More notes on ADHD
Loads of adults are getting diagnosed with ADHD. The percentage of people diagnosed with ADHD in the US had increased from 6.8% in 2005 to 14.4% in 2014. I got diagnosed in 2016, as I’ve talked about here, and about a dozen people I know have been diagnosed since then (or have started taking medication they bought online for what they believe is undiagnosed ADHD). Why is this happening? I think there are a few things at play here. The first is that basically everyone has ADHD “symptoms”. Consider the ‘Barnum Effect’, which is where people say that generic statements that apply to basically everybody are especially true of them. Most people think that statements like ‘you have a tendency to be critical of yourself’ or ‘you pride yourself as an independent thinker and do not accept others' statements without satisfactory proof’ are more true of themselves than they are of most people.
The Barnum effect is used by psychics as part of cold reading, which is when they say things like ‘I sense that someone in this room has an extremely strained relationship with their older brother’, which is basically guaranteed to be true in a room with enough people.
Viral posts (like the ones above) about people with ADHD are basically cold reading. Statements like ‘I often leave difficult tasks until the last minute’ or ‘when I tell stories to friends, I sometimes struggle to be concise and I usually include unrelated details’ apply to almost everyone. If you go to the subreddit /r/ADHDMemes and browse the top posts, you can find slightly more specific memes that I would imagine apply to a sizeable minority of people (at the very minimum), and probably apply to the majority of people low in trait conscientiousness. I think that ADHD and ‘low in trait conscientiousness’ are roughly synonymous.
The other relevant thing is that ADHD medication is insanely useful for basically everyone. So I guess the standard pattern is that people see a meme about ADHD (or hear about a friend who went from struggling to get work done to being a productivity beast), manage to get a diagnosis, find that the medication is making them much more productive, and then conclude that they have ADHD. See Scott Alexander saying basically the same thing here:
Meanwhile, Adderall works for people whether they “have” “ADHD” or not. It may work better for people with ADHD – a lot of them report an almost “magical” effect – but it works at least a little for most people. There is a vast literature trying to disprove this. Its main strategy is to show Adderall doesn’t enhance cognition in healthy people. Fine. But mostly it doesn’t enhance cognition in people with ADHD either. People aren’t using Adderall to get smart, they’re using it to focus. From Prescription stimulants in individuals with and without attention deficit hyperactivity disorder:
It has never been established that the cognitive effects of stimulant drugs are central to their therapeutic utility. In fact, although ADHD medications are effective for the behavioral components of the disorder, little information exists concerning their effects on cognition…stimulant drugs do improve the ability (even without ADHD) to focus and pay attention.
I cannot tell you how much literature there is trying to convince you that Adderall will not help healthy people, nor how consistently college students disprove every word of it every finals season.
This matches my experience (and I think much of the literature actually sort of does suggest that the medication works for everyone): people who aren’t diagnosed with ADHD will take modafinil or other study drugs before their exams, and will consistently report that it helped them a ton. Some of them will conclude that maybe they actually do have ADHD, and rush to get a diagnosis. I am unconvinced that I have ADHD, despite seeing huge benefit from the drugs. If you look at the this survey of which ‘nootropics’ (although some of these seem not to be nootropics) help people the most, Dextroamphetamine (which I take) and Adderall (which is basically the same thing) come top by a significant margin:
Weightlifting comes before Ritalin, which is interesting (and slightly surprising to me), and HIIT comes before modafinil, but study drugs in general have a pretty good showing. The fact that modafinil comes below the other medications suggests to me that it may be the case that people diagnosed with ADHD do benefit slightly more from study drugs, given that modafinil is the study drug that people who aren’t diagnosed with ADHD take, because it’s easy to get online. Although I guess it could be that modafinil is just a less effective drug.
My take is that most people would benefit from these drugs, and that they probably ought to be legal for basically everyone, instead of having this inane system where it’s trivially easy to get diagnosed with ADHD to get the drugs (especially if you have the cash to get a private diagnosis), but you can’t just ask for the drugs because they would benefit you. I have a serious heart condition and was told by my cardiologist that the drugs pose next to no risk to my cardiac health, which speaks to the fact that these drugs aren’t particularly dangerous. Scott Alexander has also summarised the risks in his post linked above:
As he notes, the increased risk of Parkinson’s is slightly concerning here, but I think you should pay much more attention to the actual absolute chance you get Parkinson’s conditional on taking ADHD meds if the 60% increased relative risk is correct, which would be an increase from 0.2% (if the NHS website is to be believed) to 0.32%. I’m unsure whether taking the drug passes the cost-benefit analysis for everyone, but my university grades saw a huge increase when I started taking Ritalin (and also improved when I switched to Dextroamphetamine), and I’m happy to take on the small increase in the risk of Parkinson’s.