Nearly a quarter of seventeen-year-old boys in America have an ADHD diagnosis. That's crazy. But worse than the diagnosis is that the majority of them end up on amphetamines, like Adderall or Ritalin. These drugs allow especially teenage boys (diagnosed at 2-3x the rate of girls) to do what their mind would otherwise resist: Study subjects they find boring for long stretches of time. Hurray?
Except, it doesn't even work. Because taking Adderall or Ritalin doesn't actually help you learn more, it merely makes trying tolerable. The kids might feel like the drugs are helping, but the test scores say they're not. It's Dunning-Kruger — the phenomenon where low-competence individuals overestimate their abilities — in a pill.
Furthermore, even this perceived improvement is short-term. The sudden "miraculous" ability to sit still and focus on boring school work wanes in less than a year on the drugs. In three years, pill poppers are doing no better than those who didn't take amphetamines at all.
These are all facts presented in a blockbuster story in New York Time Magazine entitled Have We Been Thinking About A.D.H.D. All Wrong?, which unpacks all the latest research on ADHD. It's depressing reading.
Not least because the definition of ADHD is so subjective and situational. The NYTM piece is full of anecdotes from kids with an ADHD diagnosis whose symptoms disappeared when they stopped pursuing a school path out of step with their temperament. And just look at these ADHD markers from the DSM-5:
Inattention
Difficulty staying focused on tasks or play.
Frequently losing things needed for tasks (e.g., toys, school supplies).
Easily distracted by unrelated stimuli.
Forgetting daily activities or instructions.
Trouble organizing tasks or completing schoolwork.
Avoiding or disliking tasks requiring sustained mental effort.
Hyperactivity
Fidgeting, squirming, or inability to stay seated.
Running or climbing in inappropriate situations.
Excessive talking or inability to play quietly.
Acting as if “driven by a motor,” always on the go.
Impulsivity
Blurting out answers before questions are completed.
Trouble waiting for their turn.
Interrupting others’ conversations or games.
The majority of these so-called symptoms are what I'd classify as "normal boyhood". I certainly could have checked off a bunch of them, and you only need six over six months for an official ADHD diagnosis. No wonder a quarter of those seventeen year-old boys in America qualify!
Borrowing from Erich Fromm’s The Sane Society, I think we're looking at a pathology of normalcy, where healthy boys are defined as those who can sit still, focus on studies, and suppress kinetic energy. Boys with low intensity and low energy. What a screwy ideal to chase for all.
This is all downstream from an obsession with getting as many kids through as much safety-obsessed schooling as possible. While the world still needs electricians, carpenters, welders, soldiers, and a million other occupations that exist outside the narrow educational ideal of today.
Now I'm sure there is a small number of really difficult cases where even the short-term break from severe symptoms that amphetamines can provide is welcome. The NYTM piece quotes the doctor that did one of the most consequential studies on ADHD as thinking that's around 3% — a world apart from the quarter of seventeen-year-olds discussed above.
But as ever, there is no free lunch in medicine. Long-term use of amphetamines acts as a growth inhibitor, resulting in kids up to an inch shorter than they otherwise would have been. On top of the awful downs that often follow amphetamine highs. And the loss of interest, humor, and spirit that frequently comes with the treatment too.
This is all eerily similar to what happened in America when a bad study from the 1990s convinced a generation of doctors that opioids actually weren't addictive. By the time they realized the damage, they'd set in motion an overdose and addiction cascade that's presently killing over a 100,000 Americans a year. The book Empire of Pain chronicles that tragedy well.
Or how about the surge in puberty-blocker prescriptions, which has now been arrested in the UK, following the Cass Review, as well as Finland, Norway, Sweden, France, and elsewhere.
Doctors are supposed to first do no harm, but they're as liable to be swept up in bad paradigms, social contagions, and ideological echo chambers as the rest of us. And this insane over-diagnosis of ADHD fits that liability to a T.