The ADHD Diagnosis is a War of Semantics, Waged on Children

Michael W. Corrigan, Ed.D.
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Since I am new on Mad in America, I will tell you; my mission is to debunk the ADHD diagnosis. My goal is to add common sense to a world where drugging kids for acting like kids is all the rage. When discussing ADHD with concerned adults I share how little is required to earn a diagnosis of ADHD. Learning just how non-scientific the diagnosis actually is, for many, is a shocking discovery.

Having an honest look at the 18 childish behaviors that pro-ADHD experts call “symptoms” can help even the most ardent believers realize there is something fishy going on. Understanding the details of how ADHD is diagnosed clarifies how every child with a healthy heartbeat and an appropriate level of immaturity can be “diagnosed” ADHD. So, without further ado, let us dive into the stagnant waters of Dubious Diagnosis Bay, home to Club ADHD: The Last Resort.

According to the DSM-5, there are two categories of ADHD, with two sets of nine symptoms for each. The categories are:

1) Inattention (this used to be considered the ADD part of the diagnosis in previous DSM editions)

2) Hyperactivity and Impulsivity

Under today’s standards, if a person is younger than 17 years of age they need to “have” (display or experience) six or more of the nine symptoms, in one of the categories, to be diagnosed ADHD. Those 17 years or older only need five.

However the DSM-5 further explains that if a child or adult has only a few (one or two) of the symptoms required they can still be labeled ADHD. This is called “ADHD Not Otherwise Specified.” And if the patient does not have any of the symptoms, but the professional doing the diagnosis still feels the patient is ADHD, they can still label the patient “ADHD Unspecified.”

Yes, you read this correctly: A person can be diagnosed ADHD and drugged even if they show only a few – or even none – of the symptoms.

While holding less stringent membership requirements than, say, a public library, Club ADHD gets even worse. The following symptoms have been typed word-for-word from pages 59-60 of DSM-5. As you read through each of the nine symptoms, please just say “yes” and put a mental check mark next to those that describe how you might have behaved when you were a kid or – quite possibly – behave today as an adult.

ADHD-Inattention Symptom Checklist

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or during other activities (e.g., overlooks or misses details, work is inaccurate). ____
  • Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading). ____
  • Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction). ____
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily distracted). ____
  • Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order, messy, disorganized work, has poor time management, fails to meet deadlines). ____
  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers). ____
  • Often loses things necessary for task or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). ____
  • Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts). ____
  • Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments). ____

How many of these nine symptoms did you say “yes” to? If you felt that at least 5 or 6 of these relate to how you behave today or did as a child you should not be surprised.

Beyond just describing how all kids behave while they are learning to be good students and responsible, polite adults, you might have noticed that the sentences describing the symptoms all seem to be quite similar or have been written basically to represent in essence the same thing. For example, if you said “yes” to “difficulty sustaining attention”, you probably said “yes” to “distracted by extraneous stimuli” and “often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.”

Also, did you find the DSM wording of these symptoms to be slightly vague or bothersome? For example, “reluctant to engage in tasks that require sustained mental effort”? Hello? We are talking about children. And, while we’re at it, adults. There is a reason that reality TV shows such as Real Housewives, American Idol, The Voice, Goldrush or Finding Bigfoot have huge viewership.

“Distracted by extraneous stimuli”? Uh, yes. Isn’t that what “extraneous stimuli” are?

And what exactly is meant by “often”? How many times a day, week, month or year constitutes “often”? The use of such vague, subjective terms leaves too much room for interpretation, variance and error on the part of a parent, medical professional, mental health practitioner and educator.  From a research-based child development perspective, stating that a child often exhibits many if not all of the nine symptoms is stating the obvious. To some degree children in nearly all developmental levels from infancy to adolescence exhibit these symptoms. It’s normal behavior. The begged question is; when does it become abnormal?

Now, to be fair, it should be stated that using this list of nine symptoms as a checklist for symptoms one happens to connect with is not the way the DSM suggests the diagnosis be performed. What I am asking you to do is, basically, the laymen’s approach to diagnosing ADHD. What I am getting you to do is, however, similar to the way the DSM is being misused – by far too many with a license to pill.

There are other caveats relating to the duration and the severity of the symptoms that should be attended to. Also, individuals using the DSM correctly are expected to rule out (establish beyond doubt) that none of  16 other diagnoses (e.g., Bi-polar) or categories of disorders (e.g., psychotic disorders) would better explain the symptoms. Conducting this level of differential diagnosis when working with young children takes time. Such efforts should most definitely take longer than a short visit to the pediatrician’s or general practitioner’s office.

However, it seems that the trend is for pediatricians to diagnose millions of kids with ADHD quicker than ShamWow can soak up 12 times its weight in nasty spilled liquids.

Wait, there’s more . . .

Some people want you to believe they have a test your child can take at a school. They say that the test  serves as an accurate indicator of ADHD.

Such tests are typically based on the two checklists of nine symptoms. Don’t forget, many of the folks doing this at school are not licensed to say whether or not someone is ADHD and, more importantly, the DSM makes it very clear that NO test exists for ADHD. 

More than 90% of people I share the diagnosis for ADHD-Inattention with during talks keep their hand up for “yes” for nearly all of the symptoms. In other words, if this first set of nine simple descriptions defines what pro-ADHD experts want to call ADHD-Inattention, we basically all are – or were as children – ADHD-Inattentive. When you have diagnostic criteria or a test for a mental disorder where nearly everyone answers “yes” to all of the questions, what you really have is a diagnosis of “normal.”

The DSM also states that

“Six (or more) of the following symptoms have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities.”

It’s common practice for mental health practitioners to rely on self-report from adult clients. But diagnosing kids requires a more cautious approach. Many mental health practitioners and medical doctors do not take  six months to explore such behaviors, in differing environments, as perceived by different individuals. Apparently, being cautious about rushing into a diagnosis – often requiring children to take dangerous ADHD stimulant drugs that the DEA classifies as highly addictive narcotics – is too time-consuming.

Instead, the clinical psychiatrist, mental health practitioner or medical doctor are expected to take the word of people whose possibly pre-conceived opinions are due to perceptions of disruptive behavior. Or, possibly, the word of a parent – a person not necessarily an expert in child development, or capable of determining if behaviors are inconsistent or maladaptive at specific developmental stages.

This despite the fact that the DSM-5 clearly states; “Adult recall of childhood symptoms tends to be unreliable, and it is beneficial to obtain ancillary [additional] information.” The word of individuals that may have personal agendas, or who as parents may lack an ability to provide an objective, non-biased, view, is used to determine if such behaviors were displayed often by the children for six months or more. These individuals, some who have only known the child for a short time, are expected to be able to determine if such extreme behaviors existed before the ages of seven or eleven.

For many of us, our lives are spent in an effort to correct such imperfect behaviors; an effort that helps us to be more organized, detail-oriented, attentive, polite and responsible. These “symptoms” might be okay for  an adult, trying to determine whether they could benefit from such a label and medication. For kids, however, the symptoms include set expectations for behavior that are unreasonable for the majority to achieve. I suspect that nearly every child that is sent to be diagnosed by an “expert” leaves the practitioner’s or clinician’s office labeled with ADHD.

The first nine symptoms were used to diagnose ADHD-Inattention. What about ADHD- Hyperactivity/Impulsivity, you ask? Once again there are nine highly generic symptoms that you only need to say “yes” to five or six times to be declared ADHD-Hyperactive/Impulsive. For this set of symptoms I suggest that (if you don’t have a female child that you are specifically concerned about) then as you read the symptoms answer from the hypothetical perspective of a boy between the ages of 5-11. I suggest this exercise because a high percentage of kids diagnosed ADHD are boys, and if you focus on this section’s connection to the behavior of young boys you might see why this is the case.

In other words; imagine you are a young boy (or girl) who has to sit in school, fully focused on the one-size-fits-all curriculum, as sunny days or snow-covered fields call your name for months on end. Are you ready? Begin . . .

ADHD- Hyperactivity and Impulsivity Symptom Checklist

  • Often fidgets with or taps hands or feet or squirms in seat. ____
  • Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place). ____
  • Often runs about or climbs in situations where it is inappropriate (Note: In adolescents or adults, may be limited to feeling restless). ____
  • Often unable to play or engage in leisure activities quietly. ____
  • Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with). ____
  • Often talks excessively. ____
  • Often blurts out the answer before a question has been completed (e.g., completes people’s sentences; cannot wait turn in conversation). ____
  • Often has difficulty waiting his or her turn (e.g., while waiting in line). ____
  • Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing). ____

So how did it go this time? Were you able to pay attention long enough to read basic descriptions that describe how the majority of young children behave? How many did you say “yes” to? Are you or your 7-year-old alter ego ADHD-Hyperactive/Impulsive as well as ADHD-Inattentive?

It is as if the individuals who wrote these symptoms have never been around kids before. It’s as if they don’t like kids, and most definitely don’t like little boys. Who, in their right mind, besides a few old school librarians and pastors protecting the sanctity of the quiet nature of their workplace, would expect children to play quietly?  Who would associate “quiet play” with kids’ leisure activity? For millions of kids, playing quite often encompasses – if not requires – running and screaming. This is called having fun when you are young.

When we try to keep such energy bottled up all day, while children receive seven-plus hours of direct instruction devoid of exercise, play and creative time, these behaviors will only get worse.

Experts refer to discriminant or convergent validity in the field of psychometrics to refer to the ability to distinguish between syndromal from non-syndromal phenomena. The bottom line is that the current 18 symptoms used to diagnose ADHD are so common to all children that it provides no valid method to discriminate who actually has or doesn’t have ADHD. The symptoms do not measure what they say they measure; which to some degree eliminates any claims of what is known as face, content, or criterion validity.

When it comes to the common childhood behaviors some call symptoms of ADHD, there is a wicked game of semantics – a war, if you will – being played with our kids’ futures. The pro-ADHD experts want to label basic childish behavior as symptoms.  They want us to believe that signs of being “fidgety”, “on the go”, or “driven by a motor” are symptoms of a disease or serious mental disorder. But such descriptions could also be called energetic, motivated and full-of-life.

These are just signs that kids like to be active; a welcome behavior in these days of rocketing childhood obesity. “Not waiting your turn”, “blurting out answers” or “interrupting” are painted as a bad thing rather than a sign of wanting to contribute with enthusiasm.  Supposed symptoms of ADHD such as “doesn’t follow instructions”, “doesn’t engage in a series of tasks” and “avoids organization” are also the hallmarks of highly creative and possibly intelligent minds. “Doesn’t pay close attention” and “doesn’t provide sustained attention or listen” are things that happen when we are thinking actively beyond what is being discussed.

These “symptoms” are a signs that kids are not comfortable with what adults expect of them, or able able to meet those expectations with what is provided at home and school . Some are bored while others need more time, structure, attention or love as they develop. Both are likely more accurate “diagnoses” than a label of “disorder.”  It all depends on which side of the desk – or prescription pad – you sit. ADHD is in the eye of the beholder.

For many visitors to this website, what I have shared here provides ample evidence to say “no” to the drugging of kids for acting like kids. For others who are stuck in this diagnosis’ stagnant waters, accepting such logic is not easy. Why? Because no parent medicating a child or person medicated for a supposed disease – one they have accepted as a defining part of their personality – wants to find out it was all based on pseudo-science. Rightly so; no one wants to find out they have been duped or find out they have drugged their children based upon false information.

At times the level of resistance seems strange. I will admit, at times during my efforts to convince others of ADHD’s many falsehoods, it has felt like I was telling 500,000 hippies at Woodstock to not eat the brown acid. For some surreal reason, there are millions out there that don’t care how bad the drugs are. But brave individuals such as Dr. Fred Baughman, Dr. Richard E. Vatz, Dr. Diane McGuinness, and Dr. Peter Breggin have warned us all for decades about the invented disorder of ADHD and provided ample scientific evidence to say “no” to the label and dangerous drugs. I will keep trying. Our youth deserve nothing less.

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43 COMMENTS

  1. Y’know, ALL of the disorders listed in the DSM are clinical disorders. There are no biological tests or thresholds for any of them. So tell me, if you don’t “believe” in ADHD, do you also think depression is made up? How do you know if you’re depressed? ADHD is no more an invented disorder or difference than schizophrenia or major depressive disorder. The fact you’re citing Dr. Breggin shows you’re full of it. The guy thinks ADHD can be cured with love. Please.

    • Ah, but sometimes what is diagnosed as “ADHD” CAN be cured with love, if you add some wisdom. For one thing, the symptoms of “ADHD” can be caused by dozens of other things, like iron deficiency, sleep apnea, witnessing domestic abuse at home, lacking sufficient structure, or being forced to do developmentally inappropriate things by your school or teacher. One well designed study showed that waiting a year to enroll your child in Kindergarten reduces the likelihood of an ADHD diagnosis by almost a third. Another showed that “ADHD” kids in an open classroom setting were virtually indistinguishable from “normal” kids, even by professionals, while they stuck out like the proverbial sore thumb in a standard classroom.

      We raised two “ADHD” boys without medication, and while the oldest still has some manifestations as an adult, he’s been quite successful in his employment, and the youngest is virtually “cured” in that no one who looks at him would ever identify him as “having ADHD” despite his being a classic case as a kindergartner.

      Additionally, the rate of “ADHD” diagnosis for foster children is many times higher than the general population. Unless you’re claiming that “ADHD” kids are abused at 4-5 times the rate of “normal” children, it appears that a LACK of loving interaction does in fact lead to “ADHD” symptoms. Which suggests that increasing the love available in the environment might, in fact, cure them. The overlap between “ADHD” and “PTSD” and other “anxiety disorders” is large and well known.

      So sure, some kids act in the way described as “ADHD.” Just like some people feel depressed. But the fact that kids act that way or adults feel that way does not, ipso facto, prove that they are “disordered” in any way. If moving a kid to a different type of classroom makes his/her “symptoms” go away, doesn’t it make sense to ask whether it is the classroom that is “disordered?”

      As I think we’ve discussed before, I’m not denying there is a wide range of genetic propensities in human beings, and it’s probable that some of us are programmed to have a hard time sitting still and doing as we’re told. I think we need those people. Genetic diversity is part of species survival. Just because people are different and don’t fit in well with our social institutions doesn’t mean they have a disease. Often, it is the social institution that really needs to be changed. Calling it “ADHD” removes any responsibility from those in power to take a look at the institutions they’ve created and honestly assess whether they’re working for those they’re supposedly designed to serve. In the case of our standard school classrooms, for most kids, I think the answer is a big NO. I’d rather fix the school than punish kids (like you were) for pointing out to us that they aren’t working.

      — Steve

      • In America we’ve created a monoculture. Farmers grow only one kind of corn, wheat, or cotton, one kind of pig, chicken, cow, etc. We’ve destroyed diversity in farming. This is dangerous when we depend on only one variety of something for the livelihood of a nation.

        Now, we’re carrying over this monoculture to apply to people with our efforts to make everyone conform to one acceptable attitude, set of behaviors, belief system, etc. What happens when you destroy and stamp out diversity in people?

        Psychiatry and the drug companies are very willing to enforce this monoculture in people with their “treatment” and their forcing people to see and believe everything only one way.

        In the hospital where I work the other peer worker and myself bring up the question about why is it so important to force people to give up their so-called “delusions?” We wonder aloud if it might be more productive to empower people to learn to deal with their “delusions” in ways that are not disruptive or disturbing. The psychiatrists and staff respond by saying that delusions are not true and therefore people must be forced to give them up. Let us force everyone to march in lock-step to the beat of only one drum!

  2. The same issue pops up again and again : ADHD simply doesn’t exist. It’s a sham. Ok, I don’t mind people holding that belief true. And I agree that the ADHD diagnosis can be misused ; and possibly widely misused. I also know first hand how ADHD treatment can turn out to have terrible side effects. Still, I’ve been blighted all of my child and adult life with symptoms that perfectly match the diagnosis of ADHD. What do I do with that Mr Corrigan ? Do I have to deny the reality of my symptoms and simply kick my own ass into getting better ? Actually, I tried. Sadly it didn’t work. I’ve also been trying psychotherapy. Unsuccessfully. Damn, if it’s not ADHD what the heck can it be ?

    • I don’t understand the provocative nature of your post. I don’t see Corrigan’s comments as denying that the behaviours don’t exist. The issue is whether it is a valid diagnosis or not and of course the issue what to do with children and adults who struggle with add-adhd-type behaviours.

      I’ve struggled too with distractibility my whole life and I don’t require a diagnosis or a prescription to validate or invalidate my experience. There are resources ranging from psycho-therapy, mindfulness meditation, so-called brain-traing/neuroplasticity exercises, martial arts, diet, yoga and many more and I’m aware that it’s not appropriate for me to recommend or suggest. There are all kinds of behaviours people have from being shy, distractible, impulsive, very sensitive and these don’t constitute valid diseases or disturbances of the soma. As frustrating as it is to live with these experiences let’s not criticize or play the provocateur simply because Dr. Corrigan doesn’t have all of life’s answers. We could also simply ask: Mr. Corrigan, what then do you recommend for those struggling with these behaviours including people who report having extreme behaviours related to ADD/ADHD?

        • There is also drugs. They have the same effect on everyone. The Beat writers like Ginsberg and Burroughs used amphetamine to help them concentrate on writing. But it doesn’t mean that ADHD is a valid diagnosis. It just means that drugs can be used to help people concentrate. There are costs to this and tolerance is also an issue. So other means should be used whenever possible – or accept that it’s just part of the human condition.

          I had a friend who liked his diagnosis and found it hard to concentrate on anything – except when he was doing art. At that point I think the whole diagnosis falls down. He was just an artist who hated doing anything else and did not want to admit it.

      • I’m glad you found a way to deal with your distractibility. I still haven’t. And it’s disabling. I can’t get organised ; I can’t drive ; I can’t do sport properly ; I can’t do so many things…You don’t need diagnosis ? Don’t need treatment ? Good for you. But it’s your life, not mine. I have been experiencing disabling symptoms. And I would be so very happy to find some relief, I’d be so very happy to have the same ability to focus, to get organised, to pay attention as most people. So please, don’t come and tell me I should be kind and shut my mouth when I hear someone denying the very existence of what I’m going through.

        • Tyler,

          Nutritional deficiencies can be a culprit:

          http://www.foodforthebrain.org/nutrition-solutions/adhd-and-hyperactivity.aspx

          Dr. Mary Ann Block doesn’t believe in “ADHD”, but she *does* understand that the symptoms that get labeled as such are very *real*. She, (like other practitioners of environmental medicine) treats the very *real* root causes of food allergies:

          http://blockcenter.com/programs/adhd-non-drug-program/

          Neurofeedback is helpful more many people:

          http://www.youtube.com/watch?v=dYLtM0RrIJU

          I hope some of these links are helpful.

          My best,

          Duane
          http://discoverandrecover.wordpress.comresearch

  3. Hi Michael, thanks for your challenging thoughts on ADHD. But I am unclear, are you anti diagnosis or are you more anti the treatments that go with the diagnosis? You do give some compelling arguments about why there are significant problems with the diagnosis but you and I know that for the most part, mental health professionals are diagnosing it in about 5% of children so they are able to appreciate that there are extremes to the behaviours described in the DSM and it is those children who more typically get identified.

  4. As someone who worked over a year in a kindergarten, I would say that children who don’t qualify as hyperactive/impulsive by the ADHD symptom checklist are more likely to have some psychological troubles than the kids who are.

    Often leaves seat in situations when remaining seated is _expected_?

    Often runs about or climbs in situations where it is _inappropriate_?

    Often unable to play or engage in leisure activities _quietly_?

    Since when is this natural behaviour?

    “It is as if the individuals who wrote these symptoms have never been around kids before. It’s as if they don’t like kids…”

    I couldn’t agree more.

  5. The biggest myth ever is “If you have ADHD the drugs don’t get you high”, bullshit, the way it works is your nice and high and therefor calm and focused. The worst part is when it wears of and that anxiety and real depressing more out of focus than before feeling hits. I could only imagine doing every day of day childhood but I did it as an adult for years.

    That ‘new’ drug Vyvance is a nightmare, the focus ‘good’ zone is only a few hours but the crash goes on and on and on and they call that “long acting”, the makers are such lying manipulating scum in there pursuit of profit. Vyvance is marketed as ‘effective for up to 14 hours’ but almost everyone who writes about it online in those ADHD forums report this is not true just like I found out.

    Message to parents and prescribers: Adjust for body weight and take a dose yourselves, get a clue. There are no clinical words that can describe what a day on amphetamines feels like.

    I don’t want to help sell the stuff (kids are already doing that at school) but I have to say that that ADHD stimulants are on of the best highs around even at clinical doses (higher doses don’t really help, there is a ceiling) and unlike other recreational drugs when its all over you will likely have gotten alot of things done. Windex, furniture polish is alot of fun wile on these drugs and so is that pile of bills and paperwork you have been putting off.

    Have fun parents.

        • Most psychiatrists have absolutely no idea what it feels like to be on the so-called “antipsychotics’ nor do they really care to know. But it’s perfectly fine for them to force the people enslaved to them in the form of “treatment and care” to take the toxic and poisonous drugs.

          However, I don’t think it would matter with a lot of psychiatrists if they did know what the effect of these drugs are on people. To quit forcing them on people would mean that they’d actually have to do some work and they wouldn’t get paid by the insurance companies for doing it to the tune of what they get by forcing the drugs. I think a lot of them have a pretty good idea that these drugs are not fun at all; how could you not know after watching people stumble around like zombies while drooling on themselves? They know and they don’t really give a big, fat damn at all! Their job is to tranquilize people and force them into conforming to a certain form of behavior and belief system.

  6. (deep sigh): For many years I have had parents asking me if their children need Ritalin. Personally, I have never seen a patient with a Ritalin deficiency. That said, I do encourage parents and patients to perform urine and saliva tests for neurotransmitter and endocrine screening, and treat the problem, rather than the symptoms. I also prescribe and refer for rehabilitative therapy for acquired functional disorders and neuro-developmental delays. We need to educate pediatricians, pediatric nurses and teachers to look for signs of problems and actually diagnose the cause. And don’t get me started on the increasing numbers of kids in elementary school with anxiety disorders!

    • With all due respect, your therapy is just another version of perpetuating the chemical imbalance theory that has been disproven. As a medical professional used to say who spoke out against excessive psych med prescribing, the only way neurotransmitters can be measured if you are dead.

      AA

  7. I first read this list when I finally agreed to take my son to be tested, by that time I knew something was wrong, but I also knew this wasn’t it. At that time we were seeing a child psychiatrist who was given to strong looks of disapproval (mostly for me) and that annoying smug voice they use to run over you if they suspect you might question them. I always tried so hard to be on my best behavior there, and I got all the way to “runs in inappropriate places”., .. I guess I always thought that running was a little like cussing,… part of the allure is that they aren’t appropriate. He declared my son ADHD and gave me a card for a therapist for my behavioral problems. I never used it and still run in inappropriate places, but more importantly, my son never even got the script filled. If he had listened to me he might have noticed that asperger’s was a better fit… though I’m honestly not sure how you could mistake one for the other. This led me to the conclusion that adderall must be the child version of prozac, and used to treat anything they can’t figure out or don’t want to deal with.