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Comment by WhompingWindows | Hacker News Reader

Anecdotal evidence isn't enough. There is actual neurological evidence that those with ADHD have mismatching development of their motor cortex and their PFC which controls the executive functioning of the brain. Most meta analyses of the diagnoses in recent years do not support your skepticism, in fact, some researchers believe the condition is properly or even UNDER diagnosed.

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Let me unpack what you're saying here. Note that I have not surveyed the literature, but I am slightly skeptical of ADHD as a diagnosis, having seen "early detection/intervention" results amongst the children of my peers that seem patently ridiculous.

> There is actual neurological evidence that those with ADHD have mismatching development of their motor cortex and their PFC which controls the executive functioning of the brain

That is to say that the set of people diagnosed with ADHD correlates to the set of people who have mismatching development. But the tests for ADHD (especially in early childhood) do not undergo any sort of PET or fMRI scans for mismatched development; they typically have a set of questions that they ask with a threshold for the number of "wrong" answers. I suspect (without evidence) that as the testing moves earlier in age, there is more "success" with early intervention simply because the condition is transient.

In situation where intervention is recommended, I think overreactions are common and doing large-scale studies to determine how effective the questionnaires are at rooting out both positive and negative findings of "mismatched development" through directly measurable means like fMRIs or PET scans, which are contraindicated in non-acute cases for children of the ages in question, so we have to have longer-term survey studies before we can begin to evaluate effectiveness.

The age-related results referenced in the article (thought I haven't read the study) seem to indicate that at least some of the ad hoc testing is just measuring normal childhood development milestones rather than serving as a useful indicator of ADHD.

" But the tests for ADHD (especially in early childhood) do not undergo any sort of PET or fMRI scans for mismatched development;"

That's not the entirety of the diagnostic process.

Also, you may be putting more faith in PET and fMRI than they deserve.

https://harvardneuro.wordpress.com/2016/01/21/tbt-the-lesson...

Early intervention may in fact be able to mitigate the symptoms, support earlier development of compensating skills and possibly make future treatment unnecessary. That should be considered a success, not cast doubt on the original diagnosis.

It's not a transient condition, like an infection, it develops over time as the brain matures. To call it transient implies that it's fleeting/ephemeral, and having met people diagnosed in their 60's crying because they finally understand why the struggled in life, I saw first-hand that it is not transient.

So, developmental means that it's not present at age 1, but by age 7, it must have become present. Otherwise, we're looking at anxiety or depression or something else. Even those diagnosed with ADHD as adults, one of the stipulations is that they MUST have had symptoms before age 7, though admittedly the DSM versions have changed regarding this point (side note: this is part of the reason the diagnosis is seen as trendy/over-done recently, because subsequent DSM versions have changed it up quite a bit, from what was called minimal brain dysfunction in the 50's to ADD to ADHD these days).

Anyway, the gold standard diagnosis in children is about functional deficits in multiple settings. It's the following: can you remember the items you need every day, can you focus on school, do you lose things, are you disruptive in class, can you keep your seat, are you hyperactive w.r.t. your motor activity? If you have enough deficits, you are diagnosed. These deficits are observed in school, at home, and in as many settings/by as many people as is practical. It's not about expensive scans, which would be impractical and costly. It's all about functional deficits, problems in life. I merely bring up the neurology because it's important for skeptics to understand there is a real, scientifically proven difference in the brains of those with ADHD.

I agree. I'm not completely dismissive of the diagnosis. Just highly skeptical of its application. The sad state of modern medicine is that these diagnoses come not from extensive detailed study of every individual by a specialist, but from a few brief Q&A sessions where behavior is compared to a checklist. It's certainly not hard science at the individual level.

The hard science went into developing the DSM-5, which is used for diagnosis. We don't need to conduct a study every single time a phychiatrist is presented with a kid who might have ADHD. Yes, the DSM is a checklist but it's a checklist for pretty much every single mental disorder that exists, by definition.

The DSM has been criticized specifically for causing inconsistent and over diagnosis of ADHD and other mental disorders.

It should also be noted the DSM is primarily an American text and used far far less internationally.

Appealing to the DSM-5 isn't conclusive by any means.

To say that it's been criticized doesn't mean anything, because there are skeptics who criticize ADHD diagnoses with zero understanding of the literature. If you actually read the experts on the subject, for instance my advisor Dr. Weyandt who wrote a very in-depth book overviewing the literature on ADHD, you'll see that over-diagnosis is not a commonly held view amongst actual experts. But, like climate change skepticism, many people think they can make a claim about over-diagnosis with zero expertise.

To be clear I am not arguing about ADHD.

The previous poster expressed skepticism of the DSM-5 as a diagnostic tool.

You responded the DSM 5 was developed with hard science, and that it is sufficient for diagnosis.

I'm saying criticisms of the DSM-5's diagnostic strength is valid and not a fringe position. Part of the reason it is updated periodically is to improve upon its capabilities as a diagnostic tool.

The belief the DSM has weaknesses is not equivalent to climate change denial.

ADHD is BOTH underdiagnosed and overdiagnosed, under a Bayesian interpretation of the data.

See a [Slatestarcodex article](http://slatestarcodex.com/2014/09/17/joint-over-and-underdia...) on it.

> In one of them, I was informed that America is medicalizing normal childhood mischief and loading anyone who gets worse than a B+ up with Ritalin or amphetamines as part of the pathologization of everyday life.

> In another, I was informed that ADHD is shamefully underdiagnosed and most of the children who need stimulants most are going without them and failing school unnecessarily, so we need better screening programs and more efforts to seek out potential sufferers of the condition.

> So I asked one of my attendings, Dr. L, which one it was. Are we overdosing ADHD? Or underdiagnosing it?

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