from Hacker News

Why so many children in America have ADHD

by uberdru on 3/1/25, 5:53 PM with 98 comments

  • by celsoazevedo on 3/1/25, 6:35 PM

  • by jader201 on 3/1/25, 6:41 PM

    > The actual reason why America is an outlier is widespread over-diagnosis.

    > A typical ADHD diagnosis in America is done by a paediatrician or a family doctor in an office visit as brief as 15 minutes. The norm in Europe is an hours-long assessment by a psychiatrist.

    Anecdotal evidence, but our experience is — and most people/teachers/doctors we talk to say — that most diagnosis are done via similar long tests.

    I’ve not heard of doctors/teachers trying to address ADHD without a formal test being done.

    Are others able to confirm that they know of diagnosis from a “15 minute doctor visit”?

    EDIT: In fact, our insurance won’t even cover medication for our son without a formal checkup — every 3 months.

    Sure, some may “unofficially” think or claim to have ADHD from talking to their doctor that may say something like “it’s possible you/your child has ADHD”, but I find it hard to believe that actual treatment/IEP (individual education plan) happens without a formal diagnosis.

  • by irrational on 3/1/25, 6:45 PM

    Back in the 1970s I had a bed wetting problem. They tried a medication called Ritalin to address this problem. This medication had an interesting side effect of making me pleasant to be around for the first time in my life. Both my parents and all of my teachers remarked on how much better I was able to pay attention and be kind to other people. Then they took me off the medication and I reverted to my wild ways. I don't think many or any people had heard of ADHD back then, so it didn't occur to anyone to try to medicate me for what I clearly had. Over the decades I've learned to cope with ADHD without medication, but I can't help but wonder how much better my life would have been if I had been able to concentrate and not been so hyperactive. Maybe I would have done better in school and had friends.

    Even today, I wonder if I should go through the trouble of being diagnosed and getting on medication. The last three days I wasted my time instead of doing the work my company pays me to do and got exactly nothing done. The entire time I kept thinking, "I really should do that work so I can keep my job and provide for me family" but I couldn't concentrate and procrastinated day after day.

    Most of my children have ADHD. Before they could be diagnosed, they did have to go through extensive testing by a psychiatrist and there were interviews conducted with us as their parents and with their teachers. The 15 minute diagnosis mentioned in the article has not been my experience. We have regular meetings (every 6-8 weeks) with the psychiatrist to evaluate their dosage and how things are going.

  • by vector_spaces on 3/1/25, 6:54 PM

    > A typical ADHD diagnosis in America is done by a paediatrician or a family doctor in an office visit as brief as 15 minutes.

    I'm in my 30s, and in the process of receiving a diagnosis after it had been suggested to me my entire life by teachers, colleagues, and friends. I avoided diagnosis and medication mainly because I was skeptical of the safety record of medications -- probably because that's why my parents never sought a diagnosis for me when I was younger.

    After doing more research the past few years, I learned that ADHD medications are the success story of medical management of psychiatric illness, and they have a strong safety record

    In any case, for me so far it has involved four (4) 2-hour appointments with a clinician, having trusted colleagues and close friends fill out detailed "external rater" forms in which they rated my executive dysfunction, and (yesterday) a marathon 4-hour long testing session in which I took a sequence of standardized tests under the supervision of a clinician.

    I know that diagnosis of ADHD in children is a different animal, and even for adults there are clinics that provide a diagnosis and prescription in a half hour or so -- but not everyone with ADHD is diagnosed after a single 30 minute session with a provider. And contrary to another sibling comment, there are fairly robust objective metrics for identifying the hallmark features of ADHD and executive dysfunction.

  • by qwery on 3/1/25, 7:31 PM

    > Few things agitate Robert F. Kennedy junior, America’s new health secretary, more than the rate of attention-deficit hyperactivity disorder (ADHD) among American children. And for good reason

    I'm sorry, let me stop you there. What in the world are you talking about? The government's main guy looking after America's health is obsessed with ADHD diagnosis rates -- for good reason? That is absolute madness. Got nothing better to do, I guess. No infinitely long tail of the global pandemic that was ravaging the population a couple of years ago? The threat of bird flu? Dare I mention health insurance?

  • by globnomulous on 3/1/25, 6:49 PM

    I can't read the article, but I can say (a) that Americans are generally much less opposed than Europeans to treating mental disorders through medication, and (b) the best available information tells us that ADHD is underdiagnosed, not overdiagnosed, even in America.

  • by ty6853 on 3/1/25, 6:45 PM

    The moral hazard is pretty clear. Testing is profitable and so are the drugs. If they are wrong, there is no penalty. For the same reason an optometrist lied about my perfect vision as a child and conned my parents into glasses I never used paid for by insurance.

    Remember doctors are there to advise not to command, know the hazards and be willing to say no or consider the data from your own perspective.

  • by HocusLocus on 3/1/25, 6:48 PM

    Because what used to be a generic indicator of distracted early childhoods (whether by nutrition, environment, weird parenting) got a new name.

    And it is no coincidence or surprise that brain stimulants like amphetamines dominated the first wave of treatment. People 'perform' better on amphetamines, always have. They work so long as you concentrate on the short term and ignore long term issues like increasing tolerance, increasing demand and ultimately schizophrenia from chronic deep sleep deprivation.

  • by outlace on 3/1/25, 7:12 PM

    “America’s ethos of “school achievement above all else” is part of the problem, says Stephen Hinshaw of the University of California at Berkeley”

    This may be the ethos in elite circles but I don’t think it’s the case in general.

  • by vjk800 on 3/1/25, 6:44 PM

    Scott Alexander's views on Adderall prescriptions (for ADHD) is a good read: https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...

  • by anonnon on 3/2/25, 7:10 AM

    There are newer, non-amphetamine drugs for treating ADHD like Strattera, an SNRI (Selective Norepinephrine Re-uptake Inhibitor). It will be interesting to see what happens if and when these drugs displace the amphetamines (the current front-line treatment for ADHD) to the point that getting a prescription for Adderall or Vyvanse or some other form of medicinal speed because you have (or think you have) ADHD becomes difficult or impossible.

  • by andoando on 3/1/25, 6:36 PM

    I question even calling it an "over" diagnosis, when its not even clear that the diagnosis has any non-socially constructed objective metrics by which we can call that diagnosis accurate.

  • by wkat4242 on 3/1/25, 6:47 PM

    It's weird, I'm sure I have ADHD but it's very hard to get a diagnosis. Several of my friends have it and I'm exactly the same as them. I'm not in America though (very thankful for that considering what's happening there now)

  • by slothtrop on 3/1/25, 7:03 PM

    I myself was diagnosed twice. I don't have it, at all. Notwithstanding any perverse incentive to diagnose, the process itself is not stringent and borders on pseudo-scientific. It's not to say ADHD doesn't exist, but that they (psychiatrists) egregiously cast too wide a net.

    You might ask how I know I don't have it. No one really cared about other symptoms I exhibited: chronic insomnia foremost, and some anxiety. Once I got a handle on that with non-pharmaceutical interventions, my focus was fine.

    And to the extent that insomnia was given any credence, it's to push pills. Generously you could say practitioners default to that because it's so often demanded by clientele, they want to just press a button to make problems go away. But they just don't bother giving you an alternative.

    edit: would also mention, the first time I was diagnosed as a young child was because I was a bored daydreamer who didn't always pay attention to the teacher. This is what we're treating as a weakness to be rooted out.

  • by tiahura on 3/1/25, 8:38 PM

    Have you seen their parents?

  • by cantrecallmypwd on 3/2/25, 1:00 PM

    Undiagnosed ADHD-PI/-C ruined my life from childhood, teenage years, and early adulthood. I blame by ignorant, opinionated father for espousing conspiracy theories.

  • by j15e on 3/1/25, 6:34 PM

    Can’t read the article even with archive.org. Can someone share it somewhere?