The “terrible trifecta” of: trouble getting started, keeping focused, and finishing up projects seems universally relatable. I don’t know many people who would say they don’t have trouble with each of these things. Drawing this line between normal and pathological human experiences is very difficult and is why the DSM-V criteria are quite specific (and not perfect).
It might be useful to also interview people without ADHD, to differentiate pathological ADHD symptoms from normal, universal human experiences.
The risks of overdiagnosis include:
People can develop unhealthy cognitive patterns around seeing themselves as having a “disease” when they’re actually just struggling with the standard human condition
They might receive harmful interventions that they don’t need
I wish we didn’t need to treat ADHD like a disease, and instead people could just say “yes, I struggle more along these dimensions that the average person.” Unfortunately, the medical community treats ADHD as a disease and has drawn arbitrary, frustratingly vague guidelines around it. If someone wants to access medication, they need to accept that label.
My best understanding is that ADHD symptoms are roughly normally distributed in the population. I would be thrilled if the medical community followed an informed consent model where patients could decide for themselves if they needed medication, following proper advisement of the risks and costs. Baring that, it would be great if they established clearer thresholds for what was significant enough impairment to be worth medicating, instead of the current system.
I find the DSM-V criteria aggravatingly vague and non-specific. Like “Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months.” I.e. adults who say “often” or “very often” more than 5 times on a questionnaire get diagnosed with ADHD. How often if “often”? You know, often!
I think it is worth mentioning that overdiagnosis/incorrect self-diagnosis can have costs in the way you describe, but at the same time, when you read the stories, I think there is a difference between that and the general human condition. Like, based on the stories here I don’t think I have adhd: I have trouble getting work done sometimes but my barriers seem very different to this.
Also seems worth saying that...as far as I can tell most ADHD interventions aren’t actually super harmful if given to people without ADHD? (in contrast to other medications). Like, stimulants are a controlled substance, but from what Lynette says in this post, the risks from a non-ADHD person taking them by mistake seem quite low, and they may even get increased focus anyway.
I think the point about the label is complicated. I’ve definitely been wary about whether I want to adopt psychological labels such as ‘depression’, ‘cptsd’, ‘autism’, because in pessimistic moods they can serve as focal points for negative thoughts like ‘I’m broken’, ‘I have this undeserved disadvantage is life’ ‘people will never understand me’, etc. At the same time, some of these interviewees report that when they labelled themselves as having ADHD, their self-narratives became more positive—previously they thought they were just lazy or not trying hard enough. And I think that can happen with other mental health or neurotype labels too: like better to see yourself as diseased than as morally depraved.
Seconding that the risk of harmful interventions is low. Based on Scott’s pages and the UpToDate page, the risks from taking stimulant medication as prescribed are pretty negligible—comparable to normal side effects from caffeine.
I’d love to hear from people who don’t “have adhd”. I have a diagnosis myself but I have trouble believing I’m all that unusual. I tried medication for a while, but I didn’t find it that helpful with regard to the bottom line outcome of getting things done, and I felt uncomfortable with the idea of taking stimulants regularly for many years. I’d certainly benefit from being more able to finish projects, though!
The “terrible trifecta” of: trouble getting started, keeping focused, and finishing up projects seems universally relatable. I don’t know many people who would say they don’t have trouble with each of these things. Drawing this line between normal and pathological human experiences is very difficult and is why the DSM-V criteria are quite specific (and not perfect).
It might be useful to also interview people without ADHD, to differentiate pathological ADHD symptoms from normal, universal human experiences.
The risks of overdiagnosis include:
People can develop unhealthy cognitive patterns around seeing themselves as having a “disease” when they’re actually just struggling with the standard human condition
They might receive harmful interventions that they don’t need
It adds unnecessary burden to health systems.
I wish we didn’t need to treat ADHD like a disease, and instead people could just say “yes, I struggle more along these dimensions that the average person.” Unfortunately, the medical community treats ADHD as a disease and has drawn arbitrary, frustratingly vague guidelines around it. If someone wants to access medication, they need to accept that label.
My best understanding is that ADHD symptoms are roughly normally distributed in the population. I would be thrilled if the medical community followed an informed consent model where patients could decide for themselves if they needed medication, following proper advisement of the risks and costs. Baring that, it would be great if they established clearer thresholds for what was significant enough impairment to be worth medicating, instead of the current system.
I find the DSM-V criteria aggravatingly vague and non-specific. Like “Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months.” I.e. adults who say “often” or “very often” more than 5 times on a questionnaire get diagnosed with ADHD. How often if “often”? You know, often!
I think it is worth mentioning that overdiagnosis/incorrect self-diagnosis can have costs in the way you describe, but at the same time, when you read the stories, I think there is a difference between that and the general human condition. Like, based on the stories here I don’t think I have adhd: I have trouble getting work done sometimes but my barriers seem very different to this.
Also seems worth saying that...as far as I can tell most ADHD interventions aren’t actually super harmful if given to people without ADHD? (in contrast to other medications). Like, stimulants are a controlled substance, but from what Lynette says in this post, the risks from a non-ADHD person taking them by mistake seem quite low, and they may even get increased focus anyway.
I think the point about the label is complicated. I’ve definitely been wary about whether I want to adopt psychological labels such as ‘depression’, ‘cptsd’, ‘autism’, because in pessimistic moods they can serve as focal points for negative thoughts like ‘I’m broken’, ‘I have this undeserved disadvantage is life’ ‘people will never understand me’, etc. At the same time, some of these interviewees report that when they labelled themselves as having ADHD, their self-narratives became more positive—previously they thought they were just lazy or not trying hard enough. And I think that can happen with other mental health or neurotype labels too: like better to see yourself as diseased than as morally depraved.
Seconding that the risk of harmful interventions is low. Based on Scott’s pages and the UpToDate page, the risks from taking stimulant medication as prescribed are pretty negligible—comparable to normal side effects from caffeine.
I’d love to hear from people who don’t “have adhd”. I have a diagnosis myself but I have trouble believing I’m all that unusual. I tried medication for a while, but I didn’t find it that helpful with regard to the bottom line outcome of getting things done, and I felt uncomfortable with the idea of taking stimulants regularly for many years. I’d certainly benefit from being more able to finish projects, though!