Hyperactive Prescribing? Ctd

A clinical psychologist writes:

I work primarily with children and families and I am routinely asked to do ADHD evaluations. Typically big crowds show up in October, after those first parent-teacher conferences, and again in April, as the year winds down and parents panic about their kids’ grades. I have three major points to make:

I. ADHD is absolutely over-diagnosed. There are two populations where this happens:

(1) Non-upper-class boys (and a few girls) who display disruptive or aggressive behavior, whose schools go diagnosis-shopping so the kid can be chemically restrained with stimulant drugs. In most cases, the behavior is totally operant: The kid has learned that if he curses, threatens, hits, dances on the furniture, etc., he will be sent out of the classroom and/or out of the school. Mission accomplished! And then people have the balls to tell me that “discipline doesn’t work.” Well, no shit. If you consistently reward a behavior, you get more of it.

2) Upper-class children whose parents go diagnosis-shopping so their kids can get extra services, supports, and stimulant medication to help them study.

II. ADHD is absolutely under-diagnosed. There are two populations where this happens:

1) Girls (and a few boys) who are merely distractible, not hyperactive or impulsive, so they’re not behavior problems. Your daydreamers. Your space cadets. Your absent-minded professors. These kids get called lazy. Unmotivated. Disorganized. Won’t do her homework. Makes simple mistakes; she should know better! She knows what to do, she just doesn’t do it! These kids develop a very negative self-image because they get a lot of negative feedback from their environment. They wind up depressed. I have seen one kid become suicidal because he truly believed he was stupid and would never achieve anything meaningful in life. (The under-diagnosis is more likely when the kid is intelligent and does well on standardized tests. Jimmy is so intelligent, but…)

2) Adults who are older than about 30 and were missed as kids. They (we) grew up before the great over-diagnosis wave, or grew up outside of the urban areas where it was more common. These people tend not to have achieved everything they could have. They tend to have problems in their working life because they forget things, miss details, make simple errors that most people just wouldn’t make. Quite a few develop hobbies or great big life projects that never quite coalesce. Most develop some neat tricks to compensate for their problems with attention, memory, and task completion. Some really believe, after a lifetime of negative feedback from their environment, they are stupid and underachieving. Depression and low self-esteem is fairly common in this group. A few develop anxiety problems because they’re terrified of the constant mistakes they make at work.

III. Your reader who’s a counseling psychology student is full of shit. ADHD and other learning disabilities show up when they show up, when the kid’s compensatory abilities intersect with an environment that’s too demanding for them. That can happen in childhood or it can happen later. The big points where it shows up, in my experience, are in about fourth grade, in the transition to middle or high school, or once in a while in college or beyond.

Another adds, “The fact that a third-year graduate student in psychology can say this is terrifying”:

While I agree that medicating kids who don’t have ADD is a problem, under-diagnosis is as well. I’m a 34-year-old man with ADD (the inattentive form). I was only diagnosed with it 18 months ago, and the first day I took medication was a revelation. I felt more alert and less foggy than I ever had before; the continual slush and confusion that sapped my brain on a daily basis was gone.

Why did it take until 32 for me to be diagnosed? Three of the big warning signs for ADD – bad grades in school, trouble holding down a job, and more car accidents – never showed up. The inattentive variety wasn’t well known – Driven to Distraction didn’t even come out until my freshman year in high school. ADD people thrive on structure, so if you’re someone who enjoys school and works hard, it’s possible for you to do well despite ADD. I was a creative person, too (still am) so the ADD behaviors I did have just got written off as spaciness.

Unfortunately, as my struggles with my creative work increased, my combined ADD and depression drove me to suicidal thinking, which so alarmed my therapist that she sent me to a talented and sympathetic psychiatrist who, after digging into my life, diagnosed me. (A key “tell” for him: while I like to read, I can’t get through two pages of a book without my brain veering off into some related fantasy.) I am not exaggerating when I say that without this diagnosis and treatment for the disorder, I could be dead.

Another identifies himself as “one of those ‘privileged’ students your psychological doctoral student scoffed at”:

I was diagnosed with ADHD after failing to get my master’s degree for six years. My entire life has been hampered by this problem that no one thought I had because I didn’t fit the typical hyperactive behavior profile. I think back to the times when I was playing outfield, trying desperately to pay attention through an inning and failing. About how I couldn’t excel at a simple manual labor job because I’d “zone out” and slow down. And how I got good (but not great) grades, but it took me about twice as long to finish my assignments as other people.

After my diagnosis and a prescription of amphetamine, my life fell into place. I started taking and excelling in advanced mathematics courses I’d been dreaming about for half a decade. Jesus, it even helped my fucking social issues. It was probably the most content I had ever been in my life.

But then my doctor left, and a new one took over. He decided I was not ADHD, but was in fact one of those people “gaming the system,” as your psychology student described it. Thus my diagnosis was rescinded. I have never been more furious in my life than when I was sitting in his office, realizing that he didn’t give a shit what I said; he’d already decided I was a fraud, and the appointment amounted to Kabuki theatre.

The fallout was pretty epic. I could barely keep up with my next semester’s workload, and to this day (over a year later) I’m not functioning at the level I was before stimulants. I lost my research position due to inability to work. Now I have no funding, even without taking courses or working I cannot make inroads with my thesis, and I’m realizing that without stimulants I will never excel in my chosen career of engineering. Since this is the United States, I can’t afford to see doctors independent of the university system, so I live in a state of perpetual impasse: my choice is to either be effectively owned by the psychiatric system for the rest of my life, or walk away from the career I’ve been building for most of my life. I have no money, no job, no future, and no hope.

Previous Dish on ADHD here, here, and here.

The Best Of The Dish Today

After all the rancor of the last few days, it’s great to focus on something positive in the gay world. That interview above is, to me at least, deeply, deeply moving. It’s really worth watching in full. How much better to advance understanding this way than by getting people fired.

Alas, the discourse police have been busy again. My friend Ayaan Hirsi Ali is now the latest casualty of the culture war in which elements of the hard left seem far less interested in a free exchange of ideas, than in the rigid imposition of a new orthodoxy. She just had her honorary degree from Brandeis withdrawn after the usual complaints about “sensitivity”. Yes, she’s controversial. She has said some tough, tough things about Islam. But if she hasn’t earned the right to say those things, who has? She made a statement today about it, which you can find here. Money quote:

What was initially intended as an honor has now devolved into a moment of shaming. Yet the slur on my reputation is not the worst aspect of this episode. More deplorable is that an institution set up on the basis of religious freedom should today so deeply betray its own founding principles. The “spirit of free expression” referred to in the Brandeis statement has been stifled here, as my critics have achieved their objective of preventing me from addressing the graduating Class of 2014. Neither Brandeis nor my critics knew or even inquired as to what I might say. They simply wanted me to be silenced. I regret that very much.

I regret it every time someone is silenced by intimidation.

Speaking of shaming, the most trafficked post of the day was my take on a chance to end HIV among gay men, “Why Aren’t Gay Men On The Pill?” – and how hideous shaming of men protecting themselves from HIV may be perpetuating the epidemic. Next up: the final roundup of reader emails in the thread, “A Nation Defined By White Supremacy?” Other popular posts included a depressing look at how prisons have replaced psychiatric hospitals, followed by hathos-filled trailer about a guy infatuated with attractive female bloggers.

You can comment on the posts at our Facebook page. See what people are saying about @sullydish here. Posts with reader updates you might have missed: The Impulsivity Of Suicide and Beer-Soaked Meat Is Good For You – which is now surging on Facebook.

22 31 more readers became subscribers today; you can join them here.

See you in the morning.

Quote For The Day III

“The blood of contention ran in [Hobbes’] veins. He acquired the lucid genius of a great expositor of ideas; but by disposition he was a fighter, and he knew no tactics save attack. He was a brilliant controversialist, deft, pertinacious and imaginative, and he disposed of the Thomas_Hobbeserrors of scholastics, Puritans and Papists with a subtle mixture of argument and ridicule.

But he made the mistake of supposing that this style was universally effective, in mathematics no less than in politics. For brilliance in controversy is a corrupting accomplishment. Always to play to win is to take one’s standards from one’s opponent, and local victory comes to displace every other consideration. Most readers will find Hobbes’s disputatiousness excessive; but it is the defect of an exceptionally active mind.

And it never quite destroyed in him the distinction between beating an opponent and establishing a proposition, and never quite silenced the conversation with himself which is the heart of philosophical thinking. But, like many controversialists, he hated error more than he loved truth, and came to depend overmuch on the stimulus of opposition. There is sagacity in Hobbes, and often a profound deliberateness; but there is no repose,” – Michael Oakeshott, quoted by Ta-Nehisi Coates.

Celebrity Years

Noting that 2014 has ushered in a slew of WWI retrospectives, Simon Reid-Henry denounces the “Great Year” school of history, calling it a “form of idolatry”:

Ask any adult what 1989 means to them and they will naturally mention the Berlin Wall falling and communism in Europe coming to its juddering halt. But they may well take the year to mean those two things alone—or, worse still, to assume that one led to the other. If we stand only with the crowd who gathered on the Bornholmer Strasse at the East-West German border in Berlin in 1989, then we miss the ways in which the winds of globalisation and not just the wind of democratic change, to borrow the Scorpions’ update of Harold Macmillan, were howling about the events of that year too.

It is true that some dates do seem to cleave history in two. (Those leaning to the left might point to 1789, 1848, 1917 and 1968 as well as 1989; conservatives may prefer 1812, 1914 and 1945.) But that is a call for periodisation, not compression. In the cramped room of a single year, the air soon becomes stale. The best historians recognise this. They fling open the windows onto the recent past and open the door to the future. Which leaves you wondering why they would confine themselves to such a small room in the first place.

Traffic Accidents Of A Particular Type

Car Type

Emily Badger summarizes research on reading while driving:

Two years ago, the MIT AgeLab and Monotype began to study whether more legible typefaces could make a difference in in-car media. For men, at least, the answer has been yes. In driving simulations run by the lab, male drivers took their eyes off the road for less time when the text on a small navigation screen appeared in a typeface from what’s known as the humanist genre. The difference between humanist and grotesque typefaces amounted to the equivalent of turning away from the road over a distance of 50 feet at highway speeds.

Kelsey Campbell-Dollaghan illustrates, with the above graphic, why Burlingame is easier to read:

Though Burlingame was originally designed for use in video games, [typographic firm] Monotype redesigned it for drivers based on the MIT findings. What makes it, and other “humanist” typefaces, so much less distracting? First of all, there’s absolutely no ambiguity between letters and numbers: Thanks to clever spacing techniques, it’s nearly impossible to confuse, say, the number 9 with the letter G, as you might with a square grotesque…

And see those odd oblique details on the “glyphs,” or actual letters? They make it easier to make out each glyph, even at low screen resolutions. It’s odd: You’d think the square-style, pixelated letters of the grotesque would make it better for digital interfaces. But no, the similarity of the letters and the tight spacing makes it way harder for our eyes to interpret quickly.

Beer-Soaked Meat Is Good For You

Thanks science:

A few years ago, researchers hit upon very unfortunate evidence that grilling meat could be bad for you. Specifically, they found that meat cooked at high temperatures produces polycyclic aromatic hydrocarbons (PAHs), substances that have been linked to cancer. So much for the sweet smell of summer.

Now comes some better news. Scientists have found that marinating pork in beer—yes, beer—can reduce the level of carcinogens.

The Economist has details:

The PAHs created by grilling form from molecules called free radicals which, in turn, form from fat and protein in the intense heat of this type of cooking. One way of stopping PAH-formation, then, might be to apply chemicals called antioxidants that mop up free radicals. And beer is rich in these, in the shape of melanoidins, which form when barley is roasted. So Dr [Isabel] Ferreira and her colleagues prepared some beer marinades, bought some steaks and headed for the griddle.

One of their marinades was based on Pilsner, a pale lager. A second was based on a black beer (type unstated). Since black beers have more melanoidins than light beers—as the name suggests, they give it colour—Dr Ferreira’s hypothesis was that steaks steeped in the black-beer marinade would form fewer PAHs than those steeped in the light-beer marinade, which would, in turn, form fewer than control steaks left unmarinated.

And so it proved.

Update from a reader:

I’ve been marinating and boiling steaks and bratwursts, respectively, in Shiner Black for years. I had no idea of the possible health benefits, and it’s possible that the boiling process might make them moot anyway. But I can say from experience that the darker the beer, the better the meat will taste after grilling. Your mileage may vary, but I often find it disappointing now to eat non-barbecued beef or pork that isn’t three sheets to the wind.

So, here’s to our health!

Kids Are Having Sex Before Sex Ed

CDC Sex Ed

Tara Culp-Ressler dissects the latest CDC report on sex education (pdf):

[A]lthough about 91 percent of teen girls said they received some kind of sex ed instruction in school before they turned 18, just six in ten said that included information on both birth control and how to say no to sex. And a staggering 83 percent said they had already started having sex before they heard anything about the topic in class. … 

Although conservatives tend to deride efforts to overhaul human sexuality curricula as inappropriate attempts to implement “kindergarten sex ed,” the CDC’s research underscores the point that teaching kids about their bodies can’t wait until senior year of high school. Other data on the subject has confirmed that the majority of teens have had sex by the time they turn 18, and messages about abstinence don’t convince them to make different choices.

Rachel Bronstein explains what this means for teen pregnancy:

While births to younger teens (15-17 year-olds) declined 63 percent from 1991 to 2012, they still represent over a quarter of adolescent births. That is nearly 1,700 births a week, according to this month’s Vital Signs, with higher birth rates for Hispanic, non-Hispanic black, and American Indian/Alaska Native adolescents.

CDC researchers, analyzing birth data from the National Vital Statistics System and adolescent health behavior data from the National Survey of Family Growth, found that one in four teens from this age group had never spoken with a parent about sex. While 90 percent reported using some form of contraception, most relied on the least effective methods. (Planned Parenthood qualifies spermicide and fertility-awareness methods as least effective.)

Quote For The Day II

“The question of setting fair boundaries for debate may not be as important a problem as racism, but it is a major problem for the left. It also happens to be the problem that gave rise to Obama’s political career. The president’s transformation from regular student to national figure began at the Harvard Law Review, then torn bitterly between over race and what everybody called “political correctness.” In 1990, Obama was elected the first black president of the Harvard Law Review, and thus made the subject of national news coverage, because he alone was able to understand the perspective of both enemy camps.

One can see the contours of the same debate swirling around him today as president. There’s no contradiction between grasping the deep and continuing power of white supremacy in American politics and culture while still affording one’s opponents a basic presumption of fairness. One might even call this an important part of the definition of liberalism,” – Jon Chait.