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fraa comments on Do you have High-Functioning Asperger's Syndrome? - Less Wrong
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Yes, I'm sorry, I had a mini-panic episode. It's absurd for me to react in these ways, all my posting so far was automatic talk which I didn't actually think. I'm still recovering from years of untreated anxiety and ADHD. I will post something coherent when I'm better.
I upvoted all your comments, and I understand completely: you're saying that ADHD is an accepted clinical diagnosis and that you don't think people here would agree with the bizarre, lunatic-fringe conspiracy theory that it's just a way of drugging kids who misbehave. Unfortunately, there are even people here who believe in 9/11 conspiracies, so don't get your hopes too high.
Unfortunately, it is both. There are people who have a real clinical disorder who need drugs. But there are also people who are getting diagnosed with ADD or ADHD with minimal justification.
At a greater rate than for other disorders? Any diagnosis will have a possibility of error, but that's different than calling into question the entire disorder, which is what the conspiracy theories try to do.
Right. I'm not calling the disorder's existence in question (people who do so are being stupid), but the extreme difference in European and American diagnosis rates suggests that the US has a very high overdiagnosis rate. I don't think it is useful to compare it to diagnosis rates in other disorders since many other disorders have much more clear cut standards for diagnosis. I don't know if ADHD has a higher level of incorrect diagnosis compared to other mental health disorders.
Why wouldn't it suggest that Europe has a very high underdiagnosis rate?
Good point; mental disorders are much more blurry. I'm curious, for instance, if there is an ADHD spectrum, like the autism spectrum, and if it blends into normality, or if there is a sharp divide between NTs and people with some degree of ADHD.
Exactly what I thought when I read the argument in question.
If the studies referenced in the back of Hallowell are to be believed the prevalence of ADHD has been found to between 5% and 8% across 5 continents.
To paraphrase a FAQ in the same source: Is ADHD over-diagnosed or under-diagnosed? Unfortunately, both. In some regions it is over-diagnosed and over-medicated but in others it is underdiagnosed because people (teachers, parents or doctors) "don't believe in ADHD".
Very much a spectrum, in a similar way to an autism spectrum. In fact, a majority of people who qualify for an autism diagnosis would qualify for an ADHD diagnosis too if they didn't have the autism label already.
There is no sharp divide. There are also many people who have ADHD traits in the extreme who would not be said to have ADHD because their personality (and brain functioning in general) is not interfering with their life. So roughly speaking ADHD means having a certain cluster of traits to a significant degree greater than average or in a way that obviously interferes with your life.
My conclusion in that regard is based to some extent on anecdotal evidence in that I've seen in the US people diagnosed where it seemed clear that they didn't. I'm aware of multiple cases where a diagnosis was essentially an excuse to get Ritalin as a study aid.
I wholeheartedly advocate the gaming of the medical system to get what you need or want out of them. Both because i disrespect the competence of that system in giving people what they need and because the institutions and lobby groups in question have no intrinsic right to control access to treatments or collect rent in the process.
My advice to all moderately intelligent patients is to have one (or multiple) doctors that you use for their expertise and another doctor that you go to to get then to scribble on those ridiculous pieces of paper. The latter you lie to as necessary if it helps you jump through the hoops more efficiently.
Lying to doctors is in general a very bad idea. Lying to them about what drugs you are taking is dangerous. Part of their job is so know what drugs will interact with what other drugs or diseases. Lying to doctors makes them much less likely to be able to do that well.
Accurate Assessment is what the first few doctors are for; the doctor you lie to is explicitly only there for the sake of getting drugs.
You could always just tell the truth to your pharmacist. Short of concerns about abortion or birth control, they're much less likely to impose their moral judgments on you, and collect next to nothing in the way of economic rents.
You don't have to outright lie, just emphasize different symptoms. For instance, on a diagnostic questionnaire for ADHD, depression, or autism, I could score very high or very low and remain completely honest, just by interpreting the questions in slightly different ways.
I have made it clear that I do not share your faith in the medical priesthood. Adding to what Mass Driver has already said I will suggest that pharmacists are also a whole lot better (on average) than doctors at avoiding potentially dangerous drug combinations.
I make that conclusion partly based on what I discovered while working in medical education. You know, trying to teach evidence based practices to a bunch of middle aged men (for example) who happened to have done a medical degree 25 years ago and since then have been too busy to significantly educate themselves beyond what they read in the edu-tisements from the pharmaceuticals. But if you prefer anecdotal evidence I have personally had to tell a doctor "No, you can't give me that, I will get Seratonin Syndrome and I will die.) My pharmacology professor also deal with a doctor who was trying to medicate his daughter with a drug that was known to interfere with his daughter's medical condition. He had to warn the doctor "No. No, it's NOT safe. If you do not change this prescription I will sue you. By the way, I have a PhD in Pharmacology."
Doctors are just people. If you want to ensure your optimal health, and your safety you need to take personal responsibility for your own medical treatments. As I originally suggested this will involve finding competent experts you can trust (and even doctors go to other doctors). But it doesn't mean you are best off submitting to whatever treatment has managed to make (or buy) its way into being the default mainstream practice.
Seeing doctors is primarily about a ritual affiliation with high status people, not about optimal health. When it comes to everyday things like treating infections and identifying common maladies I will take a doctor at his or her word. It is something they deal with every day and deal with well. But when it comes to any psychological condition or any condition that is uncommon you need to both shop around and to do your own research. It is often easy to find correct contrarians. Usually this is either because a) Medical practice has not caught up with research, b) optimal treatment is not in patent, c) formalized traditions (eg. performance metrics) make the payoff for doctors different from optimally treating patients or d) the "nobody ever got fired for buying IBM" effect.
If someone would benefit from Ritalin as a study aid, doesn't that mean that they have difficulty focusing and studying as much as they would like? Isn't that essentially what ADHD is?
That's not the definition of ADHD as it is normally defined. Indeed, many (if not most) humans would be more focused if they took Ritalin. But using it so that one can for example waste a few months and then spend 72 hours cramming for a test definitely doesn't count as ADHD by most reasonable definitions.
In fact, that is something that comes naturally to many people ADHD. "Attention Deficit" would often be better described as "attention variability". Many of us with ADHD also benefit from overfocus. This can mean extended periods (particularly when under pressure) of enhanced attention that can mean performance well beyond that of a 'normal' person with similar IQ.
Ironically, where a neurotypical person may use amphetamines to pump themselves up or so they can waste a few months then cram for 72 hours an ADHD individual would use amphetamines to calm themselves down and so they don't spend a few months wasting time and then have to cram for 72 hours.
ETA: I agree that the vast majority of people will benefit from Ritalin or Adderall when studying, at least for things that require rote learning or rigid thinking (ie. most exams). Which reminds me - if you want to identify ways to enhance brain function in healthy people a good place to start looking for leads is by browsing the treatments for Alzheimer's.