Astral Codex Ten

ADHD

17 min read

ADHD

Article

ADHD is a recurring concept in the Astral Codex Ten archive, appearing 13 times across 13 issues between January 25, 2021 and September 07, 2023. The archive places it in contexts such as “It is officially indicated for ADHD and obesity”; “Some, like schizophrenia and ADHD, are very genetic”; “risk genes are shared with other psychiatric disorders, like schizophrenia, bipolar, ADHD, and Tourette’s”. It most often appears alongside Scott, US, Adderall.

Metadata

  • Category: Concepts
  • Mention count: 13
  • Issue count: 13
  • First seen: January 25, 2021
  • Last seen: September 07, 2023

Appears In

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

Know Your Amphetamines
January 25, 2021 · Original source
As usual in pharma, someone bought Obetrol Pharmaceuticals, then someone else bought them, and after a few iterations of this, all their intellectual property ended up with a company called Richwood. They decided to rebrand Obetrol as "Adderall" and pitch it as an ADHD cure.
Treating ADHD with amphetamines was hardly a new invention. Psychiatrists had been doing it since the 1930s, albeit with slightly different drugs. Remember, many organic chemicals come in two versions, a "right-handed" or "d" version and a "left-handed" or "l" version. Benzedrine (a 50-50 d/l split) and Dexedrine (pure d-amphetamine) were the treatments of choice throughout the mid-20th century. So why was it Adderall - a weird combination of four different salts selected kind of at random by a sketchy diet pill company - that caught on?
I'm not sure. My best guess is good timing plus good advertising. In the early 20th century, ADHD was called "minimal brain dysfunction" and diagnosed only in the most extreme cases. A few children with absolute and total inability to function at all got diagnosed and given Benzedrine or Dexedrine; everyone else was left to fend for themselves. As far as I know, this wasn't because doctors had a principled commitment only to diagnose extreme cases - I found a paper from 1975 arguing that up to 5 - 10% of children probably had minimal brain dysfunction, the same number estimated to have ADHD today. Parents just didn't know about it and didn't really have "take my kid to a psychiatrist" in their set of plausible options to consider.
Inline links: a paper from 1975
Ontology Of Psychiatric Conditions: Tradeoffs And Failures
February 11, 2021 · Original source
Most psychiatric disorders are at least partly genetic. Some, like schizophrenia and ADHD, are very genetic, probably 80% plus. This is strange, because having psychiatric disorders seems bad, so you would expect evolution to have eliminated those genes. Researchers looking into this question argue between two hypotheses.
First, a failure. Evolution is imperfect, so some bad genes manage to slip through. This sounds dismissive, but it's definitely true to some degree. Thousands of different genes contribute to risk for conditions like ADHD and schizophrenia, with each adding only a tiny amount of risk. When a gene is only very slightly bad, it takes evolution millennia to get rid of it, and during those millennia people are getting new very-slightly-bad mutations, so it all balances out at a certain level of bad genes per generation. Those bad genes are sufficient to explain the existing amount of ADHD and schizophrenia; they're just evolution not working as well as we'd hope.
Recent research has pretty heavily favored the failure hypothesis. If you have enough people's genomes, you can use some complicated math to infer how evolution is affecting different genes. And on most of the schizophrenia risk genes we know about, evolution has been gradually eliminating them in a way that looks like they're on net harmful - not keeping them around in a way that looks like they have counterbalancing advantages. In the modern day, people with genes for psychiatric disorders tend to have fewer, rather than more children than people without those genes - except in the case of ADHD, which I'm tempted to cynically attribute to them being less likely to remember to use contraception.
Inline links: gradually eliminating them, fewer, rather than more
Highlights From The Comments On "Crazy Like Us"
July 21, 2021 · Original source
Living in Russia, I can say that ADHD (translated as СДВГ) is less recognized by the psychiatry community here because of its unclear aetiology. Doctors usually refuse to treat the patients in the absence of dangerous symptoms, and state the diagnosis as "organic nervous system disorder", "psychoorganic syndrome" or indeed "neurasthenia". Adderall and Ritalin are illegal drugs here. Patients usually get prescribed nootropics (glycine, racetams) and adrenaline reuptake inhibitors (atomoxetine).
At the same time there are some articles in popular online magazines telling stories about children and adults struggling with ADHD in Russia. Some people order illegal drugs from nearby countries. Researchers also are aware of it. At the same time, I see some articles talking about US problems with over-medicalization of ADHD with dangerous narcotics driven by profit-seeking pharma companies.
Inline links: some articles in popular online magazines, some articles
So if you ever wondered what would happen to ADHD people if stimulants weren't legal, Russia seems like a good test case.
Highlights From The Comments On Missing School
August 26, 2021 · Original source
I think there's a few places where missing school would have outsize effects. One is if the kid had some kind of treatable problem (say ADHD) that the parents are not equipped to identify but that possibly somebody at school might recommend taking the kid in for testing. Granted this could still be identified once the kid goes back to school, but if you assume the parent will fail to notice it forever but some teacher/counselor/whoever *might* notice it, then less exposure to the people who might notice will reduce the chance it ever gets noticed. For people who don't find this plausible, do not underestimate the inability of many low income or rural parents to think in these terms. My sister was not diagnosed with ADHD until she was in late high school and was prescribed Ritalin. It was literally life changing for her. It never occurred to my parents to think of her various behavioral problems in terms of anything except childish defiance they could fix with rules.
ACX Grants ++: The First Half
February 03, 2022 · Original source
#25: Scientific Research On Life History Models Of Mental Illness I'm J.D. Haltigan and I'm looking for funding to continue independent scientific research with my academic colleague investigating life-history models of psychopathology as they relate to the neurodevelopmental disorders of ASD, ADHD, and OCD. In order to optimally continue this work amidst the pandemic, funding that would allow us the potential of release from other academic duties (e.g., teaching, grant writing) would help advance this work which is pre-registered and described here: https://aspredicted.org/blind.php?x=2ea9vn. Currently I am seeking 5k USD and am happy to hold a Zoom call with anyone who who can provide funding or advice to provide further details on the project as well as my academic background and credentials. [You can reach me at jhaltiga@gmail.com]
Obscure Pregnancy Interventions: Much More Than You Wanted To Know
April 13, 2022 · Original source
With those three caveats in mind: sure, there are lots of studies showing that stress hurts fetal development. Probably the biggest is this study of 10,000 kids, which finds that maternal stress during pregnancy is correlated with increased likelihood that a kid will get ADHD. Could that just be the kind of confounders we talked about a second ago? Yeah, definitely.
Inline links: this study of 10,000 kids
Last year, Nature Reviews Endocrinology published Consensus Statement: Paracetamol Use In Pregnancy - A Call For Precautionary Action, by ninety-one leading scientists. It argued that Tylenol use during pregnancy might cause neurodevelopmental and urogenital disorders in children. They argue that Tylenol babies have higher risk of abnormal hormone profiles, abnormal urinary tract development, and ADHD. What’s their evidence?
Inline links: Consensus Statement: Paracetamol Use In Pregnancy - A Call For Precautionary Action
Other studies ask women how much Tylenol they took when they were pregnant, then try to correlate it with offspring outcomes. The Consensus Statement lists 29 of these studies, and says 26 / 29 found evidence of harm. A typical study is Chen 2018, where researchers identify 950 kids with ADHD and 3800 kids without, and compare (using health system records) how likely their mothers were to have used Tylenol (finding that the ADHD moms were about 25% more likely). Even more sophisticated is Ji 2020, which found that “[umbilical] cord biomarkers of fetal exposure to acetaminophen were associated with significantly increased risk of childhood ADHD and ASD in a dose-response fashion.”
Inline links: Chen 2018, Ji 2020
Lavender's Game: Silexan For Anxiety
May 18, 2022 · Original source
Not many treatments in psychiatry have a large effect size. There’s stimulants for ADHD, ketamine for depression . . . and now Silexan for generalized anxiety disorder.
The Psychopharmacology Of The FTX Crash
November 16, 2022 · Original source
The present case adds to the literature describing effective combinations of MAOIs and stimulants and suggests that the combination of transdermal selegiline and a stimulant may not need to be considered absolutely contraindicated. This combination therapy may be an option for some patients with comorbid ADHD and treatment-resistant MDD when used with caution and monitoring of heart rate and blood pressure.
Psychiatric guidelines are very clear on this point: only give Adderall to people who “genuinely” “have” “ADHD”.
But “ability to concentrate” is a normally distributed trait, like IQ. We draw a line at some point on the far left of the bell curve and tell the people on the far side that they’ve “got” “the disease” of “ADHD”. This isn’t just me saying this. It’s the neurostructural literature, the the genetics literature, a bunch of other studies, and the the Consensus Conference On ADHD. This doesn’t mean ADHD is “just laziness” or “isn’t biological” – of course it’s biological! Height is biological! But that doesn’t mean the world is divided into two natural categories of “healthy people” and “people who have Height Deficiency Syndrome“. Attention is the same way. Some people really do have poor concentration, they suffer a lot from it, and it’s not their fault. They just don’t form a discrete population […]
Inline links: neurostructural literature, the genetics literature, bunch of other studies, the Consensus Conference On ADHD
Highlights From The Comments On Telemedicine Regulations
April 03, 2023 · Original source
Also, for Lela, see eg here, here, and here: most research suggests that childhood use of ADHD medication decreases future risk of substance abuse; a minority of studies find no effect, but AFAIK no credible ones find an increase. ADHD treatment is correlated with substance abuse, because ADHD itself increases risk, but it’s not a causal relationship.
Inline links: here, here, here
Of course, the bigger issue is that prescription stimulants have a lot of benefits and some drawbacks for all kinds of people. Some of them have ADHD. A lot of them don't. The question is whether we're cool with this. It appears the government is not.
These suffice to get a vague sense that telemedicine is usually good and not bad, which I think is accurate. But nobody knows how well a study showing telemedicine is good at one thing in one specialty translates to being good at another thing in another specialty. For example, consider this study showing that telemedicine improves care in opioid use disorder. The clearest way it improved care was by patients being more likely to attend their appointments and continue care. This led to various other good things, like lower risk of overdose. Did doctors deliver equally good care per appointment? We don’t know. If you’re sure you won’t miss any of your appointments, will teleheath be better or worse for you than in-person? We don’t know. Does “telemedicine treats opioid use better” generalize to “telemedicine treats ADHD equally well?” I don’t know. Is the sample size large enough to notice if telehealth doctors did 1% worse at treating some specific easy-to-miss but dangerous condition? I don’t know. Does telehealth increase addiction risk in other patients who aren’t already addicted? I don’t know.
Inline links: this study showing
Highlights From The Comments On Long COVID And Bisexuality
May 11, 2023 · Original source
Also, I asked about psych conditions in two ways: do you think you have it, and were you ever diagnosed by an MD? There ought to be a strong self-identification effect for the first, but a smaller one for the second. But there was more of an association with Long COVID for the second. For example, 3.7% of people with self-diagnosed ADHD had Long COVID, compared to 4.4% of people with MD-diagnosed ADHD.
For example, the best nationwide analyses find that women have more depression than men; my survey also finds this. Too easy? It’s well-known ADHD people are more likely to have substance abuse issues; my survey finds people with ADHD are 4x as likely to report this. Still too easy? The most careful experiments find that schizophrenics are less likely to be able to see the Hollow Mask Illusion: my survey also finds this.
The Canal Papers
June 14, 2023 · Original source
We can then turn to situations in which an individual may be under-canalized in an [inference] landscape, but over-canalized in a [training] landscape. Psychopathologies potentially consistent with this configuration include attention deficit hyperactivity disorder and autism spectrum disorder (Rogers, Elison, Blain, & DeYoung, 2022). These are characterized by an inconsistent deployment of mental circuits, as well as an inability to learn or change these circuits over time.
Recent research has suggested a similar “general factor of psychopathology”. All mental illnesses are correlated; people with depression also tend to have more anxiety, psychosis, attention problems, etc. As with intelligence, the statistical structure doesn’t look like a bunch of pairwise correlations, it looks like a single underlying cause. There are obvious and boring ways this could happen - hallucinating demons might make you anxious, having ADHD might make you depressed, etc. I am told by people who know more statistics than I do that these have been ruled out, and something deeper is going on.
They only give a couple of paragraphs of explanation for why they assigned conditions to one bin rather than another. For example, with ADHD, they say:
Your Book Review: The Educated Mind
July 14, 2023 · Original source
Alice: You haven’t mentioned much in the way of neurodiversity. Would an Egan school work well for a student with, say, ADHD?
Reviewer: As a person with ADHD who has two kids with ADHD and who teaches students with ADHD, the two words that pop into my head are: hot damn. And this seems to be the common opinion of Egan-fans around the world. For a lot of us, school is just so boring, and bringing back in emotional binaries and extremes and big ideas makes it not just bearable, but enjoyable.
Contra Kirkegaard On Evolutionary Definitions Of Mental Illness
September 07, 2023 · Original source
1: ADHD
People with ADHD have more children than people without ADHD, probably because the people with ADHD forget to use condoms (here is a source for teenagers, can’t find source for adults but I’ve definitely heard this). That means that by Emil’s definition, not having ADHD is a mental disorder!
Inline links: here is a source for teenagers
But I’m not sure what the right amount of attention was in the African savanna. Plausibly, amounts of ADHD that would totally ruin your life today were just fine when the most demanding cognitive task around was hunting giraffes.