The crux of the problem is this: virtually any one of us can be diagnosed with ADHD, if not with honest self-representation then just as easily by dishonest answering of the survey. The DSM IV criteria for ADHD is:
http://www.cdc.gov/ncbddd/adhd/diagnosis.html
For me, personally, I can honestly answer yes to many of the criteria.
DSM-IV Criteria for ADHD
I. Either A or B:
- Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level:
Inattention
- Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. Check. Miss details in studying all the time.
- Often has trouble keeping attention on tasks or play activities. Tasks such as studying for med school? Yup. I have common bouts where I surf the web for 5-10 mins after every 2 paragraphs of reading.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).Yeah, it's pretty common to study for only 3 lectures instead of the 5 I plan on for the day.
- Often has trouble organizing activities.
- Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). Uh...no question.
- Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
- Is often easily distracted. See surfing web comment. In addition, in lecture I often alt-tab to reading news articles for 2-4 minutes at a time, every 10 minutes.
- Is often forgetful in daily activities. I'm not terribly forgetful, but it isn't uncommon for me to forget small things throughout the day. Like all people.
- Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
Hyperactivity
- Often fidgets with hands or feet or squirms in seat when sitting still is expected.
- Often gets up from seat when remaining in seat is expected.
- Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
- Often has trouble playing or doing leisure activities quietly.
- Is often "on the go" or often acts as if "driven by a motor".
- Often talks excessively.
- Often blurts out answers before questions have been finished.
- Often has trouble waiting one's turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games).
II. Some symptoms that cause impairment were present before age 7 years.
It's rather abnormal for a kid to be able to focus on schoolwork for long periods of time.
III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
Study at school and study at home is just the same.
IV. There must be clear evidence of clinically significant impairment in social, school, or work functioning.
Oh yes.
V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
And there you have it. I can be diagnosed with ADHD and not even be lying. Yet I still do well in school and I don't take amphetamines or other psychostimulant (other than caffeine, which merely keeps me AWAKE but not concentrated). Based on stories that I read here, I have little doubt that I could go ahead and get diagnosed with ADHD, pop a few ritalins a day and perform much better than I am currently doing. Or even if I didn't necessarily pass the above criteria honestly, any college/medical student is (hopefully) smart enough to answer the survey correctly to be "diagnosed" with ADHD. Or you could just go buy ritalin off the street illegally. The point is that ADHD is such a subjective diagnosis anyone could get it. It's not like some genetic, metabolic, or physiologic disorder that you run blood tests on and objectively see a low serum
whatever. No, this is a survey. I can answer honestly or dishonestly and get an ADHD diagnosis complete with psychostimulant and subsequently do better on exams. The cost is cheap, the professional ramifications are few, the side-effects are minor (if used properly), and the benefits are plenty.
So why don't I do it? Because for some strange reason, our society thinks it's humanly NORMAL to stare at complicated text on paper and on eye-straining computer screens for hours on end and be expected to remember and know the material read. I don't know about you guys, but there's just about
nothing normal about that behavior. Is it required for us to obtain the knowledge we need? Sure. But that doesn't mean it's physiologically and mentally normal for humans to perform such tasks. I think it's far more normal for me, a human being, to read what I find interesting (NOT lecture notes), look at what I find attractive (NOT pathology slides, and do what I find is fun (NOT photographically memorizing a 12x12 table of drugs and their side effects). What I've noticed is that we are a society that progressively demands more and more out of our children...that we be able to cram more and more into our little heads. And when we find ourselves pushed to the limit and unable to do more, we shame ourselves with inadequacy.
That other kid (0.1% of the population) can do it, why can't you? Has it ever occurred to us that the 0.1% that can cram for 10 hours straight and actually retain the material is abnormal? Nope. That's desirable, even if it means the kid is deficient in everything else. Well popping that psychostimulant seems to be able to bump my cramming abilities to par with the 0.1% kid. That must be the right thing to do. Must be. Because being on psychostimulants is the right if that's what's needed to succeed. They say somewhere around 7% of college kids regularly use a psychostimulant without diagnosis of ADHD. I've read other places that at least some 50% of med students have tried it at some point. Is that right? Is that normal? Am I supposed to be able to listen to 3-4 hours of boring ass lecture day after day, where half the material is what I already know and the other half is often well over my head, and actually pay attention the entire time? Hmmm....
I think what we need to do is re-set realistic expectations. Excessive, overachieving academics has not, is not, and never will be normal. It's not normal when a 2-year old is adding/subtracting double digit numbers. It's not normal for a 1st grader to do book reports (<---my cousin is doing that). And even at our twenties, it's still not normal to be able to sit down and read intently at the driest material you've ever seen for hours on end. Do some people inherently have more difficulties doing academics than others? Sure. Is prescription of a psychostimulant indicated for such a condition? Perhaps, maybe. But to think that most cases of what we consider to be "ADHD" and that it is a disease to be "fixed" I think is egregious lest we churn out more mindless zombies who can only push themselves further academically yet completely forget how to have fun in life. Oh, and also how to spend time and care for a family. But I digress.
So I guess the point I'm trying to make is that society asks us to do the abnormal. Some of us can pull through without drugs or adaptations. These are rare. Others can pull through by toughing it out. Still others require the assistance of medications to succeed. This is all well and good if it results in more knowledgeable doctors that end up saving lives. But to think that what we have to go through is normal for
homo sapiens sapiens, I think, is a mistake that can easily lead to self-doubt, disillusionment, and drug abuse.
I don't know many Norwegians that take Ritalin, but my best GF who started med school in Germany, and who outperformed me academically, back when we both attended senior high in Oslo, did take ritalin when cramming for exams, plus donepezil, and many cups of coffee. Just to pass. 
