[cj]

I think their opinion is along the lines of “no one is ‘inflicted’ by ADHD, and there is also no permanent cure for it, because the disorder can simply be redefined as being those who are in the lowest quartile or even the lowest 10% of X, Y, Z cognitive metrics.”

Imagine there were a pill that could boost your IQ score by 25% but in order to receive a prescription you need to have an IQ in the lowest quartile. Such a pill could also help already smart people simply become smarter.

Thats the main contention: there are two groups: (a) people who actually experience debilitating symptoms that significantly impact their life requiring medication, and (b) people who are simply looking for an edge by using medication, perhaps even convinced to do so by ads on TikTok or Instagram under the guise if ADHD.

Edit: The IQ score medication analogy is only meant to be illustrative. I don’t mean to imply that IQ and ADHD are somehow connected.

[falcolas]

> because the disorder can simply be redefined

Respectfully, disorder already has a meaning. And it's a meaning enshrined in medicine and law (ADA). "Redefining" disorder does nothing but hurt people who have a disorder.

And ADHD has no correlation with IQ (which I think you know, but it' not just a focus sliding scale either). It's a disorder that encompasses the symptoms of time blindness, a lack of ability to control focus, emotional disregulation, rejection sensitivity dysphoria, reduced working memory, an inability to form habits, and executive dysfunction.

It's also associated with a physical change in the brain.

[cj]

I added an “edit” to clarify I don’t believe IQ and ADHD are connected.

“Redefining” could have instead said “Reinterpreting”.

The reality is the diagnosis for these disorders are completely subjective. The same logic could be applied to depression and SSRIs. It’s not like a blood test that tells me I have high cholesterol. It takes dozens of hours with a qualified medical professional to seriously diagnose someone with high confidence.

Also agree there are studies correlating it with physical changes in the brain. But those studies aren’t fully fleshed out and not useful for diagnosis. There isn’t a brain scan that can detect ADHD.

[quacked]

> There isn’t a brain scan that can detect ADHD.

I think it's important to note that even if there were, it wouldn't change the inherently arbitrary nature of ADHD diagnoses (as opposed to the more objective presence of a bacterial infection or an ACL tear). Such a brain scan would legitimize the careers of thousands of people and be deeply celebrated by insurers and physicians alike, as it would dramatically simplify the diagnostic procedure, but the scan would still just be "identifying brains that fall into several of these metrics 1-N we wrote down in the DSM". It would be possible to change the DSM such that the brain scan would have to be adjusted as well, which is very difficult to do with other conditions that are more obviously "real".

My two cents, although I admit I've put more like six cents into this thread in total, is that 95% of the suffering that those "with ADHD" experience come from poorly-designed schools and businesses, which keep them captured, tracked, and timed for deeply questionable societal benefits. I'm not about to say you can operate a space station or manufacture semiconductors or supply the US cold stowage network without a good amount of capturing, tracking, and timing, but I am going to say that much of the psychological torment ADHD-havers endure is because they're failing to live up to stupid, useless goals set by people with misguided ideas about why the goals exist.

[cj]

100% agree.

(I don’t normally reply just to say that, but it felt relevant given the thread)

[TeaBrain]

You misinterpreted the part of the comment you referred to. They aren't referring to redefining the word "disorder", but "the disorder", as in "ADHD". What they were referring to with the definition is how the definition of ADHD is completely arbitrarily defined, as the diagnosis isn't based on any genetic marker.

[hilux]

> ... how the definition of ADHD is completely arbitrarily defined, as the diagnosis isn't based on any genetic marker.

Did you know that 90% of cases of ALS aren't "based on any genetic marker"? Does that mean ALS is "arbitrarily defined"? What does that even mean? Are you saying it isn't real?

[TeaBrain]

I wasn't saying anything from my point of view. I was simply explaining the misinterpretation in the comment above, though I should have said biomarker instead of genetic marker.

[falcolas]

> the diagnosis isn't based on any genetic marker

Neither is depression, PTSD, autism, chronic pain, schizophrenia, narcissism, MPD, and so forth. But they all exist. And they can all be debilitating to the point of becoming a disorder. They all have treatments according to their classification.

Being invisible doesn't make it not be a disorder.

[cj]

We all agree it’s a disorder. No one is debating that.

[TeaBrain]

No one claimed disorders don't exist.

[dragonwriter]

> I think their opinion is along the lines of “no one is ‘inflicted’ by ADHD, and there is also no permanent cure for it, because the disorder can simply be redefined as being those who are in the lowest quartile or even the lowest 10% of X, Y, Z cognitive metrics.”

That's not how ADHD is defined, though.

> Imagine there were a pill that could boost your IQ score by 25% but in order to receive a prescription you need to have an IQ in the lowest quartile. Such a pill could also help already smart people simply become smarter.

Yeah, that's a nice hypothetical but that's not how ADHD meds work; boosting dopamine out of the normal range does not continue to have beneficial impacts to executive function, instead it leads to anxiety, insomnia, aggression, and hallucinations. That's one of the reasons dosing for ADHD meds tends to start on the low end and be carefully titrated up to what works for the individual.

[cj]

> That's not how ADHD is defined, though.

How is it defined?

> that's not how ADHD meds work

Are you saying no one without ADHD takes prescribed medication?

When I was in college people with prescriptions would sell their pills for $5-10 each (10+ years ago in Boston). That’s $300 for a month supply purchased by fellow students who weren’t diagnosed, but used it to cram for exams and studying and concentrating during exams.

If what you say is true, then the free market (black market) for adderall wouldn’t be so lucrative.

Perhaps you haven’t been exposed to the plethora of Instagram ads convincing kids they have ADD based on a 5 question survey and prescribed without any other criteria besides “is trouble concentrating impacting your work or personal life?” - these days it’s literally that simple, quick telegealth appointment, say concentrating impacts your work life, and there you have it, you officially have ADD.

This thread is going on a ton of tangents. My original point was simply that diagnosis is subjective and relative to the people around you. Second point is the meds will help anyone who takes it with improving concentration and making it possible to increase productivity substantially not just for short bursts but for extended periods of time (months/years). I think both points still stand

(And none of what I’m saying invalidates the seriousness of the disorder for people who “really have it”. I fully believe there are people who find the condition truly debilitating. But there are also loads of people who are diagnosed through instagram or TikTok ads because “concentrating is hard” and “motivation is difficult” and other obvious statements that resonate with a majority of college kids, for example)

[sibeliuss]

Queue https://www.latimes.com/california/story/2024-06-13/teleheal...

Everywhere, all the time, at all age brackets. It's absolutely terrible, having suffered a terrible amphetamine addiction in my past.

Sufferers of real ADHD need to understand that when people critique the guidelines, they're critiquing the fact that this is possible, and its leading to serious problems getting on with life.

[dragonwriter]

> Are you saying no one without ADHD takes prescribed medication?

No, I'm saying that the cognitive effect on function of someone without ADHD taking ADHD medicine isn't the same directionally as that of someone with ADHD taking it, the way the upthread proposed analogy of "a drug that increases IQ score by 25%" but which is only prescribed to those with IQ in the lowest quintile framed the situation. Excess dopamine impairs function in a different way that dopamine deficit, it doesn't increase it beyond what is seen with normal dopamine.

> If what you say is true, then the free market (black market) for adderall wouldn’t be so lucrative.

It is true, but the black market for adderall isn't mostly taking it for the same effect as people with ADHD are (some are, because there are still biases and access issues which prevent or delay diagnoses for people with ADHD, as well as deliberate, government-created supply shortages in the legal market.) But largely are taking it for wakefulness (an effect of dopamine surplus), and because dopamine surplus is part of the brain's reward system such that things which have been experienced which produce it are actively sought out. Again, this is why therapeutic dosages for ADHD are titrated to avoid going overboard.

[cj]

You should add an email address to your HN profile since HN frowns on replies like (but I’ll post it anyway):

I fully agree with your comment, and good take!