a disability, so we're counting a HUGE swathe of the lower end of the spectrum as being disabled. I don't disagree the reason ADHD is considered so serious is cultural, but I find the culture to be incredibly condescending.
For context, Russell A Barkley has been a paid consultant for a large number of pharmaceutical companies. He takes the position that ADHD is akin to a physical handicap and Ritalin is akin to a wheelchair, espousing how incredibly treatable of a disorder ADHD is. I don't agree with him very much because I've found the wheelchair to have a surprising amount of side effects while not being entirely effective. It feels more like a wheelchair I sit in to please others which ruins my own health. I have watched all of Russell Barkley's videos, and took him seriously enough to try everything he advised (Which is a LOT and I had to fight with psychs to try some of it), and it didn't work. Overall, I've mostly found myself to be pretty successful without using any sort of pharmacological treatment, and thus I'm not very attached to the "ADHD as a disorder" narrative and honestly feel like it's mostly done me a disservice.
I also don't really feel it's something I have to accept due to it being scientific fact, as the sheer instability of ADHD diagnostic rates makes me sceptical scientists really have that firm of a grasp on the disorder, the differences in how people react to medication is pretty much completely unexplained by the current scientific theories, and the current scientific theories don't really explain that well why people without ADHD seem to have performance enhancing benefits from the drugs [2]. Which makes me wonder if we're "treating" ADHD, or if we're just letting people with ADHD dope while not allowing others to. To me, I suspect ADHD is an oversimplification of a more complex underlying reality, similar to IBS. I am much more keen on the "ADHD as as social construct" theory than I am on the "ADHD as a medical condition" theory.
Nearly half of US adults (age 20+) are estimated to have refractive errors in their vision [1], which would be a vision disorder. Other estimates I've found are even higher, with more than half of adults needing corrective eyewear. Is that swathe too huge for this demonstrably defective vision to be a disability? Is our society being condescending by inculcating the value of non-defective eyesight?
Not every disorder has a double-sided spectrum of behavior. What's the opposite of Bipolar?
I don't doubt that diagnosis is hard and error-prone, and I don't think any honest scientist claims they have firm explanations for every aspect of ADHD and its treatments. It's an ongoing field of research.
But 70 - 80% of children quickly show improvements in response to stimulant therapy very quickly. That's worth a try for such a debilitating condition that sees a third of its patients drop out of high school and 5 - 10% graduate college at all. ADHD's heritability is insanely high at ~80%. None of your tenuous data-free assertions really changes the good science that has been established. We're not talking about controversial stuff here like SSRIs that barely beats placebo. You're going to have to do more than poke at some gaps to twist ADHD into the wholly different "social construct" theory you have even less actual evidence for.
>But 70 - 80% of children quickly show improvements in response to stimulant therapy very quickly.
They also show improvements if they don't have diagnosed ADHD and take the drugs, as I've already cited. This says more about the drugs than the medical model of ADHD.
>That's worth a try for such a debilitating condition that sees a third of its patients drop out of high school and 5 - 10% graduate college at all.
I just don't see any reason why more and more students wouldn't take simulants so long as they can access them and tolerate them, which ought to push up standards, which ought to increase the pressure to use them. I'm generally supportive of stimulant use, but using drugs to pump grades is pretty much the LEAST compelling reason to take stimulants. I think stimulants are great to, help you cook meals, stay organized, keep your finances in order, things like that. begin with... academics.
I also don't fundamentally see low academic achievement as proving disorder. To me, I think the biggest reason something associated with low academic achievement is considered a disorder, is that the people who write the DSM and ICD are all academics, who see people with ADHD as their lessers.
Studies show that if you don't have ADHD, stimulants don't actually improve your school performance. This has been trialed, it does not beat placebo [1]. The very study you cited [2] shows that at best, there's some evidence it improves performance in rote memory tasks in patients without ADHD, not the complex memory usually needed for academic achievement (the study literature explicitly point this out, this is not just my own speculation). There's a significant difference between how it affects ADHD and non-ADHD patients.
Low academic achievement is a huge handicap in modern society whether you or psychologists like it or not.
And it's not just low academic achievement. Executive function impairment cuts across so many things. Expect huge elevated risks in teenage pregnancies, poverty & debt from financial mismanagement, divorces, inability to hold a job, violent conflict and arrests. Expect an overall life expectancy 13 - 20 years lower than the average.
Go ahead, thumb your nose at societal expectations, it won't change the measurably worse life outcomes experienced by those with ADHD. That's what makes it a disorder.
i don't understand any of the points you are trying to make. it's great you can cope, either you don't have ADHD or you found ways to deal with it, but others are not you. people with ADHD struggle greatly and in a diversity of ways. a lot of people can adapt and integrate in work/social life/school way better on medication, and studies have shown the concentration and focus have increased measured cognitive benefits.
people with ADHD have decreased function of neurotransmitter activity for dopamine and norepinephrine, which is proven. i don't doubt that the future of medication will be more controlled or targeted, as we understand more, but your idea that a lack of understanding means the drugs aren't appropriate, or that ADHD isn't a disorder is basically the same thing as saying "we don't know why people consciousness exists so why bother studying it".
i personally had issues since i was not medicated for quite a number of years, mostly social and behavioural. i never was unintelligent, just had a lot of trouble focusing on tasks, prioritising, and having things in order. the pandemic and work-from-home were very hard for me, and taking stimulants again has literally opened my eyes and removed the fog of inaction. in just a few weeks i've seen huge improvements in my mood, happiness, work effectiveness, and focus, as well as thoughtfulness in conversation.
not everyone responds well to drugs, and people can cope in various ways at varying times, but that doesn't mean we should throw decades of proven methods out the window and cancel the disorder entirely. if we were only hunter-gatherers maybe it wouldn't matter, but we quite literally live in a society that demands an exceeding amount of effort 100% of the time to be successful
I don't want to end the use of stimulant medications. Nor do I want to suggest there are not correlations between certain groups of people and those who benefit from drugs. Nor do I want to deny people have differences in neurotransmitter levels.
My issue is primarily with the jargon of calling such people "disordered". It's just such a crass and unnecessary subjective judgement. I reject the entire framing as an attack on my person and an insult to my face. Just because I can become hyper-smart by taking some drugs doesn't mean I'm disordered.
> The clinical diagnosis for a mental illness is that it impacts your life in a negative way. His attention deficit does not impact his life in a negative way, therefore it’s not a disorder.
In my experience, I noticed most the negative impacts caused by the disorder were actually due to how I was treated by others for the negative impact my disorder caused in their lives (real or perceived).
> The DSM-5 defines a mental disorder as a syndrome that causes significant disturbance in behavior, emotion, and cognition. These disorders are also usually accompanied by significant distress that affects a person's work, school, and social relationships.
I'm not sure there's a contradiction here. Tourette's seems like a clear example of a disorder that both represents an obvious disturbance in behavior and matters primarily because of how others react.
> causes significant disturbance in behavior, emotion, and cognition
According to other people.
What if I think my behavior or emotions are appropriate or justified? The people that are not like me get to tell me how I should be? Seems kind of sick to me. What about the opposite? Are the people that lack disturbances in behavior, emotion, and cognition really that much better off? Regardless, they are definitely accepted easier (assuming they have no other divergent issues causing them to not fit the mold).
To me, it seems like ADHD is basically a diagnosis in which one lacks the proper neurological components of being a good little worker-drone in a capitalistic machine.
Can't focus? Can't sit still for 8 hours straight? Take longer to complete tasks? That's no good. Take these pills, shut up, sit still, and produce! Who cares about the longterm effects of taking amphetamines everyday. It's not /their/ problem, it's /my problem/. I mean, that is all us dairy cows are good for right? And what good is a dairy cow that produces no milk?
So that might be the cynical motivation that some people have to care, but at its core ADHD makes it harder for someone to choose what to focus on, and that's quite objectively a bad feature.
> To me, it seems like ADHD is basically a diagnosis in which one lacks the proper neurological components of being a good little worker-drone in a capitalistic machine.
No, this is dumb. ADHD doesn't affect work exclusively, it affects your entire life equally and prevents you from having fun, starting a family, cleaning your house. Actually, your work is probably the last to go as you spend the most effort on it.
> Who cares about the longterm effects of taking amphetamines everyday.
We know them; they're positive. It's neuroprotective and it reduces the chance of abusing other drugs (like alcohol) quite a lot. At most you want to make sure to get magnesium in your diet to prevent tolerance.
I'll never know, but I have always been of the mentality that everyone has "something." Whether it has a diagnostic label or not. I guess, in a more terse sense -- life ain't easy for anyone.
"life is hard for everyone" for you means that we shouldn't give people mental health? if people have recognised diagnoses they are entirely entitled to treatment. whether it's "i can't sleep enough" to "i'm gay and feel like my relationship with my family has struggled" to "i have a fear of airplanes" to "i can't focus and sit still".
even if there is no true neurotypical brain, the fact is that an overwhelming number (hundreds of millions of people) don't ever question their mental state or life and have no problem doing ANYTHING they want. and then there are people who struggle and ask for help.
it's pretty demeaning to belittle mental conditions as "just something everyone has" tbh
By "something" I meant everyone has /something/ wrong with them to some degree i.e. no one is perfect and there is no such thing as normal. That 'something' could be mental or physical. If a person does not have something wrong at the moment, then time will eventually catch up.
Not to mention there are people that can have conditions to sub-clinical levels. One could technically have some of the criteria of a mental disorder without fully qualifying for a diagnosis. That doesn't mean they live life on easy mode just because they do not carry a diagnosis. Sure, they might have a /easier/ time in life, but I have never been one to think of suffering as some competition amongst others.
I would gladly trade places with if you you honestly think this. I am homeless living with a mood disorder caused by an Autoimmune condition (Neuropsychiatric Lupus) that was misdiagnosed as Schizoaffective Bipolar Disorder for the last 30 years of my life. I cannot work.
So I kind of understand how you came to have this point of view. Since anyone on the internet, and usually some of the most successful people, can put up a blog and complain about their very common phenotype to moan about how losing their gloves amounts to a disorder.
And any short amount of research on nutrition could probably fix their issue but instead they go to pharmaceuticals.
I am sorry to read about your situation and truly hope you are able to be in a better place as soon as possible.
I think being healthy in both mind and body is obviously advantageous compared to the alternatives, but I still don't think that life is easy for said people. Though, I suppose it would have to be looked at on an individual basis and not as a group.
One can be physically and mentally health and still be in abject poverty with no hope or way of getting out. One can also be healthy and on the lower distribution of intelligence. Having low enough intelligence is commonly coupled with certain disorders, but there is still a grey-area where you are still below average intelligence, but above any diagnostic criteria. I would argue that level of intelligence could cause many issues and disorder in one's life, and that their suffering isn't fake because there is no formal pathology to describe it.
Do said people suffer less than those with disorders? Perhaps, but I do not wish to view human suffering as some sort of competition. I think we should strive to help and to support all people when possible.
there are no longterm effects of amphetamine use at therapeutic dosages, that's fake news.
i hate capitalism as much as the next guy (i'm literally a socialist) but i still want to be successful, have healthy relationships, plan events in my life appropriately, and not let people down by inaction, forgetfulness, or social outbursts.
fwiw i'm hugely successful and was even without medication excelling in my field and have contributed to world-changing projects. but i still was frustrated about my utility, my actions in social situations, and the issues i had with executive dysfunction.
i don't fit any mold, and could give less than two shits about "fitting in" in the general sense, but i still want to create good works, build a career, and especially do things like raise a family and enjoy my time with others. and all of those things are domains where ADHD has an effect, and where medication helps.
i've been on-and-off medicated, and there is 100% a utility in it for some.
> there are no longterm effects of amphetamine use at therapeutic dosages, that's fake news.
Sure, I would agree they are not common, but that doesn't mean they do not exist. Not to mention we only know what we know, and we do not know what we do not know.
Other than potential cardiac and vascular issues, albeit rare, researchers are still debating whether the stimulant medications cause an increase in Parkinson's and Parkinson's-like disorders.
> there is 100% a utility in it for some.
Sure, I won't disagree. I still take mine, but it's more of a "it's better than nothing" but I question if the efficacy is as strong as many anecdotes report. Especially after longterm usage. I'll see if I can find the study, but it was some sort of meta-analysis and tracked various children-aged students across a 7 years or so long timespan. Based on the researchers' observations, the medications greatly improved the symptoms of the youth for the first year or so, but around the 7 year mark, the students were back to baseline levels symptoms.
I'm not sharing this to be the 'come all, end all' of the debate of medication intervention. I just remember being told and having read on numerous occasions that, "you gain a tolerance to the feeling of the medication, but not to the therapeutic effects" but I do not believe it. Tolerance is tolerance at least in my experience.
The expression of a disease or disorder is all that really matters. If he went into a doctors office today, instead of say 10 years ago, they would not diagnosed him with ADHD.
Unfortunately, it seems that “affected” is being taken at face value in the parent comment, and the nuances of the presence of the disorder are being ignored.
Yes, many individuals with ADHD can cope without medication and may go on to live good-enough lives that might be the envy of others. However, there may be a lot of potential being left on the table staying untreated.
So to say that someone clearly doesn’t have ADHD because they don’t have a rep of reckless driving tickets because of impulsivity lapses is a bit of a slap in the face for many who still do, but developed compensation strategies to some extent.
"The clinical diagnosis for a mental illness is that it impacts your life in a negative way."
While ADHD has a large part to play in causing mental illness, and is often misdiagnosed as bipolar, BPD, anxiety, etc, ADHD in itself it is not a mental illness, but a disability. I know this is somewhat a semantic debate, but it is important.
"If someone is managing their ADHD it doesn’t mean they don’t have it."
So someone who is managing their ADHD via medication doesn't have it? What about changing their occupation to one where intricate planning is no longer required of them, so they cease to be constantly failing?
Someone can have ADHD and have it impact their life to a much greater or lesser extent based purely on the life situation they are in.
ADHD is the result of physical differences in the brain. You could be managing as well as a neurotypical individual, but that doesn’t mean you’re no longer someone with ADHD.
You are born this way. Such as someone on the ASD spectrum.
The thing is that last D. A mental difference is not necessarily a disorder. That depends on severity and extrinsic factors.
E.g. there are cultures where punctuality is not really a thing. I'm not saying we don't gain many benefits from a culture of punctuality and reliability, or that one would necessarily want to live in one of these cultures. I'm just expanding on the author's point about extrinsic factors. Difference can often be a disorder, but difference is not equal to disorder.
That's like calling a malware infection a damaged hard drive. The way to fix them is at the same conceptual level you learned them from; we don't have offline brain editing tech.
It sure is not handled like one. If that is the case, then I find it odd that most people get treated by psychiatrist and not neurologist. Also, why are fMRI and other neurological scans not used to diagnosis the illness? It seems to be merely symptom based diagnostics coupled with psychological evaluations.
(I am not saying there are not structural neurological differences.)
Do you ever feel like they are just weird manifestations of the accumulations of various stressors in life? Perhaps, there is nothing /neurologically/ different -- at least not to a significant enough degree? What then?
I am not trying to be all woo-woo about this, but we live in a time where technology, and not just recent technology, has propelled us far further than we ready for?
I had trouble sitting still and learning in school, but I was able to fake it enough to learn quickly enough to make it through undiagnosed. However, I still caused various other problems i.e. class clown with good enough grades to not get in trouble. Still, I always found school to be tortuous and stressful (I still would if I had to go back).
However, I like to take a step back when things that bothered me like what I mentioned above start to creep back into my mind -- If I were born 100, 200, ... , 9900, 10000 years ago, how much disorder would I have likely faced? I wouldn't have had trouble focusing in classrooms when there were no classrooms for the below average to average person like myself. How would my life have been? Would I have been 'normal?' If so, then maybe... I'm 'normal,' now?
I cannot speak for mental disorders, but I hope my fellows can find peace. We didn't choose this system, and this system doesn't care about us, but when the sun goes down, the moon comes out. I feel like I have a duty to myself to enjoy life, normal or not, because really... It's not like anything life matters anyway.
First, I really hate when people downvote questions like this. It's just a question? It is inquiry! It should be applauded!
There is no doubt that stress plays a large role. Remember, it is nature AND nurture. I am more sensitive to the nurture aspect because of my genetics, and yes, I know my actual genetics.
I agree that the human condition is not capable of adapting to the quickness of technological changes, and this brings out more peoples genetic sensitivities. Even if you go back to the 1800 with the rise in transportation, It took my family away from an environment they were steeped in for a thousand years. All those genetic adaptations to the environment were suddenly faced with a brand new one.
Being on disability saved my life because it enabled me to live a life closer to my genetics. I was making bank as a network engineer at Cisco but I do not miss the money. For me, much of the neurological damage has been done as seen in brain scans, but I know I am not getting worse and I no longer need to be on medicine 24x7. I do have flare ups, but they are not continuous like they were in the past.
But probably the most important part you have left out is diet. Omega 3 is huge and for ADHD, probably Zinc and B6. But we have a system of sick care, not health care, so these things are never investigated, not even by those who are suffering with these disorders.
> There is no doubt that stress plays a large role. Remember, it is nature AND nurture.
I also should add, that I do not mean just mental stress, but other environmental stressors too. All I am going to say is that I find it odd that in my rural area in the Southeast, USA all of my childhood school friends (7 or so of us) that lived within say... a 3 mile radius of me all have or could meet the criteria for ADHD. Of course, it could be coincidental, but you never know.
> But probably the most important part you have left out is diet.
I could believe this to some degree. I have other health issues (autoimmune) that I think are impacted by diet, but I cannot place my finger on it exactly. Weather e.g. cold, dry air also as strong negative effect compared to more humid and hot summers. Though, I do not think that weather effects ADHD, for me at least.
My issue with supplements are that you have no idea what you are getting or what is in them. The only one I take is vitamin D, and I have taken things like fish oil in the past, but I never noticed any differences. Was the fish oil spoiled? Was it of good quality? Any harmful contaminants in the liquid? I have no idea, and I feel like it's basically just a game of trust, since none of the supplements are regulated in my country.
In my experience, I had an fMRI a year or so ago, and it was cheaper than the psychological evaluations I had to do almost a decade ago, fwiw. But that is just my anecdote. I am sure different health care systems, different counties, etc. impact this significantly.
And it sounds like you’re diagnosing someone based off a blog post.
By the way, don’t tell someone who is disabled and was hospitalized several times with a mood disorder that they’re gatekeeping a disorder. I can assure you, I know more than you do about mental illness, It’s genetics, and its environmental factors.
And how would what you're doing differ from "diagnosing someone based off a blog post"? You've decided they don't have it. Do you have information other than the blog post that allowed you to come to that conclusion?
Because he said he did not have it. Not me. He said he does not suffer from it. If he is not suffering from it why would one consider it to be a disorder?
"By the way, don’t tell someone who is disabled and was hospitalized several times with a mood disorder that they’re gatekeeping a disorder."
Why not?
I'm not saying it's what you're doing here, but it's quite common for sufferers of a particular condition to gatekeep their labels and online communities.
I do it myself!
Typical example: "Everyone is a little bit ADHD." Um, sure... but I can 99% guarantee it is being said in bad faith to discredit actual suffering. GTFO!
Actually, at times it makes me lack empathy and kindness for myself and then I try to die by my own hands.
What you see as a lack of kindness and empathy is a reaction to the disability porn that those of us who are struggling have to endure from the general population.
The author frankly does not know what he’s talking about. And, clinically, he does not have ADHD.
I have a mood disorder (NPSLE). I am on permanent disability and I have been hospitalized several times.
Even though I know my disorder comes with a gift, and rather unappreciated gift because I do consider myself neurodivergent, I also know at times I want to die at my own hands. And I also know it makes me unable to work.
I think the threshold for where we think some Neurotype is affecting our life has been lowered dramatically.