I mentor and teach programming to middle and high school kids in after school programs at underresourced schools and I slightly agree with some of the details but disagree with the overall conclusions.

From my experience the main disruption in the life of boys with adhd is primarily social. I have seen, privately when I was trusted, teen boys in tears of grief, regret, deep in despair of self loathing because of yet another in a long line of exploded relationships because of their impulsive words or actions that they feel powerless to stop. I've seen the incredibly strong feelings of rejection & isolation they suffer at feeling excluded or singled out because of behavior that they do not wish to have but do not know how to stop.

Succeeding in school, even learning itself is, to me, far secondary to this concern. Someone who has never read a book or learned algebra can still have a life they find fulfilling and meaningful on their own terms. I don't know that someone who cannot create and maintain relationships with their peers can.

There is some newer research, and shifting opinions among professionals, that adhd (or maybe just some variants of it) can be understood and addressed primarily as emotional regulation disorders. This fits with my observations of teenagers, yes especially boys, and also my own experience having adhd.

The hyperactivity and learning disruptions have been historically central because that is the parent or educator's experience of a child's adhd. But I think there's a lot to be practically gained by focusing on the child's experiences & goals, and how adhd disrupts them. This post isn't quite that.

I agree with the author… We need to stop pathologizing behavior that is developmentally natural. We over-medicate kids, full stop.

The ADHD self-diagnosis trend amongst adults also needs to stop. People are now ascribing any minor challenge in life to ADHD. Everyone procrastinates. Everyone forgets people’s names. Everyone has trouble focusing sometimes. It’s not ADHD, that’s called life.

My worry is that by giving it a label, it lets people give in to negative behavior because “that’s just the way I am,” or “I’m neurodivergent.” But even people with severe emotional and behavioral challenges can navigate life. It’s not an excuse to be inconsiderate.

do not listen to someone like DHH, who loves to speak at length on topics that he is deeply unfamiliar with.

> Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study

>

> ADHD was associated with significantly increased mortality rates. People diagnosed with ADHD in adulthood had a higher MRR than did those diagnosed in childhood and adolescence. Comorbid oppositional defiant disorder, conduct disorder, and substance use disorder increased the MRR even further. However, when adjusted for these comorbidities, ADHD remained associated with excess mortality, with higher MRRs in girls and women with ADHD than in boys and men with ADHD. The excess mortality in ADHD was mainly driven by deaths from unnatural causes, especially accidents.

https://pubmed.ncbi.nlm.nih.gov/25726514/

> The majority of these so-called symptoms are what I'd classify as "normal boyhood"

I mean I know what he means and I think there is merit in the argument, but on the other hand sitting down, paying attention, understanding stuff, and doing stuff you don't want to are in fact essential skills to get through middle-class adult life.

I mean if I shouted and punched every boss or colleague I disagreed with, well in some sense maybe I'd have more fun and be living a more "manly" existence, but it certainly wouldn't be good for my bank account.

It'd be nice if DHH put some more effort and focus into his posts. Or at least link to sources like for this very first sentence: "Nearly a quarter of seventeen-year-old boys in America have an ADHD diagnosis."

It's quite specific (17-yr-old boys) but I couldn't find a source for the ~25%. The CDC[1] writes it's 15% for boys (3-17 yrs old). Across all ADHD kids, 30% didn't receive medication or behaviour treatment anyways (a percentage that's risen since 2016): Where's the over-medication?

When I got started with my own diagnosis, a good friend of mine was very skeptical, like "everyone's getting their label and mental illness". Intelligent guy, philosopher with no pressure to do any work at all. It took him some time, research and self-reflection to face the diagnosis (he went to the same specialist and the tests are very thorough) and well... I guess it's true: As someone with ADHD I do have a lot of friends with the same condition, almost shocking but also understandable once you think about the effects on social interactions that ADHD bring.

[1] https://www.cdc.gov/adhd/data/index.html

DHH is always amusing in that there are times when I think he's totally spot on, and there are times when I have to laugh and shake my head, as the words that he spouts sound intelligent, but are abjectly off-base. On the subject of ADHD, this feels squarely in the latter.

I received an ADHD diagnosis a few years ago, into my late 30's, after struggling through and relishing the superpowers of my own behavior. I was suspected of having AD(H)D as a kid, and was assessed but ultimately didn't get a diagnosis. It also turns out that, being a life long technologist, you put me in front of a computer to do an assessment and I will hyperfixate on it because I was given yet another opportunity to be between chair and keyboard. Wild.

I do find that medication helps me. So does structure, and external pressures that help conform me to a healthy routine. Most importantly though, I'm incredibly interest-driven. If I am uninterested in actually solving the problem, it requires moving mountains to convince me that I actually should. Medication is a tool that helps me to do things that suck with less mental effort.

It's not about wanting to eat stimulants for fun. Hell, aside from caffeine, I'd never had a stimulant before starting my meds. And yeah, when I first started taking it, I was high as a kite. But once I leveled off, the new normal was good. It's not a silver bullet - healthy habits, and setting myself up for success are essential, and no amount of meds compensate for when I fall out of a healthy groove. But it has helped.

I'm not a psychiatrist, let alone medically trained at all, so unlike DHH I don't feel like I'm capable of commenting as to whether ADHD diagnoses in kids and providing them access to medications is the right call. What I can say though is that had I had better support as a kid to learn self-reflection, I think I would have been more aware of what I needed to be successful and could have muscled through my younger years with a little less stress and confusion.

I’m not sure where this idea in the NYT article (and now this article) that the purpose of ADHD medications was to improve learning. My own experiences (and the experiences of other people I know) was never that ADHD was significantly hindering our ability to learn. In fact most of us were pretty good at learning things. The problems in school came from the inability to do that learning in a way that conformed to the expectations of the system. Being unable to sit quietly and study for an hour at a time. Being unable to sit through a class without at least doodling in a notebook. Being unable to remember to pack or turn in assignments, even when they were already packed. The need to wait until the last moment to get the motivation to work on an assignment. The inability to intentionally write a rough draft for editing as opposed to just writing the final paper at once.

Those things aren’t going to change how much you learn or how much you retain, but they will absolutely tank your grades, get you into conflicts with your teachers and cause massive amounts of stress, anxiety and depression for you.

I wasn’t given medication as a child, and my experiences with it as an adult do nothing to suggest to me it would have made me better at learning. What it might have done though was eliminate the need to pull all nighters and late night mad dashes to complete assignments. It might have made it so I didn’t dread having to start each year and get a new set of teachers used to the idea that I really am paying attention (for the most part) even if it doesn’t look like it. My adult experiences back up the idea that the effects of the medication do wane with time, and I have been weighing the trade offs of taking vs not taking these medications (a trade off which would have been more difficult to weigh as a kid for sure, but not impossible with appropriate support). I am concerned at the tone of these recent articles that seem to be toeing very close to the “ADHD isn’t real” line again and that medication isn’t appropriate just because we don’t know the mechanism of action or because you build up a tolerance over time. We don’t know the mechanism of action for a lot of medications, and you build up tolerances to a lot of medications. It’s never been about no trade offs. It’s always with any medication a question of whether the trade offs are worth it?

Do I worry that the system itself is built and geared to chose medicating kids instead of maybe adjusting the system to accommodate, sure I do. But the answer to that issue is to advocate that the system change such that medicating to fit into the system better isn’t needed, not to just argue the medications don’t really do anything. And I feel like this and the NYT article mostly have made the argument not that the system needs to change (except to the extent that it needs to stop using medication), but that the system is fine actually and we just need to make the kids conform better. This may be sensitivity on my part to fighting the battles that ADHD has brought into my life, but if it is, then this is a plea for writers to be more explicit about what they’re advocating for, and to maybe tone down the “pill poppers” rhetoric.

wonder what diagnosis Tom Sawyer or Huck Finn would have got

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