ADHD is at best greatly overdiagnosed, and the business of providing ADHD diagnoses is quite analagous to the opiate pain pill clinic debacle, in which 'physicians' got kickbacks from the industry for providing opiate prescriptions.
With ADHD, it's 'the medication' that is being sold. Often, the doctor's client is actually the amphetamine derivative supplier, and the product being sold (on a commission basis) is the patient.
Amphetamine addiction results in the patient feeling bad when they run out of their powerful stimulant drugs, and the resulting feelings of malaise tend to confirm the patient's belief that they have a neurological disorder (rather than just suffering from the standard set of problems that come with regular amphetamine use).
I hope this viewpoint becomes a bit more accepted. The human brain is so complex and we love to put ideas in little boxes, hence the term ADHD. In X number of decades, there's a very good chance we will all look back and realize how dead wrong we were about ADHD, attention, and our extremely crude methods of "curing" it.
It blows my mind that especially in American society we are so accepting of putting millions of people on amphetamines to solve attention disorders. Anyone who has gone through higher-ed in the past 10 years knows a huge number of students are on these meds, and even if they suffer some of attention disorder, they are likely at a large advantage after adding the drugs. I'd love to see the percentage of med school students on these drugs.
ADHD is a broad spectrum of developmental delay issues that present as different behaviours but can be observed in ECGs. There is no "cure". Anyone who says otherwise has no idea what they're talking about. There are only strategies for minimising the unwanted effects that cause disruption to your life.
The large portion of people taking stimulant ADHD medication to "study" are not by and large getting the same effect as those with ADHD get. For someone with ADHD the medication balances attention dysregulation, that is curbing hyper-focus, and attention "drift" while on a task. It doesn't temporarily turn you into some superhuman memoriser or Ernest Hemingway. It's not some magical potion buff. For those using it to stay awake to cram more low quality hours of memorisation in, they most likely have good memories to begin with, that's how they got there in the first place, it doesn't enhance their abilities.
The only advantage those with ADHD get is that they finally get to play on a level playing field. That's like saying those who wear glasses are at an unfair advantage in a "spot the difference" exam. Give me a break.
So we'll treat a broad spectrum of issues with amphetamines in order to level to playing field... got it.
My point is that we don't really know what this disorder is, or its root causes. An ECG can reveal its presence in the same way an EKG can reveal certain arrhythmia. However, in the case of EKG, you can't truly determine the cause of arrhythmia; is it cardiomyopathy, fibrosis, stenosis, a combination, etc. Now imagine trying to make the same leap of faith with the brain which is infinitely more complex, less studied, and less understood. Follow that up with a draconian treatment such as amphetamine prescription. Yikes
My prediction is that ADHD as a term will either be scrapped or used an umbrella as we learn more about the nuance and complexity of attention disorders. Making broad claims about what ADHD is and how medications can potentially treat it, at this point in time, is totally ridiculous.
Are we really going to pretend that the millions of Americans prescribed these drugs are actually suffering from ADHD to the point that pharmacology is a necessary intervention?
We treat a broad spectrum of issues linked to the developmental delay of the central nervous system and underperformance of the prefrontal cortex with rigorously studied drugs with proven benefits to patients. Just checking, you have no problem with Methylphenidates, just the one that sounds like "meth" but actually isn't? Any powerful drug can be abused. It's up to professionals to prescribe accordingly. I guess this is another case of where the US medical system gives everyone else a bad name (just not those outside the US who have good medical systems and don't suffer from the same issues).
Trying to make the case that ADHD is not well studied is plain wrong. It is incredibly well studied. The assumption that we can't possibly understand it because "it's the brain" is just wrong, there is a huge amount we know about the brain. I don't know what you're getting at with this ECG business but we've been doing EEGs on people to diagnose epilepsy for 60+ years.
ADHD is already understood as a incredibly nuanced and complex set of issues, the fact that so many people continually reduce ADHD to just "attention" or "focus" shows how little is known or understood about it by people who want to draw some tenuous observational links to... what ends... I don't know? Why do you care? A tiny number of people who actually suffer ADHD would agree with anything you are saying, forgetting the just plain false statements and leaving the opinions they were trying to reverse some support for. ADHD is about dysregulation of emotion, impulse and yes, attention but much more than that, it's about how those fundamental differences effect every damn facet of your life in the most pernicious way and require you to spend more effort and energy to keep up, or fit in, or look normal or to remove you and protect you.
I can't talk to the American system (remember there's a whole world with decent healthcare out there) but just because one country has an issue with misdiagnosis and overprescription, doesn't change anything. What's your point. There are also plenty of non pharmacological interventions. Many that I can claim back through my national health care.
You're conflating to many associated but not actually linked issues and it's unsubstantiated rants like these that perpetuate the stigmatisation of those living with ADHD. You're not helping anyone.
Diagnosing people with ADHD can still yield them treatment beyond medication. The existence of the opioid epidemic doesn't negate the very real pains and ailments that led to people getting overprescribed with painkillers, either.
Other treatments would be great, yet between the ages 6-17, of those diagnosed with ADHD, over 2/3 are prescribed meds while less than half receive behavioral treatment.
My point is that unfortunately these medications are still used as primary treatment.
Is that accurate? I thought the moral panic over ADD over-diagnosis has been around since the 90s, where the narrative was too many rambunctious boys were being given medication. "The Ritalin Generation." Are you saying this situation really hasn't improved in nearly three decades?
I'm curious about this - what's informing your belief that ADHD is treated only with medication?
When talking to people diagnosed with ADHD, the diagnosis was accompanied by a mix of behavioral therapy, medication, lifestyle changes, and external support from teachers/friends/family.
Drug-seeking behavior is something else altogether, which I agree is a net-negative on both society AND people with ADHD. Regulations around ADHD medication make the medication ironically very difficult to obtain for anyone with an executive function disorder. People without an executive function disorder have no problem jumping through the extra regulatory hoops.
Surely there are other treatments for ADHD beyond the simple pharmaceutical cures, and it would be salutary to diagnose people so they can try those strategies and get the help they need.
Talk therapy is incredibly important. People with ADHD can often suffer from rejection dysphoria and depending on how long until they realise, or how self aware they are, they end up internalising a lot of negative opinions and shame about themselves that needs to be unwound. There are a lot of issues around the pain of "never fitting in" or being understood. Some of these are a result of behaviours that aren't the social norm and so they become marginalised. Others are where differences in processing and learning information are labeled as "stupid" at a young age, when the child probably has a similar IQ to their peers.
Neurofeedback can be used with good success to help "rewire" particular issues with emotion dysregulation for instance. It can be expensive and requires a lot of time to train the brain to a different mode of operation.
Coaching, specifically around time-management and task-management. A lot of people with ADHD suffer from time-blindness. Their perception and relationship with time can be.... complicated. Calendars, specifically having a rigid system for what goes on them, regularly reviewing them, keeping them and a large easy to read clock visible at all times etc can really help.
A good water bottle with a straw. No one really knows why but there are a lot of hypotheses. - One thing that never gets mentioned is the relationship between ADHD and food. Generally the nervous system does a pretty terrible job at letting an ADHD person know, when they are hungry, when they are thirsty, when they need the bathroom. Combined with time-blindness, maybe some stress induced hyper-focus because you're falling behind on whatever you need to do, ADHDers will suddenly realise they've missed lunch and binge eat simple food that doesn't require preparation. Preparing a meal would be akin to telling someone with a deadline to just go run a quick marathon first. It'll feel like one or the other, and in some cases, depending on energy levels it will be. - but back to the water bottle. Using the straw means you don't divert your gaze from what you are doing. Your brain doesn't have to judge how full it is and tilt the glass accordingly, if it's big you don't have to get up to refill it. Frictionless hydration.
It is also greatly under-diagnosed, and long-term learning skills and coping mechanisms are more effective than medication. I started my treatment with low dose meds and that has helped me developed better skills for management.
The only thing I can say for anyone reading this is to know that everyone has symptoms of ADHD from time to time. Clinical diagnosis looks over your entire life history for consistency of symptoms. So keep that in mind.
So I get that people have issues with lazy doctors who pass out pills like candy. But that's not how ADHD is handled. It requires a diagnosis which takes time, then pills are prescribed from a physiatrist at low doses at first.
As someone who was diagnosed with ADHD in my 40s, it was a great relief and surprise at how effective stimulants work. I have struggled my entire life, and have burned myself out multiple times trying to maintain a balance in my life. There's a huge mental burden every day. Trying to remember what you need to do, remember the best strategies to stay on track, spiking anxiety, feelings of guilt and shame, which can spiral into depression.
These sorts of judgement statements, dismissive words from family or friends, and indifference from the public over mental health has kept many people from seeking treatment for a very wide range of issues.
We need more empathy towards the fact that mental health IS health. We need more insurance support for these issues (because it's expensive!). Furthermore, we need more empathy and support towards those that do get addicted to ANYTHING. Addiction is not limited to drugs.
Starting with the assumption that people are drug abusers is damaging, and is entirely faulty.
Maybe that's not how your ADHD was handled. You admit that your diagnosis occurred in your 40's, and it is well known that adult diagnosis is much more rigorous. To add to that, it's important to consider the rigor of young patients and the apparent effect of amphetamines on developing brains.
>Starting with the assumption that people are drug abusers is damaging, and is entirely faulty.
I don't think many people hold this view regarding ADHD-medicated individuals. The scrutiny, at least mine, is aimed at the doctors who readily tell parents that their child has this disorder without much testing, and then scribble a vyvanse script like it's no big deal.
Are these evidence backed observations? Is this evidence general for the world or specific to your locality?
I can tell you where I am it's only just being realised how _under-diagnosed_ it is for those with primarily internal presentation. Those who are diagnosed later in life have often survived due to above average intelligence and internalising debilitating coping mechanisms their entire lives that finally buckle under the strain of large, stressful life events in adulthood (children, divorce, financial stress, change to managerial work etc.)
To the second paragraph: Maybe in the US, and that's unfortunate but a lot of places in the world they are controlled drugs requiring a psychiatric diagnosis, sometimes with an EEG maybe a drug test.
Common stimulants like Adderall, Ritalin, dexamphetamines, work on the ADHD brain differently. Running out at normal prescribed doses in line with your condition won't result in "withdrawal" or malaise as a result of stopping. Any malaise is probably comorbid depression, which is common for those who have been undiagnosed. Often the ADHD is misdiagnosed as depression when the depression is merely the symptom.
I'm not sure what you are trying to get at in your final point but by this stage it's clear you have some deep biases with little to back-up your observations and are perpetuating the views that stigmatise ADHD sufferers.
I'm curious what has led you to believe ADHD is over-diagnosed. I can point to a few papers that indicate ADHD is under-diagnosed in certain population slices, like adult women.
I'm also wondering why you believe doctors are writing scripts for ADHD medications willy-nilly, then sending patients on their merry way. In my experience, the opposite is true:
When someone with ADHD moves across state lines in the US, their new general practitioner doctor typically needs confirmation from an in-state psychiatrist (MD) before they'll write a prescription - even if you've been taking the same medication at the same dosage for years prior. GPs sometimes require that the patient be undergoing therapy too, which is a lot to coordinate on top of a cross-state move. Therapists are also licensed at the state level.
This isn't because GPs are trying to be hard-asses, but because there are strict federal regulations on prescribing ADHD medications in the US.
With ADHD, it's 'the medication' that is being sold. Often, the doctor's client is actually the amphetamine derivative supplier, and the product being sold (on a commission basis) is the patient.
Amphetamine addiction results in the patient feeling bad when they run out of their powerful stimulant drugs, and the resulting feelings of malaise tend to confirm the patient's belief that they have a neurological disorder (rather than just suffering from the standard set of problems that come with regular amphetamine use).