[tdpvb]

It's high because overdiagnosis.

- TED Talk - Recommend one of the most-watched TED Talks of all time, by Sir Ken Robinson. Gems such as, "If you sit kids down, hour after hour, doing low-grade clerical work, don't be surprised if they start to fidget." And, "Children are not, for the most part, suffering from a psychological condition. They're suffering from childhood."

- Book - Also check out the book, "The Body Keeps a Score". The concept of "pseudocertainty" is a key takeaway: symptomatic labels can be helpful to a point, but they're not explanatory -- it offers a false sense of conclusion, but no root cause analysis. It conflates "diagnosis" with "syndrome". For example cancer is a specific diagnosis, and within it much specificity of dozens of particular types of cancer. Whereas ADHD is a "disorder", or a "pattern of symptoms". ADHD as a pseudocertainty is self-referential: "I have ADHD" "What does that mean?" "It means I exhibit symptoms of ADHD" "okay, so what does that mean?" "it means I have ADHD" "sure but what does it mean? And more importantly, why do you have 'ADHD'? "

- DSM - The DSM defines how ADHD is diagnosed by two lists of nine symptoms each, from which a practitioner chooses six symptoms from each, and qualifies them as having "persisted for at least 6 months". That's the definition of medical cherry-picking. Some of the descriptions are, uncomfortably, exactly what one would expect from a small child: "Often fidgets with or taps hands or feet or squirms in seat." "Often blurts out an answer before a question has been completed." "Often has difficulty waiting his or her turn." Scary.

- Conclusion - And that's how children in the US, by acting like children, get themselves drugged up and labeled as "having ADHD". Or the poor kids just have mild- to severe trauma, or residual emotional anxiety, and instead of parents/teachers owning up to their part in it, or educating kids on how to self-regulate, or offering children meditation classes, they just drug them instead. It's the kids that are abnormal, surely it's not the adults' faults!

$$$ Oh and don't forget, the ADHD therapeutics market size in the US is ~$10B/yr. Good luck stopping that party.

[viraptor]

It's both over and under diagnosed. But you're overplaying some areas like people have no idea what they're doing. For example:

> Often fidgets with or taps hands or feet or squirms in seat

This is not describing typical kid behaviour, but self-stimulation. They're massively different. There's normally a follow-up discussion about the answers to that basic questionnaire.

If you watched that talk, take a moment to follow up with this one from Russell Barkley which addresses what's wrong with Robinson's views https://youtu.be/5jOwjbwU41o

> And more importantly, why do you have 'ADHD'?

Genetics and occasionally brain damage from accidents. That much has been proven in many studies - it's very much inherited.

[tdpvb]

Dr. Barkley's counterargument is essentially "it's preposterous to suggest that ADHD isn't well defined ... because clearly it is well defined," but that's a circular argument -- and still conflates "diagnosis" with "loose pattern of symptoms". He seems to get a bit emotional and take things personally; as if merely questioning the status quo of drugging kids implies that he is a bad person. Though we can't blame individual doctors for doing what they and the system institutionally thinks is best, it's still important to have critical, objective dialogue, even if it's uncomfortable. (Although my favorite de-motivational poster quote seems relevant here: "No single raindrop believes it is to blame for the flood".)

He also bristles that "They're only classified as Schedule II drugs!", etc. Let's be explicitly clear, they're amphetamine salts; we're drugging kids with amphetamine uppers.

Dr. Barkley is so (pseudo?)certain! Yet it all begs the question: How on earth did humanity survive back when cavepeople had such inadequate access to amphetamines?

Re: TBI leads to ADHD -- not saying that subcase is never true, but in the context of this thread, "why more US cases of ADHD vs. the world," unless children in the US suffer from proportionally more incidents of TBI to explain the uptick, then TBI isn't as relevant.

[viraptor]

> and still conflates "diagnosis" with "loose pattern of symptoms"

He doesn't, he's really precise about the naming in those cases. For now we don't have a better way to diagnose, but you can follow him review papers which do try to improve the diagnosis. If ADHD is defined in terms of symptoms, the diagnosis has to use those.

> He seems to get a bit emotional

Oh no, someone cares about their field of work being misrepresented. I'm glad it never happens in places like HN ;) You can listen to the arguments and ignore how he feels about the topic.

> Let's be explicitly clear, they're amphetamine salts; we're drugging kids with amphetamine uppers.

First, only one part of available drugs are amphetamines - there are other options. Second, they don't work for them the same as others. I've had the most relaxing naps after stimulants, which is not why others use them. I'm not sure what you're specifically against here - improving kids' lives by giving them meds that others can abuse for fun? Is this just about a moral take? Because we know that medication in ADHD lowers the chance of dying from multiple causes https://pmc.ncbi.nlm.nih.gov/articles/PMC10901868/

> How on earth did humanity survive back when cavepeople had such inadequate access to amphetamines?

Just like we do today. Some people have a bit worse experience with life than others. Is not like ADHD kills you in short term, just lowers the life expectancy.

[tdpvb]

There's definitely a moral aspect / undertone here (similar to many other topics).

I think also, disputes like this suffer from a double red herring of sorts, where folks argue past each other and confuse "whether a solution has efficacy" vs. "is there an alternate solution closer to the root cause that renders the initial problem moot".

In this case, "whether ADHD meds work" is a separate topic vs. "could most ADHD cases just be childhood anxiety, or mitigated with therapy, etc". Or diabetes: "$20B+ industry for insulin to lower blood sugar," vs. "why not just consume less sugar in the first place". Could it be that we're all be so busy trying to find solutions to a problem that itself is optional?

[const_cast]

> Let's be explicitly clear, they're amphetamine salts; we're drugging kids with amphetamine uppers.

If it saves them becoming smokers later, then good.

The reality is that people with ADHD will just medicate with other more harmful, more addictive stimulants like nicotine.

I'm willing to wager that a large reason why we "see" ADHD more is because we have less self-medication. Smoking is out of fashion. I'm sure in, say, the 70s it was trivial to be a high-functioning person with ADHD and never know it. I mean, every other person was smoking - you fit right in.

[tdpvb]

Also, can you please reference some studies that prove ADHD is inherited?

[viraptor]

https://pmc.ncbi.nlm.nih.gov/articles/PMC6477889/

There's a summary from lots of studies about it.

[tdpvb]

These studies are correlative but not casually conclusive. As in, yes there are genes that seem correlated with people who exhibit ADHD symptoms, but that doesn't mean the counterfactual is also true: "everybody with these genes will have ADHD, no matter what".

For example, if that were true then the DSM would describe a genetic test for ADHD, not an open-ended dragnet of multiple choice, "cherrypick from these 18+ descriptions of behavior".

[viraptor]

> These studies are correlative

Once you have population studies from millions and include separated/not twin studies to exclude environment differences, you really need strong arguments and theory why the inheritance is not the mechanism here.

> but that doesn't mean the counterfactual is also true: "everybody with these genes will have ADHD, no matter what".

Nobody claimed that. That's not how genes work. That's not how any(?) inheritable disease works. The whole paper is about quantifying the chances. Even the most basic thing like eye colour has a random element to it.

> if that were true then the DSM would describe a genetic test for ADHD

There's no simple mapping and the candidates for complex interactions are in 200+ range the last time I've seen. There's no "you have this one gene, you have ADHD" and nobody claimed that. The work on narrowing down how exactly the candidates interact / get expressed is still ongoing, so hopefully one day we will have a genetic test.

[tdpvb]

Right, so then "ADHD genes" are only correlated!

(You'd said, "it's [ADHD] very highly inherited" -- which sounds declaratively causal. But if you didn't mean this as a causal statement, then cool. No worries.)