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.
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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.
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
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.
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?
Constantly wriggling sounds more like the Hyperactive type.
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.
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.
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.
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?
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
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.
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?")
You can turn this shit (genetic ADHD) on and off with good old fashioned CBT.
And that's a GOOD thing. Casual psychotropic use ought to carry a stigma.
Why?
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.
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.
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
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..."
[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.
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.
Caffeine also increases absorption of calcium ions into *neurons*.
caffeinated spelling, oops.
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.
Casual psychotropic use ought to carry a stigma.
Why?
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?
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?
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.
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.
Oh. Good on you then.
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.
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.
The paradoxical effect is common to all children. It cannot be used to diagnose ADHD.
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.
"constantly forcing their neural structures to reaccommodate external influences, that's why."
Oh, you mean learning?
God forbid.
No, I mean neurotransmitter accommodation.
"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.
Sure as hell sounded like that to me.... Thank you Azkyroth for putting into words what I would have otherwise inelegantly expressed.
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.
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.
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?"
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.......
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."
Most people are credulous idiots. And just because something is medical advice doesn't mean it's good advice.
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".
Caledonian, once again someone says "This is red" and you reply with "No, it's cold". I do agree with that you lots, even most, people probably are "credulous idiots". You shouldn't exclude yourself from that category -- even if you do try to pretend to be contrarian.
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.
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).
And that's really all I'm asking of the Heathers of the world -- that we make this the default assumption rather than the other way around.
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..
Laissez-faire approaches to societal issues? But that's so... conservative.
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.
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...
"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.
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?).
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?
sounds more like menopause to me.
Yeah, that's how they diagnosed it when I was 6 years old.
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.
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?
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.
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.
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.
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?
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).
Caledonian,
There fixed it for you. Now it read as a true statement. Before it was kinda' silly. Try this: if you want to question evolution, you don't go to an evolutionary biologist. Ever. 'cause they're evil and will tell you all sorts of lies and warp your mind. Right? Oh, no? You might ask a bunch of them about the subject rather than relying exclusively on people outside the field? You know those who might have other agendas (*cough*scientologists*cough* or *cough*fundamentalist christians*cough* depending on the subject). I don't think I ever suggest that one not inquire of non-practitioners. Reading background material and criticisms by both practitioners and outsiders is a necessity if one want to legitimately question a field. But the implication that no practitioner of a field will ever question his/her own field or give an outsider the hidden truth that they are all frauds... well ...
Sorry, but your world is a little too black and white. And I think you're trying to view it through the peephole in the door.
It's already begun to be addressed here, but I still don't understand why chemical imbalances in the brain are treated so much differently by society than chemical imbalances elsewhere in the body. Sure, take insulin if your pancreas is wonky, take Synthroid if your thyroid doesn't work, but if your brain has an imbalance? Oh, no, medicating is the "easy" way out, and we can't let ourselves get "addicted" to those drugs. Saying that someone with ADHD is addicted to Ritalin is equivalent to saying that a diabetic is addicted to insulin. Brains can be fucked up, just like the rest of the body can, and sometimes that can be helped out with chemical intervention. I don't see why that's somehow a bad thing.
"a lurker," while it does seem this is an emotive topic for you, I think you really need to step back and take a breath. You are reading many things into what people have said here which is not the case. Interestingly, you accuse others of overgeneralising and stereotyping, while you over generalised and stereotyped their posts.
I don't doubt your personal experiences have given you an insight into the situation faced by parents with ADHD children, however do not for one second mistake this for an insight into the lives and motivations of ALL the parents who drug their children the world over.
Using anecdotal data of the manner you, and others, here are producing, I can comfortably assert that 80% of the American parents I know who are medicating their children are doing so, not in the best interests of the child. This doesn't for one second imply that you, or any other person you know is doing that. There are people who genuinely need pain medication and there are morphine addicts. Commenting on the behaviour of one group does not automatically carry an implication on the behaviour of the other group.
It is interesting that as more and more families have two working parents, working longer hours, with more pressure for them to succeed in work and at home, and we have more and more medications made publicly available, the incidence of child-behavioural disorders has increased. Is there a correlation I wonder.
Carlie, I blame woo. The need for some to point to "bad people" and, rather than express empathy and understanding, condemn and chastise them is a strong force for those who prefer an authoritarian system. Look, see, that's what happens when you don't follow [insert authority]. The "us" vs. "them" thing. Oh, those nasty people with their moral failing (read, mental disorders). I'm sure that this attitude existed for other more physical conditions in the past. They're just as loopy relative to mental disorders as the Christian Scientists towards physical ones.
TW: Glad to hear that you're comfortable, but sorry to say that you don't sound particularly credible. Do you have any sort of evidence to support such a claim?
Joe Bob - as I said, I am using the same anecdotal evidence as previous posters. I am sorry if I did not make that clear. Credible or otherwise, it is the evidence gathered from my personal experience.
It seems from previous comments here that this is a valid way to gather evidence and extrapolate trends...
TW said
"I can comfortably assert that 80% of the American parents I know who are medicating their children are doing so, not in the best interests of the child."
4 out of 5 of TW's friends and aquaintances medicate their children for their own convenience and not in the interest of their children? TW must have some real asshole friends. I don't know anyone who medicates their child for their own convenience.
It is my impression from reading up on the subject that ADHD in most cases is genetic. My wife has it and she passed it on to my son. Her brothers have it and her father had it. TW suggests that the cause is families where both parents work. My wife does not work. I have not heard one serious study suggest that. That sounds like Family Research Council or Dr. Laura propaganda to me.
Raindog
TW: sorry, I see, 80% of the parents you know, not a general claim. Wow, you hang around with some creepy people!
I feel I should clarify some of my comments which seem to be getting misread a bit.
In no way did I mean to imply that these people were my friends, nor that I hang out with them nor that they are the total set of American parents that I know. I am merely demonstrating how my contact with American families who medicate their children may not be representative of the general population of American parents who medicate their children. Some of these people I know socially, and are indeed assholes, some I have come into contact with professionally and are still assholes. Being an asshole does not mean they do not exist... There are good parents and asshole ones.
Repeatedly people use their own personal experience, or the shared experiences of a largely self selected population to extrapolate "science" and some of the comments in this thread are good examples of that.
Raindog - you have made a few assumptions about my post, and motives, which are not correct. First off, using your personal experience to suggest a general trend is false and I never meant to imply that ADHD was caused by working families. I will have to express ignorance as to who Dr Laura is (and unwillingness to google), but I assume you suspect I am some right wing pro-family buffoon. This is not true. My post was to point out that the diagnosis of ADHD may be influenced by working families. There is a significant difference there.
It seems to me, as I said before, this is an emotive subject where people will often post before fully reading the post they are replying to. Also, getting emotional over a subject doesn't really justify throwing away the basics of rational science.
I am all for medicating children who need it. If my children suffered from ADHD, I would treat them. I am also acutely aware that the diagnosis of ADHD is open to interpretation though...
TW, I think I get it now. You say that "In no way did I mean to imply that... they are the total set of American parents that I know". So your choice of the figure 80% for your own anecdotal evidence might just as well have been 20%, or 5%, for all we know, since we don't know what part of your personal experience you're withholding.
But you're right that anecdotes prove nothing. Do you have any evidence to share with us that might indicate roughly what proportion of American parents really medicate their children when it is not in the child's best interest?
BTW, I agree that people should works less. Too bad our societies (not just the U.S.) wastes so much work on things like war...
ugh, getting sleepy,...
BTW, I agree that people should work less. Too bad our societies (not just the U.S.) waste so much work on things like war...
TW
I see in rereading your post that you did suggest that the diagnosis is going up and you are questioning whether there is a correlation with families where two parents work. I did misunderstand that in the first reading. Sorry about that.
You cite no studies to confirm this link however. Could another possibility be that now that people are understanding it better that more people are being diagnosed with it? All disorders and diseases were at one time not diagnosed because no one understood them. Do you think that no one got cancer prior to our understanding of what cancer is and that once we understood it that psychosocial forces caused an increase in cancer rates? As disorders are studied and better understood the number of people with that disorder is bound to rise. The US may just be way out front in diagnosing the disorder. I have no problem believing that there are people who are treated for ADHD who may indeed have some other problem or no problem at all. But 80%? No way.
Most (All?) of us posting on this topic who have ADHD or kids with ADHD have done some reading on this. Most of the research out there suggests that ADHD is at least in part genetic. Here is just two of hundreds of links about the likely genetic origin of ADHD:
http://en.wikipedia.org/wiki/Adhd - I know its wikipedia but this seems pretty good to me.
http://www.genome.gov/10004297
Fixed it for you.
Those things are 'imbalances', they're deficiencies. And we *do* treat brain neurotransmitter deficiencies that way - see Parkinson's disease.
Thing is, that's not what the vast majority of mental disorders are - if any. With mental disorders, there are no known problems with the brain that we can point to, no obvious anatomical problems, no nutritional issues, no clear link with environmental factors. Most of what we know is that we DON'T know - possible explanation after explanation has been ruled out.
What we do know is that the explanation most patients are given, the one our society works so hard to instill in people, is wrong.
Joe Bob - no, I dont have any evidence which would honestly indicate what proportion of parents are incorrectly medicating. I am not even sure how such evidence could be gathered. This was largely the point I was trying to make, this is an argument where sides are bringing out arbitrary figures. People often make claims like "I dont know any people who would do X" to get their point across in emotive arguments - and it is meaningless, especially so on the internet.
As for the inappropriate usage, short of strapping every set of parents to a lie detector test, or getting the FSM to provide us with a blueprint of causal DNA, it is very hard to imagine how this could ever be known for sure. Some will admit it, some it will be assumed based on a third parties assessment of the child's condition.
Interestingly though, statistics show that in the UK (for example) the incidence of prescriptions of Ritalin has doubled between 1998 and 2003. (news.bbc.co.uk/1/hi/health/3072445.stm)
In the US, "studies of Ritalin usage show that between 5 and 15 percent of school-age children are taking medication for the disorder" and although I have no historical records, this seems high. (Dubious source: childrentoday.com/resources/articles/ritalinp2.htm)
Is it the case that 5-15% of American children have ADHD? It may well be. Is it also a case that the incidence of sufferers in the UK has doubled since the end of the twentieth century?
If these statements are not true, then people are incorrectly medicating their children - the hard part is working out how many. It is certain that people misuse ritalin (www.cesar.umd.edu/cesar/drugs/ritalin.asp#history).
Saying that all parents incorrectly medicate is as false as saying none do. The fact is there will be some who are doing it for selfish reasons. The problem is, as was pointed out previously, there are no long term studies of what this is doing to the children. What will these kids grow up to be like in 30 years?
It is ironic that the next article PZ posted here is titled "Go ahead, risk your brain not mine."
(URLS munged to avoid spam traps)
Raindog,
I am not sure what studies you wish me to cite, do you want ones showing that more families have two working parents today than 50 years ago? As for the correlation, if I had studies which showed this one way or another, I would not have asked the question.
Certainly. This is indeed very likely. I agree that it is almost certain that prior to the identification of ADHD as a disorder, people will have suffered from it. That is not the issue here though - the question is how many people suffered from it, undiagnosed, in the past. It may well be that huge numbers of people have suffered ADHD and just been thought of as "naughty" or "lazy" or whatever. The problem is making this assumption automatically.
What you are saying here is similar to the counter argument that today people call "childlike" behaviour ADHD and are quick to reach for medication. I do not doubt that families with ADHD children are put through hell - which is why I am curious as to the annual increase in cases diagnosed.
It is also important to remember that behavioural disorders are often characterised by the culture that diagnoses them. So in 10th century BC Greece, homosexuality was a non-event but in 19th century America it is a mental disorder. Which is the true status?
For increases on the scale of the UK for example, you have to question how so many cases could go undiagnosed in recent years.
I am not for one second suggesting most / all of the people who have ADHD families have not read up on the topic - but there is the very real risk of selection bias in the research being read. I have debates with people who have "Electrosensitve" family members who claim to have read research on the topic and it supports their point of view - normally the research is the biased woo pushed by Electrosensitive pressure groups.
Note: I am not for one second saying the research you, or any one else here has read is woo. I am simply warning about the risk of selection bias when a topic is not impartial.
If ADHD is genetic then that is probably a good thing. This increases the chances that a marker can be found and treatment can be better targeted. I am sure that comes as no sympathy to people who have sufferers in their family though. Sorry.
BTW: Dont get fixated on the 80% number it only reflects 17 families with a biased population selection.
[quote]What we do know is that the explanation most patients are given, the one our society works so hard to instill in people, is wrong.[/quote] I followed you right up til there. What is this explanation that most patients are given?
The explanation that "the symptoms you are giving us are consistent with a number of disorders, with ADHD the most likely among them"? That one?
[quote]There is something innately risky about deliberate alteration of the body, through use of drugs or otherwise.[/quote] Yep, and we face that risk EVERY DAY, most of the time signing off on it so we can get a paycheque. Neither my employers, nor my university, compensate me for the hunch I develop sitting at a desk. I don't see why people who voluntarily take that risk trying to deal with a performance-crippling illness should be stigmatized and looked down upon - especially if, as is often the case with late ADHD sufferers, the alternatives are tried without distinct success.
[quote]Those things are 'imbalances', they're deficiencies.[/quote] Are you a doctor?
TW said:
"what studies you wish me to cite, do you want ones showing that more families have two working parents today than 50 years ago?"
How about a study that shows that kids with two working parents are more likely to be medicated for ADHD? That seems like it must have been analyzed at some point. I googled a bunch of variations on that but came up with nothing. If there was a study that found those results to be true you can be sure that Pat Robertson and James Dobson would reference that study frequently. BTW, your guess was a good one, Dr Laura is a horrible right wing talk show host.
I'm the one who's supposed to be a libertarian, remember? I support people's rights to do all sorts of stuff with their bodies. That isn't the issue.
The issue is the medical appropriateness of a particular way with dealing with a constellation of behavioral traits. At present, the only 'diagnosis' of ADHD that can be made is to try eliminating other conditions that could cause the symptoms presented, and if no other is found, conclude it's ADHD.
Whether some of the cases are actually examples of our being rigid and inflexible with teaching regimens or a side-effect of trying to fit kids into social and behavioral structures totally alien to our evolution, we can't say. We can't say whether there are different kinds, what are responsible for the conditions, and how individuals can be treated.
The issue is the medical appropriateness of a particular way with dealing with a constellation of behavioral traits. People taking drugs that make their lives better is, somehow, medically inappropriate? If the drugs aren't working, there's no point spending the coin on them - there are cheaper ways to get high.
At present, the only 'diagnosis' of ADHD that can be made is to try eliminating other conditions that could cause the symptoms presented, and if no other is found, conclude it's ADHD. ... as is the case with a plethora of known medical disorders, for no other reason than that the symptoms do not manifest clearly. Flu-like symptoms could be a sign of many, many, many different illnesses. It's merely the most statistically likely that it's the flu. You want to open the big book of medical and scientific mysteries and conclude that the whole practice shouldn't be trusted? That's what you're doing with psychiatry and ADD medication, and I'm calling BS.
You're entitled to be a skeptic; that doesn't make it reasonable or practical.
Having a bad day with tags - that last post is particularly muddled. Sorry, Caledonian.
'The flu' can be shown to exist. We know what the influenza viruses are, what they do, and how common they are. That's why we can say that something with a given symptom profile is probably the flu.
Flu : influenza virus :: ADHD : ?
We have no idea what the '?' stands for at present. We can't begin to guess at whether pharmacological treatments are overused, because we can't say when they're necessary or even appropriate.
So much flawed information in such a small space. Wow.
Back before ADD was diagnosed as ADD, it was called a few more unpleasant things. Kids who had it didn't get medications, they got punished and humiliated, labeled as mentally deficient, and often ended up dead or in jail, or simply continuing to fail well into adulthood. Later on, as drug treatment advanced, they were treated like my brother, who was thankfully diagnosed as ADD rather than mentally deficient, but was placed in special education and given drugs to make him sleepy, and therefore easier to handle. As with many other conditions, physical as well as mental, the increase in incidence can be attributed to improved diagnostic methods. That more kids are getting medication is due in part to improved diagnosis and improved medication. While some parents might try to wheedle prescriptions for unruly children out of their physicians, it's not likely that the ADD medications will produce the desired results if the child doesn't have ADD. Try looking for some statistics on the number of children who are on medications for the long term if you want real numbers on who has a need for medication.
This statement, "Those things are 'imbalances', they're deficiencies. And we *do* treat brain neurotransmitter deficiencies that way - see Parkinson's disease." (I assume you meant those things aren't imbalances. . .) was quite interesting, seeing that medications are used for both hypo and hyperglycemia, and hypo and hyperthyroid - would hyper be a deficiency in anti-hypo-regulating chemicals, then? (I'm reminded of B Kliban's anti-jump muscles. . .) In addition, diagnosis of Parkinson's is similar to diagnosis of ADD, as well as diagnosis of many other neurological/mental conditions. The presence of a set of symptoms common to people with the disease is used to indicate that the patient has it, and if necessary, brain imaging can be used to detect a pattern that is common among other people with the condition. It's rarely a matter of "process of elimination" unless multiple conditions exist. The process of elimination comes in when medication is introduced, and even then, the symptoms are considered, since there is documentation already about which sets of symptoms are more likely to respond to which drugs or drug combinations. So we don't have an absolute knowledge that guarantees successful treatment - that doesn't mean a treatment is useless. Different cancers respond to different treatments. Some people with Parkinson's, or Schizoaffective Disorder, BiPolar, ADD, depression, Alzheimer's (the list could go on quite a bit) will respond to a treatment that has no effect on another patient, and vice versa. It still doesn't support either the idea that a condition is imaginary, or that pharmaceutical treatments are a load of bull.
A good psychiatrist does a thorough evaluation of a patient before making a diagnosis, and that diagnosis may or may not jibe with the complaint the patient initially had. He will not say "Oh, you're depressed? Try this Paxil for a week or two and see what happens," and certainly won't give a child, say, 60mg a day of dextroamphetamine, because mom says the child won't sit still. If kids who aren't ADD are getting ritalin because the parent or the teacher tells the doctor to write it up, that's still no indication of the legitimacy of the condition, any more than doctors prescribing antibiotics for viruses means that viruses are all fake.
WRONG.
We know that Parkinson's is a distinct physiological impairment that leads directly to a specific neurotransmitter deficiency. We can look at the brains of people with a symptom cluster and determine of them actually had Parkinson's - which is how we can justify treating those symptoms as being strongly indicative of that disease.
With ADHD/ADD, there is no way to check. Because we have nothing to check our diagnoses against.
There was a lot of misinformation spread about how drug therapy for ADHD worked, back when it was first introduced on a wide scale. There were people who claimed that the stimulants only had an effect on ADHD kids, and a response to the drugs indicated that the diagnosis was valid because normal children didn't respond that way.
That was a lie.
Your objections are made because you don't like the consequences of the points being made against you, not because you have any counter to those points. Do you know what consequentialism is?
Without particularly wishing to take sides on this issue, I do have a question - two related questions, actually - for some of those articulating positions on what could be broadly construed as the "anti-" side of the discussion. TW and Caledonian, and possibly others, have expressed concerns that (forgive me for paraphrasing) ADHD may in some sense not be a "real" disorder; that evidence is insufficient to warrant the presumption that ADHD is a "real" disorder; and that this uncertainty somehow calls into question the ethicality, or at least the appropriateness, of taking steps to "treat" ADHD.
If I have misunderstood or misrepresented your concerns, then by all means stop reading now and correct me if you are so inclined. Otherwise, my questions are these:
1) Why the prima facie assumption that "ADHD is a disorder" - or, for that matter, that "X is a disorder" - should be categorically true or false?
2) Why should whether or not such claims are truth-apt be at all relevant to any questions of treatment? I think that few people would agree that a person can be categorically ugly or beautiful, but plastic surgery is permitted by society. It is certainly not a practice without its detractors, but in cases where a cosmetic deformity (rightly or wrongly) prevents an individual from participating fully in society - as in the case of a cleft lip, for example, or severe and conspicuous scarring - it is basically noncontroversial. How is this qualitatively different?
To consider the question from another angle: Caledonian, both here and in the Retrospectacle thread, you have made statements that I read as sympathetic to the position that ADHD-typical behaviors are more faithfully and honestly construed as variance rather than pathology, and that attempts to "correct" these behaviors with medication are consequently misguided at best and repressive at worst. I think that this is a valid concern. But I also think that those persons best situated to judge whether the pharmacological treatment of ADHD constitutes a disservice to those diagnosed with ADHD are those diagnosed with ADHD. Even supposing that ADHD is either "real" or not - heck, even supposing that it's not - if, on the whole, people receiving treatment for it find it to be helpful (I have no data indicating that this is the case, but suppose that it is for the sake of argument), then where is the ethical dilemma?
My apologies, somewhere during that last post my train of thought got a bit muddled. The first sentence of question 2 ought to read: "Why should the truth or falsity of such claims be necessarily relevant to any questions of treatment?"
'The flu' can be shown to exist. We know what the influenza viruses are, what they do, and how common they are. That's why we can say that something with a given symptom profile is probably the flu. Yep, right up until we take that certain and definite information you want to use and find out that it can't be the flu.
We can't begin to guess at whether pharmacological treatments are overused, because we can't say when they're necessary or even appropriate. Sure we can - when the more likely options have been exhausted. Don't think for a moment kids with ADD don't deal with misdiagnosis. We'll try the more likely stuff first.
And don't get me started on certain knowledge. I don't know of one doctor that's ordered a blood test to detect a flu when they could offer a treatment for the most probable option and find out what happens.
But sometimes the unlikely happens, and they realize, hey we're seeing progress! It's ADD! And in other, more rare cases, people get unnecessarily sick or die from misdiagnosis. That's the nature of medicine. It's not perfect - again, not a good reason to say "I don't do doctors or sickness".
This happens with all positions of advisory; doctors, psychiatrists, psychologists, clergy, etc. Is it trial and error? Yes. Is it blind? Not at all. Is it medicine? Yes. What you are complaining about isn't an ADD issue, it's an ethical issue.
Alison -
You forgot my favorite, or, the bane of my partner's existence. Make a list, go to the store, still don't get everything. Or, make a list, go to the store, forget you made a list. The best for last. Make a grocery list, head for the store, come back several hours later with a pile of books, having forgotten you were going grocery shopping, because you got distracted by a tangential conversation on the MAX (Portland's light rail). My partner has threatened to pin notes to my shirt.
Thankfully, I am starting to really move forward in a career that actually takes advantage of my ADHD, songwriting. I can work on several songs at once and going on tangents is actually a good thing. When I get an idea, stemming from something I'm working on, I can almost always use it. If not now, then later. Plus I can use ADHD crack (blogging) while I work. And I can work from home, at night and spend my days playing with the five year old.
My partner, on the other hand, has had to learn to deal with the general insanity and annoyance - like when I clean, I clean every room at the same time, probably while I'm trying to cook, read and write something. This was rather irritating in the beginning, but she has come to find, over time, that it's actually rather amusing to watch. I think that acceptance was more forthcoming when she realized that our son was expressing a lot of ADHD symptoms, which we subsequently confirmed with a diagnosis. We have talked about medicating me, but we were in that dismal zone of making to much money for me to get state help and too little for insurance or even paying for the script. Now we're almost to the point where I can afford to get insurance, but due to a career that thrives on some of the symptoms.
Cal -
The issue is the medical appropriateness of a particular way with dealing with a constellation of behavioral traits. At present, the only 'diagnosis' of ADHD that can be made is to try eliminating other conditions that could cause the symptoms presented, and if no other is found, conclude it's ADHD.
Full of crap again. I was diagnosed with ADHD, because it was finally discovered, that rather than being lazy, my inability to do my homework stemmed from ADHD symptoms. Asked to write a three page paper on Thomas Jefferson, I'd write a fifteen page paper on Madison - great paper, but not what the teacher ordered, so I get a C-, only because it was a really good paper. Asked to do a series of math problems, get every single one right, unfortunately I did them in my head, can't show my work, because to this day, I can't do it their way - fail pre-algebra. Fill in this banal, ridiculous series of questions - get to the point my eyes are watering, struggling to read and answer question after question of meaningless crap. I read the material sat in class, got As and Bs on quiz's and tests - barely made it through tenth grade.
Fast forward to current day. Getting ready to head for the park with the five year old, start cleaning the bathroom, until said five year old asks when we're leaving for the park. Search for half an hour for my keys, shit they're in my hand. Three minute walk to the corner store for milk, come home with bread. Attempt to clean every room in the apartment at once. Reading two books, an article, writing a couple songs and watching a movie at the same time, not noticing the partner's interested in getting laid, in spite of the fact that she's sitting next to me naked and switched Serenity out for a porn flick.
Yes, it damn well can be diagnosed. Just like a host of other, very real, very harsh mental disorders. You can't "see" OCD, but you can damn well figure out someone has it. Bipolar disorder and schizophrenia are very real and in extreme cases very dangerous illnesses, that we can't "see." Do you propose we not medicate anyone, if we can't "see" their disease? Your bloody well insane. You're not a rationalist, your just nuts.
Assumption? It's one of the most basic principles of logic. Don't waste my time.
Genuinely helpful treatments are unlikely without either a) deep theoretical understanding of the problem and how the treatment effects it, or b) empirical knowledge that the intervention resolves the problem, which requires an effective way of identifying the problem state and contrasting it with the improved state.
No, we can't distinguish variance rather than pathology, because we can't even define what the pathological state is supposed to be. We can't tell if the problem originates in the individual, the environment, or whether this varies from case to case.
In my experience, the people who say they've tried 'everything' have usually altered some superficial details but left the overall structure of the situation unchanged.
It is quite likely that there are children with organic executive function deficits, either due to environmental impairment or innate deficiency, that cannot focus regardless of how hard they try.
It is ALSO likely that there are children who are energetic, sufficiently sensitive to detail that they are easily bored, and generally unsuited to sitting still for long periods of time without regular exercise and shifting stimulation.
It's important to remember that sitting still for hours at a time only became a part of our lives relatively recently - for the vast majority of history, and all of prehistory, we spent most of our time moving around doing and attending to things. Office work is quite unnatural. So is sitting at a desk.
Recess is becoming rarer and rarer, and often shorter and shorter in the places that do have it. Kids don't have places to play, are getting less physical activity, and are generally entertaining themselves with things that offer constant and rapidly-changing stimulation - given these facts, it is easy to see that many perfectly healthy children might have problems staying still and paying attention in much less-stimulating situations.
The question is this: of the children diagnosed with ADHD, how many have an inherent disability that accounts for their behavior, and how many simply don't 'fit in' well with the unnatural environmental patterns we want to impose on them? We can't tell, because at present we infer an innate disability from the behavior. We have no way to check this classification against reality.
Guess what happens when we don't have a way to check our ideas against reality?
Anecdotes are fine, but they have no place in a discussion about group classifications. I don't care that your grandmother smoked five packs a day and drank like a fish and lived to a hundred and two.
I'm sure there are plenty of people who, no matter what changes were made to their environment, could not function in school or society without chemical intervention. I'm also sure that some troublesome children are put on drugs because teachers and parents don't want to take the effort to deal with them and adapt their behavior to the child's needs. There are also probably troublesome children that are diagnosed as ADHD by well-meaning people who intend the best for them and go along with society's pattern, not looking deeply and questioning into the conventions that have been established.
How many ADHD diagnoses belong to the first category? How many to the second? How many to the third?
WE HAVE NO WAY OF KNOWING.
If you don't think that's a problem...
Actually, my arguments are made because I have done a great deal of research over the course of my life trying to understand what was wrong with me - what was ADD, what was me, what could be fixed and how it could be fixed, what had to be dealt with or changed behaviorally. The article PZ linked to, which also had some interesting links, had a great deal of data which contradicted most of what you've been saying. If you visited some Internet ADHD help resources, you'd find even more data which contradicts you, and has been scientifically tested and peer-reviewed. However, your denialist comments over at retrospectacle indicate that you either did not read, or read and dismissed, the information that was presented that conflicted with your already-established views.
ADD is a wide-spectrum disorder. People who have a mild case or who have been able to cope with it are more likely to object to its labeling as a Disorder, because of the stigma of the word. People who have a degree of it that responds to treatment want to keep the label because insurance companies will grab any opportunity to deny treatment, and insurance coverage allows them to function and focus when they would otherwise be floundering. People who have it to a degree where medications have no effect, or not enough of one to allow sustained employment, successful social interaction, or even self-care, would fit anyone's definition of Disordered. Psychologists, Psychiatrists, and Neurologists acknowledge that ADD exists and that certain medications help. People who know people with ADD acknowledge that it exists. People who have ADD know with absolute certainty that it exists. Your insistence upon its nonexistence will require studied ignorance in the face of increased knowledge, testing, and studies, because even now the bold statements you have made indicate that you have a bias that protects you from information that conflicts with your view.
As I said initially, Think a Mile in My Brain. I'd love to be able to transport someone in just long enough for proof. That would be so much easier than showing studies and papers and tests to someone whose mind is made up and doesn't want to be confused with the facts. However, since I have proof in my head, and more and more science is backing us ADDers up, I'll have to be satisfied with recognizing an argument from ignorance.
One of Caedonian's bugaboos seems to be of the sort "it's not natural", that the problem is the environment has changed and these people are maladapted to that environment. I don't necessarily disagree. But then he takes it further and dismisses medication because he feels it's the environment that is wrong and so treating the individual is somehow missing the point. And that's where I think he goes off track. Sure, if I could wave a magic wand and make the change to society such that the perfect niche existed for those with such disorders, why not. But we can't so it seems just so much wishful thinking.
In the last few hundred years or so we've seen a "myopia epidemic". There are probably several reasons behind the increase in nearsightedness. One is that modern civ (reading&writing) puts an abnormal strain on the eye; another is that we've eliminated the evolutionary advantage of decent eyesight; and there's the overall increase in the ability to diagnose the problem and more availability/afforability of eyewear or corrective procedures. But those fixes are simply to the symptoms -- we fit people with corrective lenses, we do not change the underlying problem of elognation of the eyeball. But it's not "natural" and there isn't a huge push to fix the environment to accomodate the issue; rather we simply treat the symptoms. So why isn't there a clamoring for people to give up their glasses and just live with the symptoms? Make the world adapt to them rather than the reverse?
"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."
Yep, and plenty of those people lived in total misery with untreated depression and other problems with no way of treating them! But they lived, assuming they didn't commit suicide or just gave up on life. What a sanctimonious ass you are!
Thanks for a lot of the comments above, especially Alison. I'll be making appointments to get tested, because so much of what you've said (and that I've read elsewhere) is true of me.
Raindog - I am not trying to be argumentative here so I may be phrasing my posts badly. You ask:
Again, I know of no studies which indicate this. I never claimed this was a proven relationship. I asked the generic question of the possibility of a link between increased family pressure and increased diagnosis of ADHD. I am not screaming about wives staying at home or similar nonsense (my wife works and I wouldnt have it any other way!).
I am not, in any way, trying to downplay the suffering of individuals who are posting here, but this does not encompass the full set of families where one or more family member is being treated for ADHD.
What criteria is there at the borderline cases? What divides the genuine ADHD child from one who is simply easily distracted or badly behaved? Families are often under extreme pressure to both appear "normal" and maintain the increased work pressure of modern life. With this pressure it seems to me (as I speak for no one else here) very likely that borderline cases run the risk of being misdiagnosed.
kjupi: Sorry if I have misrepresented my position. I have no doubts at all that ADHD is a real condition. I am not even arguing against medicating sufferers - as I said before, if my children suffered I would medicate them.
There is, in my mind, a great risk that the desire to "normalise" people leads to a dangerous thing. While at the moment ADHD carries enough stigma to make false claims unlikely, this will not last for ever. At the risk of a slippery slope, should the incidence of cases continue to increase as they have in the past, the majority of the western world will be undergoing treatment.
While the treatment of genuine sufferers is a GOODTHING™, the treatment of people who simply fail to conform to society is not. There are some people who are keen to read more into peoples statements than ever was intended so let me repeat my self. I strongly feel the treatment of genuine sufferers is a good thing and would advocate it on a regular basis. Remember patient consent is tricky area here though.
Truth-apt and false.
TW-
Since the position is yours, I don't think it's possible for you to misrepresent it. The error was apparently mine. I appreciate your civility, though.
TW
Fair enough. I have been a bit reactive here. I am easily annoyed by people who question giving this medication to children. It has made such a big difference in our lives and such a big difference to my son's life. People like my son more often than not would have been doomed to failure in school, getting picked on for being stupid and then a likely bout with drugs and alcohol until they died a sad early death prior to the diagnosis and treatment. When people question whether I and others in my situation are doing the right thing I get very angry. The way I see it this is a genetic illness that can be cured with medication. What do you think of Christain scientists who don't give their kids medication when they are sick? I, and other parents like me, would be criminally negligent not to give our kids the chance for a somewhat normal life and that is what the medication provides. I noticed that not one of those questioning the diagnosis and treatment of ADHD has the problem or a kid with a problem. Its a whole different story when its you who is dealing with it.
Wrong.
WRONG.
I'm willing to respond to criticisms of my arguments, but not to misrepresentations of them. (If I did that, there'd be no end to the arguments - people would just keep lying about my explanations, and I'd have to explain why they were lying, and the vicious cycle would continue.)
The use of medication is not something I've complained about - you clearly haven't understood a thing I've posted. I could explain, but who would explain the explanation?
"The use of medication is not something I've complained about - you clearly haven't understood a thing I've posted."
Oh, no, you don't complain about medication, you just complain about the use of medication for any condition less obvious than a bruise.
Caledonian writes: "The question is this: of the children diagnosed with ADHD, how many have an inherent disability that accounts for their behavior, and how many simply don't 'fit in' well with the unnatural environmental patterns we want to impose on them?"
Ah, the old 'don't fit in with the imposed environment' canard.
What about the kid that can't accomplish their own goals?
"It's important to remember that sitting still for hours at a time only became a part of our lives relatively recently - for the vast majority of history, and all of prehistory, we spent most of our time moving around doing and attending to things. Office work is quite unnatural. So is sitting at a desk."
So, you're saying that people who don't naturally fit in that situation should be consigned to a life of mediocrity and failure to achieve goals?
Isn't that precisely where your ideology leads?
Because lots of personal goals involve doing boring things for hours and hours. And achieving excellence in almost anything requires exactly that.
At best, your dream world would have hothouse schools producing students who become utter mediocrities, if not outright failures, as adults, because the world would not spoonfeed them any more.
After a lifetime of edutainment, they'd drop every endeavor as soon as it got boring - as they inevitably do - long before achieving any degree of mastery or accomplishment.
Did it really not occur to you that it might be possible to adjust the environment to fit the people and STILL accomplish things?
Caledonian writes: "In many cases we have no clear grounds for deciding that various states are pathological or even maladaptive"
Sure we do: "Does it cause the patient difficulty?"
The patient, not the teacher, or the parent.
This doesn't just go for psychiatric/neurological issues. A hernia for instance, can often be left untreated as long as it doesn't cause any problems. If it does cause the patient difficulties, then treatment is justified.
Note that just because the ADHD patient might temporarily do well in your utopian concept of an edutainment society of free-range schoolchildren, actual people have a real world to deal with.
Caledonian writes: "Did it really not occur to you that it might be possible to adjust the environment to fit the people and STILL accomplish things?"
No, you're missing it - the problem is not the environment, the problem is the inherent property of the tasks involved in accomplishing many goals, whether self-directed or externally imposed.
Adjusting the environment alone is never going to help the typical ADHD-type person finish a novel or become a concert cellist.
By that reasoning, gifted students who are too bored to function properly in normal classes have pathological intelligence.
As a functional ethical and pragmatic standard for judging when treatment is appropriate, it would seem to have a few problems.
"By that reasoning, gifted students who are too bored to function properly in normal classes have pathological intelligence."
You could indeed, but talented & gifted programs and AP classes are generally sufficient 'treatment'.
Put a gifted kid with ADHD in that environment, and while in class activities he may do better, he'll still be screwed on the term papers and do worse than his peers due to having difficulty studying.
I think they are headcases who should be prosecuted for child cruelty. I think the same about people who refuse blood transfusions and the like on "religious" grounds.
Care and treatment of children is always a thorny topic, not least because most societies do not give them the ability to make informed consent, even when they are actually old enough to do so. (Similar arguments can be used about the medication of people classed as mentally ill though, but that is whole new set of debates!)
So would giving the kids antipsychotics until they're dumb enough not to be bored. But I don't think you'd consider that appropriate.
In order to help people, you have to know how what you'd like to do will affect them in a deep sense, otherwise you run the risk of offering a suboptimal solution, or even one that's as bad or worse than the problem.
Caledonian, you are a coward. Respond to my whole comment.
Jon H -
Don't bother. Caledenialist is just interested in answering what he thinks he can and ignoring the rest. He doesn't think it exists, unless science can explain every aspect of something. Thus neurological disorders are not real. Brain chemistry is easily compensated for, so those who have so called neurological disorders, are apparently not trying hard enough. He is nothing but a pathetic denialist.
Jon H, you are an idiot. Your whole comment isn't worth responding to.
ADHD is a catchall diagnosis - if it can't be explained by anything else, we call it ADHD. Saying that a particular treatment is necessary for a catchall diagnosis is absurd - it is in fact quite unlikely that everyone who gets the label has the same condition, and even more so that everyone will require the same sort of treatment.
The reason you don't believe one way of responding to bored, gifted children is as good as another is that you believe you understand what's 'wrong' in such cases, and so you have grounds for evaluating the different solutions and judging which deal with the problem itself and are good for the people involved. If we had a single category for all children who are bored and inattentive in class, with no distinctions between causes...
Well, that IS what we have.
Caledonian, it is you that is absurd.
Yes, ADHD is something of a catchall diagnosis. But then again every (honest) diagnosis is to some degree because one never does have perfect knowledge. In essentially all cases one see a cluster of symptoms, rules out various alternatives and goes with one's best guess. It's only very recently that have we had the diagnostic tools to really pin down many illnesses to a root cause.
But I'm confused by your claim that labelling someone with the diagnosis of ADHD somehow means that everyone with the same classification "will require the same sort of treatment". Haven't we repeatedly stated that that is fundamentally not the case how it's dealt with in real life. As I've previously told you my child's psychiatrists were very upfront that his treatment was going to be very individualized with a bunch of approaches (some pharmacetical, some not). And even the pharma wasn't a "one pill fits all". If you knew anything at all about the subject, just a cursory reading, you'd know this. We went through Adderall, Concerta, Strattera, Tenex, and others... His current medication seems to work quite well, though has the side affect of affecting his appetite (oddly enough in the more rare sense of making him always hungry).
You deny being a denialist, but your second paragraph implies that you think that ADHD children are simply "bored and inattentive". My son is a gifted-talented child (enough so that the school psychologist seemed a bit freaked out) but the problem isn't that he's simply "bored". He's also impulsive and figgity -- even when doing something he enjoys, even when he's hyperfocussed. Different ADHD/ADD sufferers exhibit different combinations of symptoms, so there really isn't simply a single category. Girls, forinstance, seem to exhibit what is more a daydreamy (i.e. non-hyperactive) set of symptoms. Yes, in general discussions both these get labelled as ADHD/ADD but they aren't necessarily treated the same. So your claim of "no distinctions" seems to fall flat. What has been found empirically is that while the different subsets to the ADHD diagnosis can be remarkably different in the expression of symptoms, that often similar treatments do provide relief from the symptoms. Yes, it may be simply symptom relief rather than fixing an underlying fundamental problem -- but that's just like wearing glasses fixes the symptoms without reshaping the fundamental enlongation of the eyeball. On the other hand there seems to be scientific evidence that stimulants are at least partially treating fundamental issues of neurotransmitter deficiencies.
Sorry,
should have read
Also, it should be noted that ADHD seems to bring with it a high rate of comorbidity with other issues such as learning disabilities, dyslexia, anxiety, depression, bipolar disorder, Pervasive Developmental Disorders (PDD), Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). Oddly asthma also seems to be common. I seem to remember reading that the fraction of ADHD individuals diagnosed with an additional difficulties could be as high as 30% to 50%.
This tendency for comorbidity means that treatments are very individualized because they often must be adjusted to take this into account. This is the very opposite of what Calendonian seemed to be claiming that practitioners take a "one treatment to rule cure them all" approach.
a lurker -
Please, click on my name and email me, my address is on my page. I would really appreciate it, I would keep our correspondence private, except to possibly share it with my partner.
Nonsense. There is significant variation between individuals in their baseline levels of neurotransmitters, normally, and we haven't been able to find any correlation between relative levels and behavioral/cognitive traits.
In the few cases where a neurotransmitter deficiency IS to blame for a condition, we can not only identify the damaged region of the brain, but we can show that between 80-90% of the relevant neurotransmitter has been depleted before symptoms appear. Further, such conditions are irreversible and slowly lose responsiveness to pharmacological treatment.
ADHD - and the vast majority of mental disorders - are nothing like that. What we've found isn't evidence of a deficiency, but that regions of the brain associated with attention and focus activate differently in people diagnosed with ADHD.
That says absolutely nothing, given that they're supposed to be unusual in attention and focus in the first place. It tells us nothing about the cause at all.
Whether a behavioral trait constitutes a "disorder" depends upon context. It may well be that ADHD is a behavioral trait that is beneficial in some contexts, but is a detriment in many modern school and work environments. It may well be that in an appropriately structured learning environment, ADHD kids would do as well--or better--than non-ADHD kids.
But for a parent with a bright child who is flunking out of school because he can't focus, these theoretical considerations necessarily take a back seat to more immediate concerns. Their kids have to deal with the schools that they have, not the better ones that somebody may invent someday. Psychostimulants might not be the ideal way to deal with the problem, but in many cases they make a critical difference between a kid who is failing and one who does well in school and goes on to a successful career.