Parentdish.com interviewed me a few weeks ago, about ADHD. I do not treat ADHD myself, which allows me to have a kind of broad, unbiased perspective on it — and, like most diseases considered “new”, history tells us it is old but “newly named”. The very popular article, widely reblogged, is here:
http://www.parentdish.com/2009/05/11/would-you-drug-your-child-to-enhance-academic-performance/
and here are my original answers in the interview :
> Please provide me with your definition of ADHD and ADD. Is this a truly physiological disease? I am skeptical, I admit. It seems like when I was a kid, students with ADD or ADHD were just called “hyper” or “active.”
Look, forget about clinical definitions; let’s talk about people. ADD/ADHD is the disease that caused Alexander to be The Great. It also caused him to drink himself to death.
If you look at any historical primary source (or the recent movie which does a reasonable job of following them), the pattern is clear: in childhood and youth, the classic oppositional-defiant disorder that is a common co-morbidity of ADD; impulsiveness and thoughtless actions, causing him to kill his friend Cleitus in a drunken argument; and at the same time, a genius for operating under pressure, an ability to see solutions others overlooked — whether the incisive solution to the Gordian problem, or the brilliant maneuver at Gaugamela — a need to keep moving, in his case through most of Asia, never pausing long enough to establish working governments, never bothering with details, alternating great kindness with wanton destruction, rarely thinking through a plan but improvising brilliantly — and dying weakened by alcohol. This is the key to ADHD: people with ADHD need to be either entertained or frightened to perform to their full potential. They make bad baseball players, as they never quite figure out why they can’t run straight to third base, but excellent football and basketball players, able to see an opening and capitalize instantly. ADHD is certainly a disease in the 21st century: they are clearly at a disadvantage in the world of forms to fill out and regulations to comply with; but you sure as hell want them on your side when used diapers hit helicopter rotors.
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> How do drugs help ADHD/ADD kids and adults, or do they, in your opinion.
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> Exactly how do these drugs “enhance” performance?
 yes they do work — by stimulating the same nerve centers as adrenalin does, in people either enticed or startled into paying attention. The big reason they are recommended is that they definitely reduce the incidence of substance abuse, otherwise quite common in ADHD individuals. Most commonly abused drugs and alcohol create a rapid-onset, short-duration subjective clearing of their minds, a feeling that this is what their brains have been missing all their lives. For the same reason, it is not unusual for ADHD people to become adrenalin junkies. ADHD stimulant medications are specifically made to have a gradual onset and long duration, bypassing the highly addictive “rush” which the same active ingredient might cause if given all at once. In particular, “crystal meth” is identical to one of the active ingredients in some ADHD drugs, yet is far less addictive in sustained-release form.>
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> A recent article in the New Yorker states that more and more healthy young adults are using neurologically enhancing drugs to improve their overall academic performance. Is it healthy for non-ADHD people to use these stimulants for off-label reasons?
> The same article cites a study in the journal Nature, which showed that parents would be willing to give their young children these drugs to enhance their academic performance. What is your opinion about this?
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After all is said and done, standard pharmaceutical stimulants give most people a competitive edge over unenhanced peers. Imagine your thoughts and memories jumping around like middle-schoolers at recess; stimulants make them behave more like Marines on maneuvers. True clinical ADHD does not affect anywhere near the majority of people, but it is likely that an incremental improvement in attention and focus could be produced by small doses of stimulants in many more people than fulfill the ADHD criteria.
> Are there side effects? If yes, what are they?
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Insomnia and loss of appetite are the big ones; and any drug (or food, for that matter) can cause allergic or hypersensitivity reactions. Therapeutic stimulants can cause cardiac arrhythmias and blood pressure fluctuations, headache, dizziness, nausea, tics, and (but less commonly than rapid-acting drugs) addiction. The classic amphetamine disasters — uncontrollable rage, depression when stopped, paranoia, violent outbursts, delusions, hallucinations, movement disorders, tremors — are common when amphetamines are used irregularly (especially in the “I need it right NOW!” mode so familiar to ADHD individuals) and in poorly controlled doses.
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> What kind of side effects could young, non-ADHD kids suffer?
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Too enthusiastic a use of ADHD meds could produce a hyperfocused state in which, in terms of performance, they could become obsessed with a non-essental task (such as sharpening pencils), and, in psychological terms, become obsessed with thoughts to the point of paranoia. They could also lose enough sleep to counterbalance any advantage from the stimulant.
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> Do you see this as a trend? Will these stimulants be available for this use? Should they be? Why or why not?
They have been, particularly by various military forces, since at least WWII. We know cocaine as a rapid-acting, highly addictive drug today, but as “sustained-release” formulation, chewed coca leaves, it allowed many generations of Andean warriors to maintain peak fighting efficiency. It was clearly destructive in the long run, but as it improved their chances of survival in battle, it allowed them to HAVE a long run in the first place.
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> Why do you think parents are so willing to drug their otherwise healthy kids to improve academic performance? What does this say about modern parents?
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Why is this even questionable? Stage moms, pageant moms, sports parents, academically ambitious parents are common enough to be archetypical; asking for stimulants to beat other competitive school applicants is not a far step from yelling “Kill him!” at a hockey game.
It is perhaps worth noting that ours is not a society that eats the runts of its litters, but enough families act as if it were.  “Vaulting ambition” was certainly a concept known to Macbeth, and one can have no doubt that amphetamines would have been on Lady Macbeth’s menu had she lived in modern times.
