It's a great illustration of the lack of rigor around this stuff.
My college provided significant benefits to ADHD diagnosed students. Rather than take finals in stadium seating, you got a personal, air conditioned office, received unlimited time and could use reference material.
A few of my friends found a "Do you need Ritalin" quizzes in a magazine, went to a doc-in-the-box and got the diagnosis. They sold the Ritalin and got better grades.
This is very belittling to the amazing amount of research that goes into ADHD.
Many studies have been done with regard to treatment and diagnosis, and at this point we are better able to treat ADHD than we are able to treat depression
There might be a bit of an over-treatment culture (I'm not sure, though), but the science is extremely well developed and tested
There's a big difference between the rigor of the question of whether ADHD is a real thing or that of ADHD diagnoses being reliable in practice.
There are huge regional variations to rates of ADHD diagnosis. For example, it's 3.5x higher in North Carolina vs. Nevada. There doesn't seem to be any reason why this would be given that ADHD is believed to be almost entirely genetic.
I had to take a long questionaire, a computer program testing focus/reactions, and a comprehensive IQ test before I was diagnosed with severe impairment from ADHD a year ago. In fact, I was originally diagnosed with ADHD after taking a comprehension IQ test to get accepted to kindergarten at a magnet school, but my parents figured it was just a phase and never did anything about it.
It's frustrating to think about the lack of consistency in ADHD diagnosises and treatment. In /r/ADHD (ADHD subreddit), some people get diagnosed after a few minutes of talking with a psych. Others live in countries where ADHD isn't even considered a thing. Many went through the same rounds of tests that I did. Even after diagnosis, I had the same problem as several /r/ADHD members in that the first psychiatrist I went to looked at my psychologist's diagnosis and was like "Meh, you got decent grades in high school anyway. You're just stressed/tired/depressed/etc." Wasted my time with four months on four different depression medications before I got a second opinion.
My (UK) diagnosis was an endurance test. It took 2 years of consultations, appointments and referrals to get a diagnosis. Of course, this is the NHS so everything non-life threatening takes longer but if there was no impact day to day there would be no motivation for the many hoops and consultations. Due to the nature of the beast, many who do suffer could drop out of such a marathon because, for example, their referral form had fallen underneath a filing cabinet due to a chaotic office and thus forgotten about by both sides (happened to me - called up because after 3 months after prodding by my mrs. She was going insane).
Overdiagnosis is almost a cliché. This might happen in some places. There are just as many that the diagnosis is painful and thorough.
Genetic predisposition doesn't mean a guarantee. There are often environmental factors.
Also, you're assuming two things: 1) that genes are evenly distributed among the population, which they're not. And, 2) that diagnosis and treatment options are the same everywhere, which they're not.
I don't think you can responsibly state that the science is "well developed and tested" when we are prescribing dangerous medication to children to treat the fact that they were born in October.
Obviously, the diagnostic protocol that allows such a situation needs some work.
This is off of the top of my head, but something like 50% of people treated for depression show positive response for the treatment, and 20% achieve "full recovery" (still on meds but the symptoms linked to depression are basically gone while on meds). Meaning these people can move on with their lives not having to deal with this.
Medicated treatment for ADHD has hit even higher numbers. Something like 70% of patients respond positively to medication (sometimes takes a while to get the right medication though), and 45% achieve full recovery (that is to say, ADHD stops being an issue for them if they're on their meds).
I mentioned this because conventional wisdom is something like: "Yes, depression as a chemical imbalance is a thing that exists, and you can kind of do something with it through treatment." But a lot of people are also "ADHD might not even be a real thing and is a result of helicopter parenting and lazy kids". But the science is much further ahead on understanding ADHD and treating it on ADHD than depression.
I consider it one of the great paradoxes of modern thought that the loudest proponents of evolutionary theory are often the loudest proponents/defenders of pharmaceutical-based treatment for mental illness.
So the logic is:
- evolution is this amazingly powerful process that has resulted in the development of a vast diversity of astonishingly sophisticated and beautiful species of plants and animals, with the most advanced observed to exist in the known universe being the human inhabitants of planet Earth. However...
- a significant portion of this most beautifully evolved and advanced species are unable to function successfully without the use of medication to alter the naturally evolved chemical activity of their brain.
Personally I believe the first statement too much to be able to accept the second.
That is: I believe that conditions like depression and ADHD have evolved for a reason, and to suppress them with chemicals rather than understanding the reasons for their existence and responding to those reasons is to devolve or suspend evolution.
Where the paradox becomes so profound and damaging is that the people who go to serious effort to understand these conditions and to develop and advocate non-pharmaceutical methods of treatment, are often condemned and mocked as un-scientific.
But mercifully the tides are changing, and I can see a time in the future, not all that far off, in which we look back on the practice of dealing with non-compliant kids by feeding them amphetamines as one to be viewed with great shame.
ADHD is a trait that drives a need to explore, to discover - it's a handy gene if you're a tribal nomad, and going finding that cool new valley will allow your genes to survive.
If you're a first world schlub, however, it prevents you from sitting tidily in your little box and people get mad and you get sad, because conformity is identity. Your genes only get passed on to a sports sock. There are no new valleys to discover.
So it works with both ideas - and depression isnt dissimilar - old adaptation for dealing with sickness, injury and winter that just isn't helpful anymore.
Cage a bird and you need to adapt its diet and care. Same with humans.
It just needs the right kind of awareness and encouragement.
Cage a bird and you need to adapt its diet and care. Same with humans.
Indeed. And my hope (and belief) is that we'll soon see much better techniques than amphetamines for providing said care. Opening that metaphorical cage is probably a big part of it.
Do you also advocate stopping cancer treatments? Stopping vaccinations, because not getting smallpox is interfering with evolution?
Evolution doesn't happen for a reason. The whole point of evolution is that our biology and the way our brains work is bafflingly random at times. Depression is a crippling mental illness, it doesn't happen for a reason.
Hi there. I'm sure you're well-intentioned, but this isn't a very charitable or productive response, and it contains at least 3 argumentative fallacies.
Responding to your points...
Do you also advocate stopping cancer treatments?
No and that's a misrepresentation of what I said.
I didn't say we shouldn't treat mental illness.
I said we can do better than giving amphetamines to children as a way of dealing with aberrant behavior, and that perhaps the key to finding the best treatment is likely to be found by understanding (not denying) its evolutionary origins.
I believe this to be true as I've seen this approach work on myself and others.
Stopping vaccinations, because not getting smallpox is interfering with evolution?
Again, I didn't say we shouldn't treat. And I'm not antivax, no.
When done right, vaccination enhances evolution. (FWIW I'm less convinced about giving flu shots to people with healthy immune systems for the same reason most sensible people are concerned about over-prescription of antibiotics).
In short, I'm fine with any medical intervention that steers the world further down the right path (I.e., enhances evolution).
I'm very confident that the widespread prescription of amphetamines to children will one day be shown not to be good for the world.
Evolution doesn't happen for a reason. The whole point of evolution is that our biology and the way our brains work is bafflingly random at times.
This not a statement of established fact; it is a statement of your understanding of evolution, which may or may not be complete or correct.
But natural selection is not a random process. It is a very deliberate process of adoption and distribution of traits that benefit the species.
So the fact that depressive and ADHD-like behaviours exist in so many people across many different regions and cultures, indicates that they have been positively selected and reinforced over many generations.
Another commenter in this subthread has offered a very plausible explanation as to why this may be.
Depression is a crippling mental illness
Trust me, I know, I've had it for much of my life and have witnessed many other lives be destroyed by it.
it doesn't happen for a reason.
Well for me the key to overcoming depression was discovering that it does have a reason, then addressing that reason at the most fundamental level (genetic expression).
And now I plan to devote as much of the rest of my life and available resources as I can spare, to researching the topic so more people have the chance to be saved from this menace.
Assuming that what you want is a complete end to mental illness - for everybody, regardless of their genetic predisposition - we both want the same thing.
> Drug treatment is not indicated as first-line treatment for moderate ADHD.
> Offer parents or carers referral to a group parent-training/education programme on its own or with other group treatment (CBT and/or social skills training) for the child or young person.
> Consider individual psychological interventions (such as CBT or social skills training) for older adolescents.
> Where ADHD is present with a learning disability, offer referral to an individual or group parent training/education programme according to the preference of the child or young person and the parents or carers.
In England children should only be getting medication if they've been through a rigorous assessment and are seen as needing those meds.
Yeah I think it's particularly bad in the US, where society has "advanced" to the point where the attitude of "there's a pill for that" seems to apply to pretty much any life setback.
Of course I oversimplify; I know not all people/doctors/regions are like that.
And I do see some of that kind of attitude among some in Australia too, but societal attitudes and the government controls on pharmaceuticals that exist here and the U.K. keep things more moderate.
As someone who has dealt with ADHD both with and without medication, at least from my experience this line of reasoning leads to much pain.
I cannot speak for those with depression, but ADHD has easily tripled the amount of stress I have in my life, if not more. It causes impulsive behaviour that can wreck relationships(both personal and professional), and makes it extremely hard to concentrate on many things that aren't totally gamified from the outset.
There's a trope about how ADHD ends up being a gift because of creative thoughts coming to you, and that the medication will dull your senses... but I don't buy it too much. There have been studies that have measured no noticable difference in "creative capabilities"(hard to measure, granted) when being medicated and non-medicated.
Before being put on medication, I had never finished a single piece of homework in my life. Afterwards I was able to finish the homework assignments before class was even over. I would study autonomously, and was able to reach my full potential because I was able to manage my thoughts for the first time in my life.
There is no moral high-ground to not medicating oneself, just like there is no moral high-ground to using crutches when you have a broken leg. Asking me not to medicate is the same as asking me to go through meaningless suffering in almost every social interaction. Countless studies have shown that medication is much much more effective than any form of behavioural therapy (and that BT has an extremely high failure/"relapse" rate).
I don't think it's right to mock people looking for non-medical treatment, because various reasons mean you cannot have access to alternatives.
But medication has been proven to be very effective, and BT has proven to be a very difficult path... if you are a parent of a child suffering from ADHD it is your duty to at least explore the medication option in my opinion.
There is likely to be no higher reason for ADHD and depression to exist. We have looked at "normal people's" brains, and see that for depression/ADHD some things work differently. And that these people tend to have lower-quality lives because of a lack of something... It's hard to argue that there's a reason for it all except in some religious context. It's not like there's a higher reason for brain tumors either.
As an aside, despite the fact that I currently love where I live (Japan), I always consider moving back to the US if only to get access to medication that is illegal here. My life is a lot shittier (still great overall though) because of some drug laws. I have spent a lot of time working on different non-medical coping techniques that have helped out a lot, but nothing matched the chemicals.
I'm sorry to give the impression that I think you and those like you should suffer without treatment.
I really don't.
And I don't believe ADHD is a myth or anything like that. Quite the opposite.
I just believe we can do better that what the medical profession currently offers.
I mean, don't you think it would be a shame if we couldn't?
Don't you think it would be great if we could come to fully understand mental illness at a fundamental level, then develop treatments that gave you even better health than what you've already experienced, without the need for stimulant drugs?
There is likely to be no higher reason for ADHD and depression to exist.
Not wanting to labor the point on a topic that's clearly sensitive to you, but in short: evolutionary theory says there must be a reason why these traits are so widespread.
Countless studies have shown that medication is much much more effective than any form of behavioural therapy (and that BT has an extremely high failure/"relapse" rate).
Yes I can accept that. Behavioural therapies tend to be formalised ways of telling patients to "just try harder". They fail because the real issue is below the conscious mind (where "trying harder" works), in the subconscious mind and in the physiology (organ function, gene expression).
My personal experience is that there is a highly effective approach to treatment that works both on a physiological (all the way down to gene expression) level and a subconscious emotional level.
It may not be widely known or adopted yet, but it is attracting growing interest among ordinary people looking for better answers, if not mainstream science researchers, yet (due, I think, to the perverse economic incentives that prevail in that field, and the professional disincentives to pursue unconventional theories).
But from what I can see, it's just a matter of time.
There's probably over diagnosis, but since ADHD medications are safe at low doses, there's not much downside with over diagnosis. On the other hand, there's 2-8% of the general population that has ADHD, and those individuals gain significant benefits from medication.
If you're unsure if ADHD really exists, it may be useful to read the genetic studies that show ADHD correlation with specific SNPs, and decide for yourself [1]. Personally, I find the evidence satisfactory.
That said, I personally believe that ADHD type symptoms could be caused by several different disorders. ADHD is kind of like bipolar disorder - it covers a lot of areas and is sort of a fallback category when other diagnosis don't fit.
But the doctors prescribing the amphetamines aren't thinking about actual solutions or alternatives; they just go through the motions and cash checks.
My roommate was one of the largest Adderall prescribers in the United States. He has 20 cars, 3 homes and brags that he spends money "like a trillionaire". If you ask him where he lives, his response is, "what day?"
He is about 150 pounds overweight, dresses like a 90s rockstar and usually drives a Lamborghini Aventador. I don't trust he is impartial or an expert in his prescribing people what is effectively a daily routine of methamphetamine.
I know a few people who are prescribed Adderall who have attempted suicide. It's very easy to abuse amphetamines and abusing them makes one irrational. Meth has destroyed my hometown and as Dr. Carl Hart states, there is really no difference between Adderall and methamphetamine.
It is very dangerous to suggest that you can cure lack of focus by amphetamines, or that somehow this "ADHD" disease can only be cured by amphetamines.
you got a personal, air conditioned office, received unlimited time and could use reference material [...] They sold the Ritalin and got better grades
As unfair as that seems to the students who took their finals in stadium seating, that's a pretty sweet hack. The system is fucked up, but I can't help but admire your friends deciding to use it to their advantage.
Really? Lying about having serious developmental disorders is a 'sweet hack' now?
I mean, the comments below are overstating things but the danger of amphetamine addiction (especially for people who are using the meds off prescription and are more likely to do especially risky behaviors like snort it) is there and selling the Ritalin is a felony and everything about this story is actually pretty terrible.
> Lying about having serious developmental disorders is a 'sweet hack' now?
Your perspective on this will depend on whether you lean towards legalizing substances and taxing them. I personally think the prohibition of drugs does far more damage than consumption, and I consider this scenario to be similar to the easy access to medical marijuana - all it took was filling out a quiz and getting an easy diagnosis. Reselling marijuana is illegal, but it's an everyday occurrence that fills DEMAND.
> using the meds off prescription and are more likely to do especially risky behaviors like snort it
As long as you support the legality of alcohol, your worry about someone hurting themselves on drugs ignores the everyday harm already done by the most dangerous yet easily acquired behavior-altering substance. As for snorting amphetamines - people have been snorting, smoking, and imbibing things since the early days of humanity. It won't be going away soon and, until it affects you directly, it's none of your business really.
>Your perspective on this will depend on whether you lean towards legalizing substances and taxing them.
Fairly libertarian, but thanks for your patronizing attitude.
Lying to get an unfair advantage over other students isn't positive sum behavior. It's zero sum behavior that leads to things like red queen races (https://en.wikipedia.org/wiki/Red_Queen%27s_race) and everybody having to compete for unlimited time related benefits. A competition which then eats up the supply of this resource for the people it exists for: Actually disabled people with ADHD.
Your perspective here is akin to saying that in a busy parking lot there's demand for the disabled parking spaces, so people who go out and lie about their ability so they can park in the handicap spot are performing a 'sweet hack' to get around a 'fucked up' system.
> A competition which then eats up the supply of this resource for the people it exists for: Actually disabled people with ADHD.
If the system is so flimsy that the only thing preventing abuse is a quiz and a doctors certificate, who are the "Actually disabled people with ADHD"? If diagnosis is so easily achieved and the rates of diagnosis around the world fluctuate so greatly, you should ask whether it's a largely inflated phenomenon and we need to reassess what it is and how we deal with it. Similar to depression, we seem to be medicating for slight deviations from what has been deemed normal, which is quite scary.
As for the act itself, if they were stealing the answers to a test then I wouldn't say it was a sweet hack, I'd say they were cheating. However if you're willing to provide the benefit of an office, additional time, adequate cooling and access to reference material to a specific group of people, I say take what the system will happily give you or anyone else who goes through similar motions.
>If the system is so flimsy that the only thing preventing abuse is a quiz and a doctors certificate, who are the "Actually disabled people with ADHD"?
You're right, the biggest lesson to take from that story is perhaps we should give patients a bit more scrutiny before giving them an ADHD diagnosis. This is still not a 'sweet hack', nor is it laudable behavior.
> However if you're willing to provide the benefit of an office, additional time, adequate cooling and access to reference material to a specific group of people, I say take what the system will happily give you or anyone else who goes through similar motions.
You're right, from a game theory perspective in the long run we should expect 'rational' actors who aren't punished for doing this to do it until we start punishing them for doing it. That is completely orthogonal to the question of whether this is the incentive structure and behavior we actually want. You're basically saying people should push any system as far as they can before the system pushes back. This is what a low-trust society looks like and it's not pretty. One of the major benefits you get living in a 1st world country is the reasonable expectation of good behavior from most people you interact with.
Part of maintaining that is social disapproval of people who are cheating off the charity of others.
> from a game theory perspective [...] expect 'rational' actors
IMO, the problem with taking a complex situation and reducing it to game theory is that you can miss some of the nuance and end up with binary results that don't fully agree with the mushy reality of human society. It's useful for constrained scenarios. Perhaps if you were dealing with a purely psychopathic, transaction-focused population it would be suitable.
> You're basically saying people should push any system as far as they can before the system pushes back.
Not at all - perhaps what's ultimately learned is that better conditions should be provided to all students. Just as we might want basic care extended for all persons, rich and poor, rather than means testing it. That way security is baked right in, everybody benefits, and there's less administrative process.
Your description of your school's accommodations surprises me. I looked into the one for my school and it appears much stricter. Just having ADHD doesn't cut it -- a full write up is necessary. In other words, wouldn't be worth the hassle to fake it.
"A full write-up" is mostly to satisfy the bureaucracy.
At a high level, it contains: a label (the name of the condition you have), some proof (anecdotes demonstrating that you meet the criteria for the condition), and some recommendations (accommodations that the expert thinks are reasonable, such as a separate room or extra time).
When I was a kid, my psychiatrist got the anecdata from the parents. But write-ups are only valid for something like 5-10 years, so I had to get a second one when I got into college -- and for that, my school sent me to a local psychologist (non-doctor) to get an "updated" write-up. The psychologist did the write-up mostly with stories I retold during our meetings.
When I was in school, the accommodation I wanted was permission to leave the exam room early when I finished my exams. The accommodation that was written in my file was "write in a separate room" (which, in practice, meant that the special education staff who supervised me had the discretion to let me out early), and "30 min extra time for every 1 hr of exam time" (because this is the "normal" accommodation that justifies writing in a separate room).
Here's the entire epub buddy. Please edit your post, gosh.
""By adolescence, these chronic and cumulative experiences with school failure, learning disorders, school misbehavior, and sometimes lower intelligence begin to generate other adverse educational outcomes. For instance, the academic outcome of the hyperactive (ADHD) adolescents was considerably poorer in Barkley and Fischer’s Milwaukee follow-up study at the teen follow-up than that of the typically developing adolescents followed concurrently. At least three times as many hyperactive (ADHD) children had failed a grade (29.3 vs. 10.0%) or been suspended (46.3 vs. 15.2%) or expelled (10.6% vs. 1.5%) (Fischer, Barkley, Edelbrock, & Smallish, 1990). Others have also identified such high educational risks in longitudinal studies dating back as much as 40 years (Ackerman, Dykman, & Peters, 1977; Mendelson, Johnson, & Stewart, 1971; Stewart, Mendelson, & Johnson, 1973; Weiss, Minde, Werry, Douglas, & Nemeth, 1971; Wilson & Marcotte, 1996). In another sample of clinic-referred teenagers with ADHD, a similar risk for school retention and suspension was documented (Barkley, Anastopoulos, Guevremont, & Fletcher, 1991). Almost 10% of the hyperactive sample followed into adolescence had quit school at this follow-up point in the Milwaukee Study, compared to none of the normal sample (Barkley, Fischer, et al., 1990). Fischer and colleagues (1990) also found that the levels of academic achievement on standard tests were significantly below normal on tests of math, reading, and spelling, falling toward the lower end of the normal range (standard scores between 90 and 95)." (Quoted from the 4th edition)"
"Substantially fewer hyperactive than control children had ever enrolled in college (21 vs. 78%) or were currently attending at this follow-up point (15 vs. 66%). These findings were reaffirmed 6 years later at the age 27 follow-up (Barkley et al., 2008). In the Canadian follow-up study, approximately 20% attempted a college program, yet only 5% completed a university degree program, compared to over 41% of control children (Weiss & Hechtman, 1993). The longest running (30-year) follow-up study of hyperactive children into midlife likewise indicates that less education is an outcome of childhood ADHD, with 30% either not completing high school or getting a general equivalency diploma (GED), compared to just 4% of the control group (Klein et al., 2012). These findings demonstrate that the educational domain is major in terms of impaired functioning and reduced attainment for children growing up with ADHD."
Chill out. I didn't claim that ADHD doesn't exist. I asserted that there is a lack of diagnostic rigor in diagnostics and implied that the incentives are aligned to provide over diagnosis.
We've moved to a model where "raising standards" in education and increased evaluation of teachers equates to formulaic, inflexible school curriculum that younger kids cannot handle. So they act out and get referred for evaluation. My public school district begins assessing children using computerized testing starting in November of the kindergarten year. There's a big difference between a 5 year old born on January 1 and a five year old born on August 1, and those later born kids are going to get labeled with mental health conditions for life and drugged because they are square pegs that don't fit in the prescribed round hole.
The article didn't claim that ADHD doesn't exist either. A key quote:
> Zoëga says the only country studied so far where the relative age of young children doesn't seem to have an effect on ADHD diagnosis is Denmark, where there's more flexibility for when children enter school
Bullshit ADHD diagnosis are bad for people like you who are genuinely affected, as the resources available to help you end up getting shared and stretched to cover disciplinary and structural educational problems. A non-ADHD child isn't helped by ADHD prescription and unnecessary services, and an ADHD child isn't helped by not getting the attention he needs.
> Bullshit ADHD diagnosis are bad for people like you who are genuinely affected, as the resources available to help you end up getting shared and stretched to cover disciplinary and structural educational problems. A non-ADHD child isn't helped by ADHD prescription and unnecessary services, and an ADHD child isn't helped by not getting the attention he needs.
I'm interested in you developing the last thought you had.
My dumb friend in the 90s scored a phoney diagnosis and got an expensive prescription and an expensive accommodation for free. He wasn't alone, and the insurance dollars consumed and "reasonable accommodations" obtained took away or raised the cost of things that you actually need.
?? Do you know how much has changed since the nineties? There's ecological EF deficit tests now(barkley's). Yeah like one guy getting an odd diagnosis is enough for you to continue your opinion.
This is just classical bayes rule dude, there will be a lot of false positives _no matter what_ unless the diagnosis rate is an absurdly high number. You're blaming other people for not knowing that's the way the numbers always come out?
> Suppose that you are worried that you might have a rare disease. You decide to get tested, and suppose that the testing methods for this disease are correct 99 percent of the time (in other words, if you have the disease, it shows that you do with 99 percent probability, and if you don't have the disease, it shows that you do not with 99 percent probability). Suppose this disease is actually quite rare, occurring randomly in the general population in only one of every 10,000 people.
This doesn't surprise me. My youngest is a July baby and was constantly in trouble up to around the age of 11, for being a bit silly and immature. We, as parents, got to realise this and would often say, "If he was in the year below, his behaviour wouldn't be unusual."
Or middle class children with behavior that annoys their parents.
Well, it's both that and a legitimate medical condition. The problem is that the medication that works for ADHD also works for suppressing childish behavior that authority figures find annoying. Everyone involved are fallible humans that respond to incentives, and often the incentives align for teachers, parents, and psychiatrists to medicate children into compliance.
The thing is, the youngest child is not just taken to the specialists with the suspect of ADHD, it really is diagnosed with ADHD. Gifted children also diagnosed frequently with ADHD, they even have a name for it, twice exceptional. The ADHD comes to me like a deviation from the social standarts. What's normal, and what's not. For most children, ADHD is not a cause of worry until school age. The normal student is defined by current education system. ADHD comes to me like being gay, you are not sick or nothing's wrong with you, just different than the average, and have problems with fitting in the current social standarts.
Is there anywhere that divides up their younger grade classes into who is born in the first half of the educational year and who is born in the second half? That could help somewhat although the teacher of the second half kids probably is going to have a tough time.
I don't see how that solves the issue, as it just moves (w/ optionality) the cutoff from 1st Sep back a few months. Meaning if everybody opted in, the spring kids would become the youngest in class, instead of late summer kids.
Edit - I see this helps ensure kids don't start Reception (ie, the equiv of Kindergarten in the US) too early. But it also shifts the point of youngest back a few months, so in later years, the kids born in spring season will be the least mature in class, and judged in this regard relative to the others.
Exactly, it just changes which group of students are in the "too early" group. When I start a new job, they don't say, "Well, your job offer was made on 12-May, but our fiscal year starts in April, so you'll have no choice but to wait until 1-Apr to start work." The solution likely involves abandoning the model of childhood education consisting of fixed, arbitrarily-long cycles beginning on arbitrarily-chosen dates, progressing linearly. But when you leave it up to voters, abandoning "The Way Things Were Always Done" is about as impossible as curing cancer.
Once upon a time no such reference letters existed, you had slow kids, fast kids and middle of the road kids. All of a sudden kids are getting the labels as if they belong on supermarket shelves. An old schooler would say there's a cure for that, either bad parenting, not eating the right foods or balanced diet, bad sleeping pattern. Or basically some parents just like to get extra government money to support their own needs. (I know a family that's done this - and it's disgusting) What's next?
"By adolescence, these chronic and cumulative experiences with school failure, learning disorders, school misbehavior, and sometimes lower intelligence begin to generate other adverse educational outcomes. For instance, the academic outcome of the hyperactive (ADHD) adolescents was considerably poorer in Barkley and Fischer’s Milwaukee follow-up study at the teen follow-up than that of the typically developing adolescents followed concurrently. At least three times as many hyperactive (ADHD) children had failed a grade (29.3 vs. 10.0%) or been suspended (46.3 vs. 15.2%) or expelled (10.6% vs. 1.5%) (Fischer, Barkley, Edelbrock, & Smallish, 1990). Others have also identified such high educational risks in longitudinal studies dating back as much as 40 years (Ackerman, Dykman, & Peters, 1977; Mendelson, Johnson, & Stewart, 1971; Stewart, Mendelson, & Johnson, 1973; Weiss, Minde, Werry, Douglas, & Nemeth, 1971; Wilson & Marcotte, 1996). In another sample of clinic-referred teenagers with ADHD, a similar risk for school retention and suspension was documented (Barkley, Anastopoulos, Guevremont, & Fletcher, 1991). Almost 10% of the hyperactive sample followed into adolescence had quit school at this follow-up point in the Milwaukee Study, compared to none of the normal sample (Barkley, Fischer, et al., 1990). Fischer and colleagues (1990) also found that the levels of academic achievement on standard tests were significantly below normal on tests of math, reading, and spelling, falling toward the lower end of the normal range (standard scores between 90 and 95)." (Quoted from the 4th edition)
ADHD IS real and really bad and it goes away on meds, your brain is underdeveloped 30% compared to your peers, in exec functioning. So if you're 18, you're at 12.5 on average. It's called Barkley's 30% rule.
It's serious but responds great to meds, STOP believing the anti-adhd hype.
This article fails to admit the possibility of mistaken non-diagnosis caused by the same phenomenon. It would be interesting to see the relationship between being old for grade and late (eg adult) diagnosis of ADHD.
"But perhaps older, more mature-looking students are just being underdiagnosed and not get help they might need, he says. The studies didn't look into that."
Can you expand on your criticism? I've heard people offhandedly criticize Gladwell's work but I've never really gotten a full explanation of why they dislike his style.
> The youngest students were between 20 percent and 100 percent more likely to get the diagnosis or ADHD medication than were the oldest students in the cohort, says Helga Zoëga, an epidemiologist at the University of Iceland who worked on the Icelandic and Israeli studies.
> "Within that age range there is a huge difference in developmental and social and emotional maturity," says Dr. Adiaha Spinks-Franklin, a developmental and behavioral pediatrician at Texas Children's Hospital who was not involved in any of the studies. "A 6-year-old is just not the same as a 7-year-old."
> And yet a first-grader might stand shoulder to shoulder with another student nearly 12 months her elder. "And the way we diagnose ADHD is we talk to the parent about the child's behavior, and we mail the teacher questionnaires," Spinks-Franklin says. "The teacher will be comparing the child's behavior relative to other children in the class."
That is disturbing. It is clear they aren't taking age into account except at the broadest levels when handing out ADHD medication.
This rings dangerous close to "That kid is too much trouble, just medicate them and move on."
ADHD is a developmental disorder, they're 30% behind their peers anyways in exec functioning(front part of brain) in development, it's called "Barkley's 30% rule" It's very severe and bad but goes away if you just take your meds.
So if you're 18, you're when people were at 12.5 in your ability to perceive time/planning. It's worse than having low intelligence, EF deficits.
""By adolescence, these chronic and cumulative experiences with school failure, learning disorders, school misbehavior, and sometimes lower intelligence begin to generate other adverse educational outcomes. For instance, the academic outcome of the hyperactive (ADHD) adolescents was considerably poorer in Barkley and Fischer’s Milwaukee follow-up study at the teen follow-up than that of the typically developing adolescents followed concurrently. At least three times as many hyperactive (ADHD) children had failed a grade (29.3 vs. 10.0%) or been suspended (46.3 vs. 15.2%) or expelled (10.6% vs. 1.5%) (Fischer, Barkley, Edelbrock, & Smallish, 1990). Others have also identified such high educational risks in longitudinal studies dating back as much as 40 years (Ackerman, Dykman, & Peters, 1977; Mendelson, Johnson, & Stewart, 1971; Stewart, Mendelson, & Johnson, 1973; Weiss, Minde, Werry, Douglas, & Nemeth, 1971; Wilson & Marcotte, 1996). In another sample of clinic-referred teenagers with ADHD, a similar risk for school retention and suspension was documented (Barkley, Anastopoulos, Guevremont, & Fletcher, 1991). Almost 10% of the hyperactive sample followed into adolescence had quit school at this follow-up point in the Milwaukee Study, compared to none of the normal sample (Barkley, Fischer, et al., 1990). Fischer and colleagues (1990) also found that the levels of academic achievement on standard tests were significantly below normal on tests of math, reading, and spelling, falling toward the lower end of the normal range (standard scores between 90 and 95)." (Quoted from the 4th edition)"
"Substantially fewer hyperactive than control children had ever enrolled in college (21 vs. 78%) or were currently attending at this follow-up point (15 vs. 66%). These findings were reaffirmed 6 years later at the age 27 follow-up (Barkley et al., 2008). In the Canadian follow-up study, approximately 20% attempted a college program, yet only 5% completed a university degree program, compared to over 41% of control children (Weiss & Hechtman, 1993). The longest running (30-year) follow-up study of hyperactive children into midlife likewise indicates that less education is an outcome of childhood ADHD, with 30% either not completing high school or getting a general equivalency diploma (GED), compared to just 4% of the control group (Klein et al., 2012). These findings demonstrate that the educational domain is major in terms of impaired functioning and reduced attainment for children growing up with ADHD." (quoted from the 4th edition handbook) linked below
> The best thing for worried parents to do is just give the kids a chance to grow up, Chen says. In most of the studies done on relative age and ADHD, the difference in diagnosis rates vanished by the time the students reached their teenage years. "I think we have to wait for a while, he says. "We have to have more time to evaluate their behavior, attention and brain development."
The problem is they are diagnosing 6-7 year olds and not diagnosing true peers but using proxies for age.
False. The most cited person is Russell Barkley and his advice is the one that goes through. His work is considered a paradigm shift that the literature revolves around. We know it is very severe from the 4th edition it states there have been over 300 studies done on stimulants in kids in ADHD and we know it's safe. Wait till they're in high school but it's too powerful to be overcome, sorry, it's strict consensus and well corroborated. Not even high intelligence is powerful enough to overcome it.
It's a developmental disorder, their brains aren't done developing until they're in their late twenties or early thirties, you can't "wait it out".
Their life failure rate is that much higher. The data is too strong and well corroborated.
I'm providing data and you haven't. When it gets to last 2 years of high school meds matter, but what if they've repeated a grade already? That's not fair to them.
> Who doesn't believe in accurate diagnosis? I do.
Then you shouldn't be pushing ADHD meds on 6-7 year olds.
> I'm providing data and you haven't. When it gets to last 2 years of high school meds matter, but what if they've repeated a grade already? That's not fair to them.
You are aware I was talking about 6-7 year olds based on what I wrote in the first comment I replied to, right?
I'm not talking about high school students or even Jr High students. I'm perfectly fine with them being diagnosed at that point.
I think the problem is you are missing what part of the OP I was talking about.
> They're still behind in effective brain development no matter what.
The whole point of the article is they were "finding" 20-100% of the younger members of the same grade level had ADHD. ADHD shouldn't be detected at 20-100% higher rates at 6 instead of 7 at the same grade level if the process was working correctly.
That isn't okay. Period.
Maybe I take this a bit personally because I have a friend who had all 3 kids who were misdiagnosed at 7-8 and at 8-9 they were told they were "normal" and to stop medication.
> Elder said the “smoking gun” of the study is that ADHD diagnoses depend on a child’s age relative to classmates and the teacher’s perceptions of whether the child has symptoms.
> Overall, the study found that about 20 percent – or 900,000 – of the 4.5 million children currently identified as having ADHD likely have been misdiagnosed.
> Morrill explains that the study shows that children born just after the kindergarten cutoff date were 25 percent less likely to be diagnosed as having ADHD than children born just before the cutoff date. “This indicates that there are children who are diagnosed (or not) because of something other than underlying biological or medical reasons.
That isn't okay. You can't be wrong 20-25% of the time and handing out drugs.
> No matter how accurate the test diagnosis is there will still be false positives. Please go away, it's stubborn people like you who never go away that make this disorder so hard to take seriously.
The fact you insist it is okay to prescription medication to 4-7 year olds with a 20-25% error rate is the problem here.
> I don't care if you take it personally, you don't know math.
The fact 1 in 5 times the ADHD diagnosis is wrong is the problem here.
> God dude you have no idea about what you're saying. LOOK AT THE BAYES RULE EXAMPLE. DO YOU SEE THERE WILL ALWAYS BE A LARGE FALSE POSITIVE RATE? At this point you respond in bad faith and are demonstrably clueless.
> Despite these potential problems with classification, general medicine seems to fare much better than psychiatry in terms of accuracy and reliability. The high rates of misdiagnosis and disagreement among psychiatrists support this point: for example, Kirk, Gomory & Cohen (2013) cite a recent estimate according to which the diagnostic error rate is 38% for ADHD
> Arthur Elstein, a cognitive psychologist interested in ‘how doctors think’, studied clinical decision making for his entire career and concluded the diagnosis is wrong 10–15% of the time.7 A diverse range of research approaches that have focused on this issue over the past several decades suggest that this estimate is very much on target.6
You keep insisting higher than average error rates are okay and worthy of medication. I'm saying they aren't. We don't agree yet you keep responding and calling me names.
K.
> Suppose that you are worried that you might have a rare disease. You decide to get tested, and suppose that the testing methods for this disease are correct 99 percent of the time (in other words, if you have the disease, it shows that you do with 99 percent probability, and if you don't have the disease, it shows that you do not with 99 percent probability). Suppose this disease is actually quite rare, occurring randomly in the general population in only one of every 10,000 people.
You make statements like this which are demonstrably false and insist I'm the one acting in bad faith.
> Approximately 11% of children 4-17 years of age (6.4 million) have been diagnosed with ADHD as of 2011.
2) The test isn't 99% accurate. Multiple people with PHDs publish literature stating the error rate is higher than that. You repeatedly insist this one source is more reliable than any other. Great. I don't agree.
3) You insisting a high rate of diagnostic error compared to general medicine being "okay" is not going to magical change my mind.
> Why don't you get it? For 4-5% of the population, even if the test is 99% accurate you will still get a large percentage of false positives no matter what.
1) I just linked you to it being 11% of the population under discussion. I'm not sure if you are blindly lying on the assumption I won't notice or really don't understand.
2) I honestly don't care at this point. You genuinely do not seem to understand what I'm talking about while insisting you are 100% correct because of something that has nothing to do with what the issue I have with it is.
> 4-5% is the base rate of the ADHD in population, the 11% is the false positive + true positive rate. It's always going to be a number like 11% you dolt, it's harder to get lower than that. Again you actually didn't get the bayes rule example! It's not possible to get the fundamental rate that much. Because of how the numbers multiply out.
I'm honestly taking that as a concession since you simply don't understand what I'm saying.
> I demand you concede verbally.
There isn't anything to concede since you keep tilting against a windmill and failing to understand my issue is medicating 4-9 year old children with such a large percentage of false positives.
The methodology and the difficulty doesn't matter, the end result does.
You're not even saying anything at this point. I already quoted you a quoted showing that medicating children is demonstrated to be safe. Stop pretending already! There's hundreds of studies.
You haven't made a point! I've quoted the reference literature, shown you that your little major point about diagnosis was false and now you just keep repeating your point. Your cdc point at 11% was your silver bullet and now you know its useless.
You also missed the point about asymmetry of harm for <not medicating diagnosed> vs <medicating misdiagnosed>. That quote from the 4th edition demonstrably refuted what you said. Sorry buddy, hate to tell you, you've lost. =)
I was diagnosed with ADHD as a kid in elementary school but I didn't want to take the medication (Or I may have just been being contrary...). and now as a junior in college I'm considering talking to a doctor to see whether medication might be able to help me focus. I find myself constantly unable to fin-
""By adolescence, these chronic and cumulative experiences with school failure, learning disorders, school misbehavior, and sometimes lower intelligence begin to generate other adverse educational outcomes. For instance, the academic outcome of the hyperactive (ADHD) adolescents was considerably poorer in Barkley and Fischer’s Milwaukee follow-up study at the teen follow-up than that of the typically developing adolescents followed concurrently. At least three times as many hyperactive (ADHD) children had failed a grade (29.3 vs. 10.0%) or been suspended (46.3 vs. 15.2%) or expelled (10.6% vs. 1.5%) (Fischer, Barkley, Edelbrock, & Smallish, 1990). Others have also identified such high educational risks in longitudinal studies dating back as much as 40 years (Ackerman, Dykman, & Peters, 1977; Mendelson, Johnson, & Stewart, 1971; Stewart, Mendelson, & Johnson, 1973; Weiss, Minde, Werry, Douglas, & Nemeth, 1971; Wilson & Marcotte, 1996). In another sample of clinic-referred teenagers with ADHD, a similar risk for school retention and suspension was documented (Barkley, Anastopoulos, Guevremont, & Fletcher, 1991). Almost 10% of the hyperactive sample followed into adolescence had quit school at this follow-up point in the Milwaukee Study, compared to none of the normal sample (Barkley, Fischer, et al., 1990). Fischer and colleagues (1990) also found that the levels of academic achievement on standard tests were significantly below normal on tests of math, reading, and spelling, falling toward the lower end of the normal range (standard scores between 90 and 95)." (Quoted from the 4th edition)"
"Substantially fewer hyperactive than control children had ever enrolled in college (21 vs. 78%) or were currently attending at this follow-up point (15 vs. 66%). These findings were reaffirmed 6 years later at the age 27 follow-up (Barkley et al., 2008). In the Canadian follow-up study, approximately 20% attempted a college program, yet only 5% completed a university degree program, compared to over 41% of control children (Weiss & Hechtman, 1993). The longest running (30-year) follow-up study of hyperactive children into midlife likewise indicates that less education is an outcome of childhood ADHD, with 30% either not completing high school or getting a general equivalency diploma (GED), compared to just 4% of the control group (Klein et al., 2012). These findings demonstrate that the educational domain is major in terms of impaired functioning and reduced attainment for children growing up with ADHD."
You get remission of symtoms very frequently if you take your meds, it works great. there's no way you can "overcome" it as you're a) time myopic (look it up) b) cannot execute knowledge you have acquired.
As an adult male with ADHD that went undiagnosed until I was in my late 20s, who was one of the youngest in his class, who faced the potential of "corporal punishment" (spanking on the rear-end with a wooden paddle was the threat) both at school and at home (it was only ever administered to me at home by my parents), and who now has a daughter who has just passed through the elementary years at a school that does not practice any physical punishment, and who has never practiced any sort of physical punishment on my daughter, I strongly disagree.
The biggest change I've seen in the style of schooling between my elementary years and today is not the administration of corporal punishment. Yes, it was an option when I was a child, but it was rarely administered. Less than half a dozen times a year across six grades and about 1000 children, perhaps, is my rough guesstimate.
Instead, the biggest change I see is the near total removal of recess as a part of the day. When I was in elementary school, we had two 15-minute recesses, one 25-minute recess, and an additional 10-15 minute recess period after lunch. My daughter, throughout her elementary school years, was given a single 15 minute recess, and this was often taken away from the entire class as a collective punishment. To me, it's no wonder the kids can't sit still or pay attention. Children that age need to run and play without structure and with as few rules as possible. That physical energy has to go somewhere. And it too often goes to acting up and inability to pay attention in class.
You say strict but don't you really just mean threatening children with violence?
The last time someone told me to stand still so they could hit me as hard as they could with a cane was when I was 7 or 8 years old. That's not education. Real educators, much like real democracy, do not rely on fear and violence to control others.
I definitely understand why using fear to control children is a bad thing, but as for violence, it's at the root of all power anyway. Whenever you impose a disciplinary sanction, it's implicit that if the sanction is not respected, it will be replaced by an alternative, at least as harsh sanction, and eventually the alternative sanction will be violent.
Fear is clearly not a great way of controlling your children, but no one does it in any other way. If instead of corporal punishment you discipline your child by revoking privileges, you're still using threats and fear. The alternative is to reason with your child, to present a convincing argument for why they should listen to you. But kids aren't (always) rational actors, so that doesn't always work.
Both hitting your child and grounding your child are based on fear and violence. They each have their disadvantages. Hitting your child might end up teaching them that hitting people is OK, grounding your child gives them a lot of time to build resentment and keeps them cooped up with negativity and inactivity so that they're more likely to get into trouble again. I'm not sure which I would have chosen as a kid, but now I'd choose corporal punishment.
While it's often pointed out that children are not rational actors, I'd also like to include that parents are not rational actors all the time either.
Often people want to impose a rule on their children without properly evaluating it because its what they were taught, and has become part and parcel of their socialization.
Other times people must impose a rule on their children due to government regulation (e.g. you can't leave children under X age home without someone over Y age responsible for them). In those cases, people fail to explain their guiding logic because no one likes to say "I have to do this, the government is making me do it through threat of jail time" and thus their justification---both to themselves and their children---comes off as flimsy.
> Fear is clearly not a great way of controlling your children, but no one does it in any other way. If instead of corporal punishment you discipline your child by revoking privileges, you're still using threats and fear. The alternative is to reason with your child, to present a convincing argument for why they should listen to you. But kids aren't (always) rational actors, so that doesn't always work.
The most effective method I know to get your desired behaviour out of anyone is to withdraw attention from bad behaviour until your child is ready to reason about why they did what they did. Give extra attention for good behaviour. So much bad behaviour is down to trying to get an adult to actually pay attention, and if you punish you give attention that reinforces that their bad behaviour works.
Incidentally, this works well with adults too - the next time a co-worker does something you don't like, turn your body away from them and minimize verbal interaction; the next time they do something you like, turn your torso to face them fully, give eye contact, and interact more - the way they interact with you will generally start changing fairly quickly.
With a small child, withdrawing your attention (looking away; not talking to them) for as little as 30 seconds has an incredibly strong effect (and you really should not do it very long, and you need to set clear expectations). When we did that with my son from around 2 years old, he would almost immediately get desperate to regain attention (he'd grab my head and try to force me to look at him and ask me to please look at him and talk to him) and would usually cave within about 10 seconds. Very rarely we'd have to extend it with a second 30 second period. Most of the time just telling him that if he doesn't stop we'd do this would be enough.
My son is 6 now, and we still do this. He's getting more sophisticated about trying to regain our attention, but still yields very quickly when we're firm about it. We're very clear about telling him exactly what we will be doing, why, and what he can do to stop it. Typically we'll tell him he's free to go sit and sulk somewhere, but we won't be talking to him for the next e.g. 10 minutes unless he apologises and talk to us about what he did.
Most importantly to me is that he understands what we do and why (because we always explain each step and why we do it), and he will think over and reason about what made him agry/upset and realise that most of the time the surface thing that set him off is not the real reason, and then we work with him on fixing the underlying problem.
> Your boss doesn't punch you for not filing your TPS reports; your spouse doesn't hit you for not doing the shopping.
You're right, but he also has a point in that eventually, if you just don't do things, the cops will drag you away. Eventual violence is a cornerstone of order in our society. I find this unpalatable, but at least another cornerstone of order is motivation to do good things.
Just as short timeouts are not solitary confinement, open-handed slaps on the butt are not gang beatings. It's generally the parent that determines whether the punishment is abusive, not the type of punishment itself.
> open-handed slaps on the butt are not gang beatings. It's generally the parent that determines whether the punishment is abusive, not the type of punishment itself.
No, this is criminal in many countries and any parent who hits a child is incompetent.
Hitting a child is unambiguously abusive in many countries, because we see that the parent lacks skill.
Well, I disagree I guess. (Yes, it's criminal in ~50 countries.) In general I believe there's a middle ground to be found on just about any issue, and that given enough perspective there are pros and cons to any situation. More than anything else, the practice of seeking this middle ground has helped me to deal with the effects of growing up in an abusive environment.
I'm not a parent. I do work with kids in a limited capacity, as a volunteer. I obviously don't use any corporal discipline in that context, and if I had children of my own I wouldn't have the heart to hit them. I'm just interested in the theory of it; are we sure that corporal punishment isn't more effective in a practical utilitarian sense, and, if we are, what explains the difference.
Jesus fucking christ no it isn't. Your boss doesn't punch you for not filing your TPS reports; your spouse doesn't hit you for not doing the shopping.
The point is that eventually if you refuse to comply it will lead to violence. It might be indirect, and in some cases it will sound contrived, but everything eventually comed down to an implied threat of violence. If you don't file a report, you might experience some minor consequences. Probably the sort of thing you can't refuse to comply with. If you keep failing to file reports you might be fired or at least suspended. If you don't respect that and continue to show up for work, they'll probably have security throw you out. If you come back in they'll probably call the police and you'll be arrested for trespassing. If you resist arrest, you might find yourself subject to violence. This is to say that every threat boils down to a violent threat, and therefore every threat is inherently violent; threatening your kid with a revocation of privilege is violent.
Time outs are not long - one minute per year of age. A 12 year old gets a 12 minute time out.
A time out doesn't apply for everything kids do. Great when you're watching them and they misbehave, but that doesn't account for everything. If you catch your 10 year old stealing, you're not going to put them in time out. If your eight year old beats some kid up, you're not going to put them in time out. I would consider any form of corporal punishment too much of an ordeal for the things a time out would be appropriate for. I was refering to inflicting pain on your child as an alternative to grounding them.
But this is a hot-button topic for me. I've made this mistake before. So it's really best if I just avoid it until I can talk about it in a way that's compatible with HN rules.
You're not presenting any kind of defense for your claims. You're saying things like they're obvious truths, when they're obviously not for the sake of this discussion.
But so are you, and since the action you're proposing (violence against children) is a violation of that child's human rigts as defined in international agreements, and is illegal in several countries, and will draw attention from child protection in many others, you have a higher threshold.
No parenting expert recommends violence against the child - (although a few religious extremists claim to be parenting experts).
Note that any experts dealing with children whose behaviour is described as difficult or challenging will reject violence against that child - and it's that behaviour which you have said should be met with violence.
As one example of an evidence based programme (although the evidence is weak) you might wantto lok at Webster Stratton.
I'm presenting this as self-evident truth because the evidence is over-whelmingly against hitting children. You might think there's some debate to be had, but that's because you live in the US which is i) extraordinarily violent country, and ii) has religious extremists who promote violence against the child. The rest of the developed world had this debate in the 1980s and decided that hitting children needs to stop.
Or we could recognize that young boys are naturally energetic and that this is not a bad thing. If we could teach them in a way that channels that energy instead of forcing them to sit in a chair for 6 hours a day, they might actually learn something.
Although hated, this comment raises interesting points.
Indeed, kids are given much more freedom and are less "disciplined" than ever before.
At the same time, there's never been so much pressure and coerciveness than right now. You "don't have to take the meds", but you most likely will do that.
Indeed, kids are given much more freedom and are less "disciplined" than ever before.
Excuse me? Less disciplined, sure, but not more free. Kids today have no freedom. They are supervised by adults from when they wake up til they go to sleep. In school they are explicitly encouraged to not resolve conflicts on their own but instead to go to a teacher. The play that they engage in is not only always supervised, but also usually adult-structured. No groups of 2–5 kids going off to play by themselves and making up their own games, they have to participate in whatever nonsense the adults are forcing on them. Children aren't children in the brave new world, they're liabilities.
My college provided significant benefits to ADHD diagnosed students. Rather than take finals in stadium seating, you got a personal, air conditioned office, received unlimited time and could use reference material.
A few of my friends found a "Do you need Ritalin" quizzes in a magazine, went to a doc-in-the-box and got the diagnosis. They sold the Ritalin and got better grades.