…and this is a 
Brain doping can be good for you
Category: Neurobiology
Posted on: July 28, 2007 11:33 AM, by PZ Myers
Shelley has a good post on the biology of ADHD—the lesson, once again, is that the mind is regulated by physical and chemical processes, and we're learning more and more about how seemingly nebulous, fuzzy, higher level functions of thought can be traced back to relatively simple material causes.
The basic story is that norepinephrine is the molecule behind ADHD, and that what the stimulants given to people do is increase the effective concentration of NE. I've never been a victim of ADHD — as a kid, I'd say I was more often characterized as being the extreme opposite of what we see in ADHD — but there's an interesting comment that stimulants like caffeine can also release more NE … and that coffee addicts may be self-medicating. I confess: I am a coffee addict. Maybe I've been making myself worse over the years. Of course, being on the other end of the attention spectrum isn't stigmatized like ADHD.
Coffee also doesn't bear the stigma of Ritalin. It's too bad; human beings have been willfully modifying their brain chemistry for millennia, and we really shouldn't treat the more precise pharmaceuticals of today like they're a cause for shame.
Comments
Given how addictive caffeine is, if it were introduced today, it would probably have a far greater stigma than Ritalin.
And that's a GOOD thing. Casual psychotropic use ought to carry a stigma.
Posted by: Caledonian | July 28, 2007 11:54 AM
Right on PZ. My son has ADHD - he is of the inattentive type who seems to be constantly wiggling. He has a hard time remembering what 2X3 is when he is off his medication but 15 minutes after taking his pill he can reel off all the muliplication tables. He does not like to take it, at least in part becasue people make jokes about it.
Nothing pisses me off more than parents of children who do not have this problem who judge the parents of those who do for giving them medication. The way we figure it he would be stigmatized far more for being a 12-year-old third grader which is where he would be stuck (in some subjects anyway). He makes the honor roll now and I think he would feel really really bad about himself if we did not give him the pill (as opposed to just mildly bad about himself).
Coffee does seem to work for him. We don't have him take the pill (concerta in his case)in the summer. We give him coffee if he is going to have to concentrate on something. A shot of espresso seems to do the trick! I don't think that the school gives out caffienated beverages but if they did we might even consider going that route.
I talked to a child psychologist and asked him what people with ADD did before medication and he said "drink lots of coffee." So there is a lot in what you say.
I am like you in that I think I have the opposite problem. I get hyperfocused on the task at hand to the point hwere I block out everything that is going on around me. Does that mean that I have an overabundance of NE? I actually have a hard time with coffee in that it makes me unbearably talkative and controlling. I try to avoid it.
Thanks for the post anyway.
Raindog
Posted by: raindog | July 28, 2007 11:55 AM
Raindog wrote:
I think the reason people judge parents who give their kids pills for such things is because often times the parents' initial answer is to just give them a pill. It's the American way. Just look at the amount of people on antidepression medication.The way I figure, we humans have been around for hundreds of thousands of years. Generally, our brain is working. Reworking our brain with pharmaceuticals doesn't achieve much, especially evolutionarily. Yes, there are cases where it's necessary, but it shouldn't be the first thing people run to. Work at it, educate yourself on nonpharmaceutical methods, and if nothing works, then depend on them. But don't rush to altering the body's chemistry out of pure convenience. That is why there's such a stigma.
It might be unfair to those parents who have exhausted every other option, but so goes life.
Posted by: Tom @Thoughtsic.com | July 28, 2007 12:02 PM
PZ, you drink Coffee? That is amazing!
Who ever thought that someone that writes 50,000 words a day, and sleep 2-3 hours a night, would be a coffee drinker?
Personally, I always suspected crack with an epinephrine chaser to be your drink of choice.
By the way, do you actually grind the beans, or do you just eat them directly out of the bag and wash them down with boiling water?
Posted by: Lago | July 28, 2007 12:03 PM
Constantly wriggling sounds more like the Hyperactive type.
Posted by: Monado | July 28, 2007 12:04 PM
I think part of the stigma comes from the solution being overused. Kids who have "stereotypical" ADHD really need help of multiple types, and certainly pharmaceutical help is needed. But kids who have lesser problems would benefit from trying other interventions, either as an alternative to drugs, or at least in addition to the drugs, and some families seem to view the drugs as an alternative to creating some structure for the kids.
It's like with learning disabilities, among other cognitive and emotional problems...a real problem for a small number of kids seems to expand to include many children who really are behaving normally, or responding to their environment. In a developmental psychology class I took, I was shocked when one of my fellow students described her niece as unable to sit through a movie at three because of her ADHD...that's normal behaviour for that age group, not worthy of being pathologized. Even if this little kid has other problems, you shouldn't expect a kid that age to have that attention span yet.
Posted by: Carolyn | July 28, 2007 12:56 PM
We've been consuming stimulants and psychotropics all that time. Given the prevalence of stimulant and drug use throughout history and across cultures, I think it's more likely that we're adapted to it.
Posted by: poke | July 28, 2007 12:59 PM
Coffee helps only a fraction of the way the Concerta or Ritalin does. It's like eating more broccoli for your vision problems. It's definitely better to just wear the glasses. And not taking it in the summer? Same argument. Why would you not wear your glasses in the summer? Don't you need to see all the time? ADHD affects people all the time. Yes, it's nice to do better in school but it's also nice to not forget stuff and be able to carry on conversations and direct your creativity and all the rest of it every day, even on weekends and during summer break.
Thanks, PZ, for the link.
Posted by: jim | July 28, 2007 1:07 PM
Yes indeed, ADHD another brilliant triumph for that wonderful designer deity. For more great design elements see: cancer, cystic fibrosis, hermaphrodism, and every genetic syndrome imaginable. It's just more proof of how beautifully DESIGNED we are. Now where did i put my damned Adderall?
Posted by: Jsn | July 28, 2007 1:10 PM
ah, Ritalin. once it was introduced in Britain, ADHD became a badge of honour, and the kids wouldn't take their damn meds... now ADHD is even more prevalent than ever. thank you, Yahweh, for another wonderful biological triumph (i hear ya, JSN).
Lepht
Posted by: Lepht | July 28, 2007 1:29 PM
Tom@thoughtistic said:
>Work at it, educate yourself on nonpharmaceutical >methods, and if nothing works, then depend on them. But >don't rush to altering the body's chemistry out of pure >convenience.
Tom, listen to yourself lecture those of us who have to deal with this problem. Do you not feel a tiny bit embarrassed? My guess is that you do not have a child with these problems and that you probably don't have children at all.
This is what really pisses me off. The assumption is that someone's kid has a bad day and then people rush off to get him doped up. It was SO not like that. We tried everything. I would urge you to assume that people have tried everything before resorting to medication rather than assuming them to be guilty until proven innocent.
My son finished kindergarten and could not remember the alphabet. Most kids have that down when they are 2 or 3. We went over it and over it. One day he would have it and then the next day he could not get past D. He stayed back in kindergarten and halfway through his second year he still could not remember it. We tried everything we could find, took him to specialists who misdiagnosed him and were looking at sending him to a special school. We repeated things over and over and over. We were strongly opposed to putting him on medication. Finally we relented when his teachers and our doctor urged us to try it. Well two days later it was really like someone had flicked a switch. It worked so well. He has a chance at a pretty normal life now.
Go read the post that PZ links to. I was interested, relieved but not that surprised that kids who take these stimulants are less likely to have drug and alcohol problems later in life than untreated kids. I would also guess that their self esteem is higher because they don't feel stupid and their parents have not been yelling at them for 15 years.
I implore all of you who claim to know better than people who have been through this to try to put yourselves in our shoes.
Who knows? As someone else posted, perhaps we received something similar to these drugs through plants that we ate in the distant past and that helped. Also, concentrating on schoolwork was not as important even 50 years ago as it is now.
Posted by: Raindog | July 28, 2007 1:29 PM
Hmmm, yet more evidence that I have some form of ADHD. (The biggest clue was a few weeks ago when I mentioned to my mom that a few people had said I probably had some form of it and her response was "And this is news?")
Posted by: MyaR | July 28, 2007 1:34 PM
You can turn this shit (genetic ADHD) on and off with good old fashioned CBT.
Posted by: John Danley | July 28, 2007 1:38 PM
And that's a GOOD thing. Casual psychotropic use ought to carry a stigma.
Why?
Posted by: Djur | July 28, 2007 1:51 PM
Raindog wrote:
Funny how people like you try to ream someone else claiming they're assuming and then go ahead and make a blatant assumption directly after that.I do have a child. And I grew up with possible mild Asperger's and/or mild Tourette's. The reason I'm not sure is because my parents didn't have me tested and instead relied on conventional wisdom. They made it work without pharmacology. It's largely unnecessary and is overprescribed out of nothing more than convenience.
Had you read my post you would have seen where I say quite clearly that there are cases when it's necessary, and that those parents are wrongly looked down upon. You needn't be defensive; I'm on your side here. I'm just giving a reason why society justifiably, in many cases but not all, looks down on parents who automatically dope up their kids.
Poke wrote:
That's true, but that doesn't make it right or what's best, either.Posted by: Tom @Thoughtsic.com | July 28, 2007 2:02 PM
With all the side effects and unknown interactions ("try this. made it worse? ok, try this one instead") I'm not sure it's reasonable to describe today's pharmaceuticals as all that 'precise,' even relative to historically self-medicated drugs like caffeiene, or, say, marijuana.
Posted by: Jake | July 28, 2007 2:18 PM
The way I figure, we humans have been around for hundreds of thousands of years. Generally, our brain is working. Reworking our brain with pharmaceuticals doesn't achieve much, especially evolutionarily. Yes, there are cases where it's necessary, but it shouldn't be the first thing people run to. Work at it, educate yourself on nonpharmaceutical methods, and if nothing works, then depend on them. But don't rush to altering the body's chemistry out of pure convenience.
As someone above comments, we also been altering our brain chemistry since time immemorial. In fact, some evidence seems to indicate that the desire for altering brain chemistry is right up there with the need for food. (Alcohol, nicotine, caffeine. I rest my case.)
Additionally, here in the 21st century most of us live in an environment which is vastly different than the one for which our bodies were evolved. Most importantly, we don't get as much sun and are disconnected from light and dark cycles. Both these things severely impact the brain's ability to regulate serotonin, a neurotransmitter vital to emotional and intellectual functions.
I suffered periodic bouts debilitating depression for years before science gave us selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors. Yeah, living something approaching a normal life is certainly convenient but the drug side effects, not so much. They're not as bad as clinical depression but they aren't something you undertake or endure casually. And then there's always the problem of dealing with ignorant yahoos like you.
I suggest you take your holier than thou cause I don't need drugs attitude and shove it.
Thanks.
MKK
Posted by: Mary Kay | July 28, 2007 2:20 PM
You did indeed say it; however, given the tone and phrasing of the rest of your post, it's quite plausible that Raindog did read it and simply interpreted it as analogous to the eponymous "I'm not a racist, but..."
Posted by: Azkyroth | July 28, 2007 2:57 PM
[I am not a neuroscientist, or a 'consumer' what the drug-funded advocacy organization has used to usurp the label of 'patient'.]
"Caffeine is a competitive adenosin receptor antagonist. Adenosin is a modulator of intracellular signalling that reduces cell excitability. In the central nervous system (CNS), adenosine inhibits the release of acetylcholine, gamma-aminobutyric acid (GABA), glutamate, dopamine, norepinoephrine, and serotonin." The D2 receptor of dopamine specifically. Caffeine also increases absorption of calcium ions into neurotransmitters.
There are 5 types of dopamine receptors and quite a variety of 5-HT receptors.
Caffeine was almost banned in Muslim countries. History is fun.
Khat is a very similar drug or seemed so to the people of earlier science. However, it's been a bad drug for some countries.
Antipsychotics that you're promoting often state "unknown mechanism" on rxlist.com despite the familiar balance-of-neurotransmitters spiels. Altering levels of serotonin and dopamine directly is a big deal. Serotonin and dopamine have a shunt for moderating each other's level as well as everything else. Most serotonin is found in the guts, not in the brain. Serotonin is used to regulate body temperature and limit physical exertion.
For some antipsychotics, over half of the patients get morbid obesity. Ever having morbid obesity once correlates with taking 6 years off your life. Yikes.
Do you read these comments? Hope I'm not wasting my time.
Then there's the self-aware angle, will there ever be a Ritalin 3.0 to replace the limbic system?
Go ahead, get rid of stigmas. I just don't buy your statement that today's pharms are superior to caffeine which is more popular than any other drug and which has been studied more than any other drug.
Posted by: s. taylor | July 28, 2007 3:43 PM
eh..
Meant to say that some health issues may not be from congenital conditions so much as environment unknown to the evolutionary environment of adaptation. Such as milled wheat, sugar, subsidized corn which has almost no vitamins, high temperature cooking which has AGEs, food ad libitum, fortified vitamins, 8+ hours of television daily, SSRIs causing bipolar disorders, that sort of thing.
For example, until recently caffeine withdrawal was not taken into account for clinical trials despite 90% of USA population using caffeine.
ok, enough bs for today.
Posted by: s. taylor | July 28, 2007 3:58 PM
Caffeine also increases absorption of calcium ions into *neurons*.
caffeinated spelling, oops.
Posted by: s. taylor | July 28, 2007 4:09 PM
ADHD is fairly common in my family. I'm pretty sure our Dad had it. He was an advertising copywriter and relied on heavy use of both caffeine and nicotine to make it through his work day.
Unfortunately heavy use of caffeine has been linked to prostate cancer. He died seven years ago after trying to control the growing pain from metastitised prostate cancer with massive doses of ibuprophen, destroying his kidneys. He also had emphysema, but his penchant for self-medicating instead of talking to a doctor was what finally ended things for him.
Posted by: Merle Insinga | July 28, 2007 4:45 PM
Casual psychotropic use ought to carry a stigma.
Why?
Posted by: Graculus | July 28, 2007 5:09 PM
A neurologist diagnosed me as having "residual AD(H)D" when I was in my early thirties. He told me that the "residual" label was a technical one; in practice, it was unnecessary to use it. He also told me that I had the variety of AD(H)D more commonly diagnosed in girls (--I'm male). In my case, I was prone more to daydreaming and losing focus than hyperactivity. I was put on Ritalin, which gave me a constant headache, then Wellbutrin, which left me mentally flat-lined, and then other drugs, none of which seemed to come without side effects worse than the ADD.
When I was growing up, there was no talk of ADD. I was simply considered a "bad student". Teachers told my parents I just needed to "try harder". My parents told me I needed to stop trying to be an artist and buckle down, get serious, deal with reality. I left high school early after passing the CHSPE in the top 2%. I went to college, where I also did poorly. I failed at just about everything. The only time I felt anywhere near "normal" (based on what others said that was) was when I drank lots and lots of coffee. I averaged twelve cups a day, and spent a lot of time hyper-focused on creative writing.
The neurologist told me that people who suffer from ADD find very strong stimuli (video games, roller coasters, new music, new relationships, sex, amphetamines) comforting because they create focus, and the brain of a person with ADD yearns for it. I totally understood what he meant. I wasted a few years of my life on amphetamines, trying to satisfy the craving.
The diagnosis was a long overdue vindication for me, but it was a victory worthy of Pyrrhus' name. I have had to learn how to work around my ADD. People in my life have had to learn to work around it, too. You can't talk with me very easily if a TV or stereo is on nearby, or if a loud car drives by, or if I'm trying to deal with some issue or situation. If I am writing or studying something, anything that badly distracts me will too often necessitate my having to start over with what I was doing.
I drink a fair amount of coffee every day (between seven and eleven espressos on weekdays), and I have learned how to deal with my ADD for the most part. I just wish that I'd been diagnosed many years ago. My life might have turned out a bit better, you know?
Posted by: Moody834 | July 28, 2007 5:20 PM
Thi seems to me to obscure the fact that adults can choose to drink coffee or take anti-depressants.
I don't see that kids have any choice when they get given ritalin because adults don't like certain aspects of their behaviour. Nor could they make a choice, informed or otherwise.
No matter how much we seem to want to pathologise acts like drinking coffee and to normalise taking pharmaceutical products, there is a big difference between drinking coffee and taking ritalin.
A student who took amphetamines to pass an exam would normally be considered to be 'cheating'. So, why is it not cheating, but boosting their self-esteem to give kids amphetamine-like drugs so that they do well at school?
Of course there are lots of children with brain chemistry problems that causes them to act in ways that adults don't like. However, there are also lots of children trying to expressing things that aren't acceptable to the adults around them.
As adults, we can terrify children, pressurise them to fit in with adult lives, subject them to our own mistakes, override their real needs without thinking. We then fail to interpret their inarticulate complaints and drug them into "normality."
Kids who take these stimulants are "less likely to have drug and alcohol problems in later life"? Ignoring the fact that taking daily amphetamine-style drugs might reasonably be considered a problem (imagine the uproar if kids bought them for themselves on the street) how much reliable evidence of this can there be? Have we been mass-medicating huge numbers of kids for the 40 or 50 years it would take to get evidence of this?
Posted by: heather | July 28, 2007 5:33 PM
Because most people are morons that will consider neither habitutation effects nor the consequences of constantly forcing their neural structures to reaccommodate external influences, that's why.
Posted by: Caledonian | July 28, 2007 6:04 PM
1) Hyperfocus is not necessarily "opposite" to ADHD, in fact it's a characteristic compensation. (Basically, it uses a different "circuit", which "sorta works, but....") Up through middle school, I would use this for reading -- I could read d-mn fast, but to get my attention you basically had to grab my shoulder and shake me. Over high school and later years, I learned to read in a less "closed-off" state, but I also lost some of the speed. (Still fast, though.)
2) Anyone who claims that nobody "really needs" medications either has never needed meds, or is afraid to admit they do.... Yeah, overdiagnosis and overmedication is currently a problem, but the parents typically have a lot to do with that -- they can always find a "willing" doctor if they shop around enough. Note that I say this despite my own horror story -- after the Ritalin quit working on me (around puberty, as usual) I was put on Thorazine for several years (and they lied about what the drug was). Of course, that was back in the 70's....
3) At this point, learning disorders (including ADD) are no longer medical mysteries. There are tests and checklists to diagnose them, and (in most cases) various treatments including CBT, OT, and meds. These days, doctors should be held responsible both for false diagnosis and for failure to diagnose.
4) Up to around puberty, stimulants work very well for ADHD, producing a dramatic "paradoxical effect" (calming down instead of getting hyper). (To the point where giving the kid a cup of coffee can often tell you the diagnosis!) After this point, the stimulants still help some with attention, but they do that for most people! The paradoxical response, however, becomes unreliable and often stops working altogether.
Posted by: David Harmon | July 28, 2007 6:48 PM
Oh. Good on you then.
Posted by: Djur | July 28, 2007 6:52 PM
I have ADD inatentive type that was diagnosed a couple of years ago. You can check yourself at a Web site called brainplace.com, which has a questionnaire that will give you a probability of having a condition. Answers to questionnaire have been callibrated against brain scans.
I am currently taking Concerta and Strattera and they do make a difference, but they're also fighting against the habits of a lifetime. They help me to remember what I'm supposed to be doing an not get sidetracked.
Posted by: Monado | July 28, 2007 6:52 PM
To me, the most amazing thing is that we engaged in such a massive pharmacological experiment on children with no real knowledge of whether these stimulant drugs were safe for the developing nervous system. Based upon what we now understand regarding the potential for excitotoxic damage to nerve cells, it would not be at all surprising if those kids were to start coming down with Parkinson's Disease or some form of dementia at age 30 or so. We've been using these drugs long enough that the first generation of kids to be medicated for ADHD are reaching the age where such diseases tend to crop up, and there's no evidence of any huge spike in neurological disease. So I think that we dodged that particular bullet. But we seem to have done so by sheer, dumb luck.
Posted by: trrll | July 28, 2007 7:05 PM
The paradoxical effect is common to all children. It cannot be used to diagnose ADHD.
Posted by: Caledonian | July 28, 2007 7:17 PM
This is where i get to have fun as a sociologist. I wonder if part of the reason why we have seen "increases" in ADHD over the past several decades isn't due to social factors beyond just attempts to regulate and control children's behaviors. We live in a world in which we are being visually stimulated far more than at any time in history, and we're asked to interpret more stimuli simultaneously. ADHD is functional in such an environment, but when placed in an environment without such a constant rush of stimuli, we get bored, fidgity, etc.....just a thought.
Posted by: MAJeff | July 28, 2007 7:27 PM
"constantly forcing their neural structures to reaccommodate external influences, that's why."
Oh, you mean learning?
God forbid.
Posted by: Jon H | July 28, 2007 9:06 PM
No, I mean neurotransmitter accommodation.
Posted by: Caledonian | July 28, 2007 9:10 PM
"ADHD is functional in such an environment, but when placed in an environment without such a constant rush of stimuli, we get bored, fidgity, etc....."
Perhaps, the problem is that all-singing, all-dancing curricula are a band-aid: many worthwhile endeavors (whether self-directed or teacher-directed) are not conducive to that treatment. And even if we revamped school systems to be based around the Nintendo, you certainly won't get that in the workplace.
Posted by: Jon H | July 28, 2007 9:18 PM
I had a long post all written ... and then lost it. But I have to chime in on this constant refrain of "kids today are overmedicated". The constant harping does not help those who are in need -- no one goes around with a forehead tatoo saying "I'm misdaiagnosed with ADHD and I'm taking meds" so it seems since the "common wisdom" is that overmedication is soooo severe that the default is taken as guilty until proven innocent. Also, I'm not convinced that the problem of overmedication is as bad as claimed. If some say that the conditions doesn't exist at all (and there are those that believe that) then all medication is "overmedication" and there are few, if any, that say we are undermedicating then the "concensus" is always going to be skewed towards the claim of overuse.
We do live in a different world from 99.99% of the previous hundred thousand years. So is it really suprising that we are in some ways maladapted to it? Is the increase in meds really just because of overmedication, or could it be making up for a prior underdiagnosis?
And for the Heathers of the world, worried about the lack of choice by children: do you really think that parents willfully overmedicate just because Jonny acts out a bit? Well, lets just say I deleted what I really wanted to say to you because, well, it was rude -- almost as rude as your own "I'm more concerned for your children that you are" attitude. I haven't met any parents of kids who've casually strolled into the doctor's office demanding Ritlian &co., rather we've stuggled for years before giving in and admitting that meds must play a part. Concern trolls and Scientologists... How's that for push back? Perhaps those of us who recoginize the need for using our powers as parents to give informed consent should take that up as a refrain: sure there are those out there who are legitimately concerned about overmedication, but the majority of those harping on it are wackos and scientologists. Would that improve the conversation? Because that's what it sounds like, in reverse, whenever this comes up and the concern trolls jump in with the "I'm not a racist, but..."-sounding arguments.
Posted by: a lurker | July 28, 2007 10:34 PM
I have ADHD (inattentive type) and was only diagnosed last year. I spent a lifetime being called a lazy underachiever, and it hurt me in so many ways. I couldn't process information and ended up either frozen, unable to start a task, or I'd wander off half-way through and forget about it altogether. I beat myself up, and "tried harder" over and over again. It was virtually impossible, a cycle of failure, winding up in depression and anxiety. After a year on meds, my life has improved 100%. I am a new person, someone who can accomplish not just major projects, but day to day living. You have no idea how good it feels to have a little confidence again.
ADHD is a real disorder, with real consequences. As someone said above, people with poor vision aren't constantly told to 'try harder' to see. Because it's a chemical disorder and therefore hidden from view, people seem to think that drugs are the lazy way out. They work, and they're not hurting me. Now that I can cope better, I started therapy to work on my ingrained habits. But without the drugs, I could go to therapy for 20 years and it wouldn't change a thing.
My beautiful 7-year old son almost certainly has the same type of ADHD that I do. He's not acting out in class, in fact he's one of the "quiet" ones. But he is inattentive and distractable to the point that other children think he is an oddball. Should I let him struggle through rejection by his peers, and the depression and low self-esteem that would inevitably follow? Or should I allow him the same level of focus that other children take for granted, by giving him meds? It's a tough decision to medicate a child, but I don't see how not medicating him would be better. It's something we'll probably do when he's a little older.
Posted by: Ali | July 29, 2007 3:05 AM
Raindog and a lurker,
I personally know two children that did not have any of the problems you describe in your children, but whose parents decided they had ADHD and found a doctor (the third doc they went to) willing to prescribe drug therapy. There really is a problem with some parents. However, I know three other children whose personal lives and school performance improved dramatically after being diagnosed and treated (combo drug and psychological treatment).
The bottom line is that there are always going to be a few people who abuse a particular type of therapy (look at pain medications). However, it is unwise to assume someone is doing so because the vast majority of people are not. Though I don't have children, I have noticed the huge amount of unsolicited advice and judgement even strangers heap upon parents. I think the assumption that people are turning to drugs first (or that your child's ADHD isn't real) is just another manifestation of the tendency of many people to think they know how to raise your children better than you do.
When someone starts to complain about the dependence of ADHD or ADD sufferers on drug therapy, I always ask them "Would you expect someone in pain to simply think it away?"
Posted by: Pygmy Loris | July 29, 2007 3:39 AM
Re a lurker
Are there any other social scientists or philosophers here who could explain some of the reasons why anecdotal evidence != evidence please.
Blimey, wacko, scientologist, racist even? :-D
For suggesting that doping kids to fit in to their environment may not always necessarily be a good thing?
For saying there's a difference between choosing to take drugs and having them thrust upon you?
Better start taking the meds and it will all make sense to me.
Oh, brave new world.......
Posted by: heather | July 29, 2007 8:10 AM
Thanks to Pygmy Loris for her insight. I have not personally met anyone who medicates their children against medical advice and without reason but I am sure that you are right. Again, I would urge people to assume that most parents just want to do what is best for their children. I would guess that a very small percentage go doctor shopping to find one who will give ritalin to kids who don't need it. I'll bet there is a higher percentage of parents whose kids who probably could benefit from ritalin but who choose not to medicate them because of the stigma. They may be committing their children to a lifetime of self-loathing and failure for no good reason.
As for Tom@thoughtastic,
You have a point that I did make an assumption about you that you might not have any children. I can't tell you the number of times that I have heard judgemental comments from childless people who think they know best. Your comments did reek of this sort of person. I am sensitive about it becuase we really did not and do not want to medicate our son. It's a terrible position to be in but I feel that given all the information we have that giving him the medication was the best thing to do.
As for heather who seems to think that taking ritalin is cheating I really don't know what to say. My son is still just a slightly above average student even with the concerta. It is really his only chance to have a normal life. Here is the money quote from the paper on the likelihood that kids who take ritalin are less likely to have drug and alcohol problems later in life:
"While the benefits of psychostimulant treatment for ADHD are clear, scientists are only beginning to explore how these medications help protect children with ADHD against later drug abuse. Two possible explanations have been proposed--one neurobiological and the other psychosocial. Stimulant medications might make drugs less desirable through direct neurobiological effects in the brain that reduce the pleasurable effect that drugs elicit. A second explanation is that the medications may reduce children's vulnerability by helping them act less impulsively, perform better in school, and relate better to others, thereby reducing negative feelings and the likelihood of joining socially deviant peer groups--psychosocial characteristics known to be risks for drug-taking. Possibly, both mechanisms contribute to reduced risk."
Posted by: Raindog | July 29, 2007 8:10 AM
Most people are credulous idiots. And just because something is medical advice doesn't mean it's good advice.
Posted by: Caledonian | July 29, 2007 8:37 AM
Because most people are morons that will consider neither habitutation effects nor the consequences of constantly forcing their neural structures to reaccommodate external influences, that's why.
- Caledonian
Fascinating, a real live solipsist.
Our entire existance is predicated on "habituating" and "reaccommodating".
Posted by: Graculus | July 29, 2007 9:43 AM
Caledonian, you never did respond to my request in the scientology is evil thread about what were the "filthy, fithy lies" and "comfortable fabrications" about mental disorders that " many medical professionals have embraced in an effort to get people to accept the treatments they offer.".
Let me interject here a bit of observation I've come across in my research. There are those out there that suffer from some of these problems (ADHD, etc) and have rejected medication. For whatever reasons - it was forced upon them and they resented it; the particular medication was wrong for them; whatever. And some of them strike back by putting forth the proposition that medication is wrong in all cases (or with the caveat that there may be a very few cases where it is warrented). Lots of this is just a way of justifying their own choices by tearing others down. Many claim to be proud of being different. If they are of age and choose freely I have no problem with their choice.
Heather, you and your ilk are the ones claiming that kids are being wildly overmedicated. I thought I was asking that you prove that your postive claim is true. To date all in this thread there are 1 anecdotal case (w/ claim of 2 kids) for and numerous cases against. Now, I do know that anecdote is not the singular of data, but I'm not the one wildly running around saying 'the meds are coming, the meds are coming'. We parents and/or sufferers get pretty damn tired of those of you out there that aren't really all that familiar with the situation stigmatizing us unfairly.
And how do we know that you aren't just a scientologist wacko in your concern troll attitude about "Oh, the poor little kids don't have a choice"? That implies that we parents aren't concerned about our kids and won't attempt to do the best for them and you get to move forward your anti-anti-psychotic agenda. Oh? You don't like the stigma of being labelled a wacko scientologist? Now imagine that being the default assumption about everyone who spoke up against any (neuro)medication of kids. That is the equivalent stigmatization that we get -- put yourself in our shoes and imagine that assumption we medicate simply because our child acts out a bit when in fact it is a last resort for a serious condition. We lived with the hyperness for years. But in a modern society you must succeed in school to make any gain in life -- it's just a fact. He's a bright kid (tested into the gifted-talented program at the same time that he was put into special ed for learning disabilities) but if he can't sit still and concentrate he'll never be able to make use of those abilities. Sorry, but your type creates a hostile environment for us. Yes, there probably are those that do medicate unnecessarily but why should that be the default assumption?
Heather, you've had numerous example of people here pointing out that "doping [them] to fit their environment" was a good thing. Now, sure there are borderline cases and cases that aren't cut-and-dried, but can't we just assume that in general those making the decision (individual, parents, doctors) are doing so in the best interest of the individual? You keep implying that the assumption should be the other way -- and I don't get the hostility. As other have pointed out we don't skip taking pain medication or getting glasses for those conditions. And work on the reading comprehension. I didn't claim the arguments were racist themselves ... but analogous to the common "I'm not a racist, but..." phrasing that often precedes a racist statement, i.e., "I'm not against medication in absolutely all cases, but..." and then proceeds to claim that it is wrong in general with no indication that there really are any justifiable cases.
Posted by: a lurker | July 29, 2007 10:30 AM
a lurker said:
I haven't met any parents of kids who've casually strolled into the doctor's office demanding Ritalin &co.
There are always counter-examples, but most of the parents I have encountered have given their children Ritalin only with reluctance. On the other hand, I have often seen teachers demanding that parents medicate their children, as well as friends and acquaintances of parents strongly recommending Ritalin for the children of others (and in almost all cases the parents doing the recommending had the naturally compliant kids themselves).
Posted by: Theo Bromine | July 29, 2007 10:31 AM
As for teachers and acquaintances ... yes, some give bad advice. But there are two other gatekeepers: the parents and the doctor. I think the barrier is relatively high. And in some cases it's true that they don't block bad input when they should. On the otherhand sometimes that advice is the right thing.
Oh, how I longed on occassion for a quiet, docile, naturally compliant child. Hell, even a marginally rambunctious child. To be able to take him to the park or social activities and have him play with the other kids without constant redirection and intervention. But we didn't rush out and have the doctor turn him into a zombie. And I don't think that we're the exception. Most parents of ADHD kids, by the time they turn to medication, don't want zombies they're looking for relief from the worst excesses and symptoms so that their children -- still at the extrema of acceptable behaviour of society -- can make meaningful forward motion in life.
Sorry all for the length and forcefulness of my posts. This topic tends to be a bit of a raw nerve..
Posted by: a lurker | July 29, 2007 10:56 AM
Laissez-faire approaches to societal issues? But that's so... conservative.
Posted by: Caledonian | July 29, 2007 12:09 PM
I find that arguments about AD(H)D tend to sound a lot like arguments by fundamental religionists against atheism or homosexuality. You know, pronouncements of absolutes by people who have no personal experience. Yeah, just like that.
Think a Mile in My Brain, guys and gals.
My brother and I both have ADD. So did my uncle and maternal grandmother. I'm a bit skeptical of "acquired ADD" because almost every other ADDer I know or have spoken with belongs to a family with ADD and/or other related problems. If you've gone through life with this wild and crazy brain, you know that one way or another, you need to adapt to Neurotypical environments and situations all the time. School is the first one, and your success or failure in this is a major determinant of your success or failure in life. Not only is the structure a bad fit with your thinking pattern, but you have endless opportunities to be rejected socially and have no idea why, to try and try and try and be called a failure, to spend hours more than everyone else doing the same things and be told you're not working hard enough. Unless they start making ADD schools, it's the ADD student who has to adapt. Someone whose ADD is milder might be able to manage his or her behavior enough to cope, but for some it simply isn't possible. Or wasn't, until now, with medications.
If you do manage to get through the school environment, you're faced with another challenge, the work environment. Some jobs are better suited to an ADD mind than others, but an ADDer who's been mentally all over the place except for the directed learning situation in school might have a terrible time finding or keeping even these, since it involves committing to a single thing - making one kind of product, focusing on a single skill, repeating a particular action - even if the environment itself changes enough to be stimulating. Plus, it involves a completely different skill set than what you may have found effective during school, and there are no teachers or psychologists giving you suggestions on the best way to get organized and stay focused. Some of us could make a lifelong career out of finding the best way to organize a file cabinet or supply closet, and that's nowhere near as funny as it sounds.
People who don't have ADD, or are not living with someone with ADD, don't have an inkling. Do you walk into a room and forget what you were there for? Do you lose your keys? Do you sometimes find yourself unable to concentrate because something else is on your mind? Sure you do. But I bet you can't imagine what it's like for this to be the way every single thing is in your life, every hour of every day. Stand in a room. Put a movie on the TV, turn on the radio, open up a book, get out the vacuum cleaner, and make some phone calls. Try to pay attention to all of them at once. It's only a tiny taste.
I spent over 40 years like this, edging gradually towards a depression that was almost suicidal, coping on antidepressants, but only just, mental chaos and clutter echoed constantly by my physical surroundings. Yeah, I could probably have managed to cope for the rest of my life, and deal with never feeling like I was ever good enough, smart enough, creative enough, or deserving enough. However, I finally started medications, and I can tell you first hand that regardless of side effects or potential failings, or any other negative thing you can say about them, you don't know how good they are. You have no idea.
I can see why kids would be less likely to abuse other "drugs", because when your brain is your enemy like this, you self-medicate. The stimulants help you calm down and focus. More of them, please. Alcohol makes you more energetic and gregarious, and when you drink enough you can blame your failings on the alcohol rather than yourself - plus, you fall asleep, which is a rare and wonderful thing. You try to find something that will either help you focus, or help you forget, because you are, after all, a sub-prime human being who's never tried hard enough or worked up to potential, which is why you're a failure! The stimulants for ADD, though, make it so you can think of one thing at a time. They make it so you can remember what you're supposed to remember. They make it so you can prioritize, and finish what you start before starting something new. They make it so that the opportunities for negative criticism from others and by yourself are minimized, and success breeds success. The need to self-medicate to overcome the thought obstacles and the negative self-image becomes less and less.
My understanding of AD(H)D is longstanding and personal. I've exhibited almost all the symptoms, have several of the comorbid conditions, and have gone through a whole lot of therapeutic approaches (and self-medicating approaches) before reaching the point now where I wish I had been this person I am for all those previous years. A child who genuinely has ADD might not be able to articulate as well the problems he has without medications, or the specific benefits he gains with them, but they're there. If the medications help him or her to avoid the frustration and misery that's almost inevitable during an unmedicated childhood and adolescence (and adulthood) then nobody should be denying him its benefits. Especially someone who has no clue what it's like to live with ADD.
Posted by: Alison | July 29, 2007 12:38 PM
Caledonian: "most people are morons". Actually, no, most people are of about average intelligence. They just appear to be morons to you because you are a genius. I am only a sub-genius. Do I at least appear average to you? Hoping for a good evaluation...
Posted by: Joe Bob | July 29, 2007 12:43 PM
"Do you walk into a room and forget what you were there for? Do you lose your keys? Do you sometimes find yourself unable to concentrate because something else is on your mind? Sure you do. But I bet you can't imagine what it's like for this to be the way every single thing is in your life, every hour of every day. Stand in a room. Put a movie on the TV, turn on the radio, open up a book, get out the vacuum cleaner, and make some phone calls. Try to pay attention to all of them at once. It's only a tiny taste.
sounds more like menopause to me.
Posted by: irmi | July 29, 2007 1:02 PM
Caledonian: Always ready with the quip but never the explanation. I'm still waiting for a response to my request for clarification in the scientology is evil thread about your claim of "filthy, fithy lies" and "comfortable fabrications" about mental disorders that "many medical professionals have embraced in an effort to get people to accept the treatments they offer." Feel free to put it here in this related thread.
Actually, I think I'm being quite liberal. I'm asking that we stop stigmatization and condemation -- generally, in my experience, conservative traits. I'm not arguing for a laissez-faire approach to medication with Ritalin next to the Tums in the corner pharmacy. There are regulations and roadblocks: doctors and parents. And the medications do come with severe warnings, so the assumption of casual use just seems so out of touch.
Again I have to ask why aren't these people equally agitated about giving kids glasses (just squint harder, you'll be able to see), or other medications (yup, that kid in my boy's cub scout den should give up his anti-inflamitories and just live with the arthritis -- he could do it if he only had some discipline)? I'm proposing the answer is that the majority of these people are scientologists. Okay, possibly not every one, there will be individual exceptions of course, but ... Prove me wrong. Of course, if you do, in your case, I'll just pass it off as one of those rare exceptions.
That last bit was only half in jest. But those with a bit of empathy should be able to envision what it's like residing in our shoes. Or is it something about the afflictions of the mind that brings out the woo-ness in people.
Gad, I hate getting it both coming and going. From the one side there's the "If your child was just more discipled then he'd be under control" (yes, I suppose I could beat him completely senseless...) and from the other it's "You're completely evil to medicate the child [without his consent]" (of course, in fact, we do have it -- he appreciates being able to control his impulsivity and not always being in trouble -- but you didn't know that when you condemned me, did you?).
Posted by: a lurker | July 29, 2007 1:03 PM
Exactly. Average intelligence = moron.
Have you ever spent much time looking at the decisions made by average people? Ever notice what reading level newspapers have to lower themselves to so a majority of people will understand them? Or for that matter, military training manuals?
lurker:
I've explained it in detail many times before.
Quick summary: we don't know what mental disorders are, we have no clear grounds for distinguishing between pathological and unusual-normal states, our treatments were found by trial-and-error, and they are not known to be corrective in any way - they were found to alter symptoms in a way we found useful.
Any suggestions or plain statements to the contrary, given our current state of knowledge, are not only false but easily known to be false, and are thus either examples of gross ignorance or filthy, filthy lies.
Any questions?
Posted by: Caledonian | July 29, 2007 1:19 PM
sounds more like menopause to me.
Yeah, that's how they diagnosed it when I was 6 years old.
Posted by: Alison | July 29, 2007 1:30 PM
Caledonian, so they can't conclusively test for it - along with plenty of other disorders and conditions. None of them exist, then? Trial and error have led to the discovery of drug treatments - if that's wrong, should we also discard all the other helpful off-label treatments of other meds? You'll have to deal with cancer doctors and patients then. I wouldn't go there. And I'd like to see a further definition of "Not known to be corrective in any way", because I'd say that no longer being suicidal, no longer unable to leave the house, going back to taking pleasure in things you enjoy when you were too miserable to move off the sofa are indeed evidence of antidepressants being corrective, and I'd say that being able to comprehend what you read, finish what you start, and concentrate despite distractions (when before you'd blank out while reading because you were thinking of several things simultaneously, consistently start new things as an alternative to finishing other things you'd started, and pay heed to each distraction as it arose) are evidence of corrective results for ADD. If you have not yet conclusively found the mechanism that causes the symptoms, that doesn't mean the symptoms don't exist or don't need to be corrected. If you found something that works but you still need to do more research to find out why, that doesn't mean it doesn't work. And just because it alters symptoms in a way that some people other than the patient might find "useful" doesn't mean that the alteration of symptoms isn't equally or even more useful to the patient.
The only statements that I've seen say "these are the symptoms" "these are the effects of these medications on people with these symptoms" "these are the test results on people before the medication was administered, these are the test results after medication". I haven't found any "gross ignorance or filthy, filthy lies" except from people who think that everyone with ADD is faking it.
Posted by: Alison | July 29, 2007 1:49 PM
Cal, no, you never put your objections it this clearly (and certainly not "in detail"; others brought up some of these issues (or were you doing a sock puppet thing that we were supposed to intuit was you?).
Yes I do have a question. Do you actually have any real examples of people claiming otherwise? Yes, we don't know what all mental disorders are ... but then again we don't know what all physical aliments are either. Some we have a better understanding than others and some we're still flailing around a bit in the dark, just like other ailments. Treatments for physical disorders are also often found by trial-and-error. Less so nowadays, and there is where mental health lags behind -- not entirely unexpectedly given the stigmatism and additional complexity. And not all treatments for physical disorders are known to be corrective -- they too "were found to alter symptoms in a way we found useful". On the basis of this lack of complete knowledge you seem to be implying that we should hold off on any attempts at treatment, spurn any and all medication ... for mental disorders. But apparently not physical ones.
Data point or anecdote: I've previously stated that our experience with psychiatrists wasn't of the "Hi. Here's some pills. Everything will be fine." sort. I think they all covered your basic points in fact. So, perhaps we just got the exceptions and every other medical professional out there is spewing the "filthy, filthy lies". But I doubt it. I suggest you find a different psychiatrist if that's what you were told. And if you don't think the doctor is doing right by you (or your child) then find another is something I'd suggest in all medical cases. But I doubt that it is the norm that doctors are so cavalier. Again, are there any reliable scientific studies showing that kids are overmedicated to such an extreme that one should assume by default that the vast majority of children on (neuro)medications shouldn't be?
Posted by: a lurker | July 29, 2007 1:55 PM
Caledonian: Average intelligence = moron... Ever notice what reading level newspapers have to lower themselves to so a majority of people will understand them?
Watch out, there's a common grammatical error there, often made by people of only average intelligence. Someone might mistake you for a moron. I know better, though.
Posted by: Joe Bob | July 29, 2007 2:01 PM
I've never claimed to be anything but.
I also tend to ignore the rules about splitting things - most of them were originally principles of Latin that stupid people tried to apply to English as well. I'm funny that way.
Posted by: Caledonian | July 29, 2007 2:03 PM
Then I can only conclude that you have not been paying attention!
We simply do not know what most mental disorders are. In many cases we have no clear grounds for deciding that various states are pathological or even maladaptive, other than tradition and societal consensus. (And guess how much respect I have for societal consensus?)
We're at a high point at levels of respect for patient autonomy, freedom, and variations from 'normal' - relatively speaking. It wasn't very long ago that people could be declared patients and have all of their civil rights stripped away by a single person. Then we added a few protections and required multiple people to be involved, but it's not that much better - and so very far from what it should be.
But I digress - the point was that there are various groups who work very hard to spread disinformation about what psychiatry is and does. Some of them are against it - more of them are for it. And very few of them possess the level of understanding and critical thinking necessary to make accurate statements about the field.
A friendly suggestion: if you want to question a field, you don't go to practioners within that field.
Posted by: Caledonian | July 29, 2007 2:08 PM
Caledonian: most of them were originally principles of Latin that stupid people tried to apply to English as well.
Those damned, moron, Latin grammar (principle?) fetishists! Are they the same ones that think there might be such a thing as mental disorders, and that it's OK to drink coffee?
Posted by: Joe Bob | July 29, 2007 2:27 PM
Caldedonian, let me put things in some perspective here.
There is nothing innately wrong about deliberate adaptation of the body, through use of drugs or otherwise. We've been doing the same shit both deliberately and absently for as long as we've existed. We eat because it makes us feel better. But really, we need to just stay on task, right? Who needs good food; just work harder! Get back to reality!
The reality is the brain is an organ and sometimes shit happens where it performs sub-optimally. The people best able to understand that are, you guessed it, psychiatrists, followed closely by nutritionists and other body experts. No, we're not entirely clear on things - we're just getting started on the complications of the brain. What do you propose as an alternative - ah, that's right, traditional apporoaches, reflecting contemporary societal values. Those values, by and large, don't accept that a brain can be ill except when it comes to outright insanity.
I'll trust the specialists before I trust outside observers, thanks. They have a clue.
(speaking as a student who struggles against these symptoms all the time, who is in the midst of trying all the 'alternatives' before returning for a diagnostic regimen).
Posted by: Patness | July 29, 2007 2:46 PM
Caledonian,