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Skepticism is common. I believe this is because the idea of ADHD as someone who can't sit still or is disruptive in group classroom settings has been popularized and accepted as the defining characteristic of the disease.

What people do not understand is what you called out in #1. ADHD is primarily an executive function disorder, and people do not understand what this means or the impacts it has on someone's life. Though this does materialize as impulse control and risk taking, it also represents an inability to plan, execute routine behavior, make decisions and have perspective to retroactively modify behavior.

If we popularized the idea of ADHD as the adult who always leaves at the time they're supposed to be somewhere, has had their utilities shut off because they forgot to pay their bill, poor credit, constantly loses items, always seems to be making last minute decisions (or is painfully indecisive), has poor dental hygiene because they consistently forget to brush their teeth or go to the dentist and so on, people might be better able to relate to what happens in the day to day life of ADHD. Low self-esteem, anxiety and depression are co-morbid with ADHD at staggering rates. Imagine being someone expending immense amounts of energy and thought just to do the "normal" expected things of individual life, and failing consistently to actually do them. Additionally, you're producing consistent disappointment in those around you ("Why can't you just show up on time just this once!?") compounding the sense of worthlessness.

I believe if people viewed ADHD through this more nuanced lens, they might focus less on the "drugging children" aspect of ADHD and far more on the human reality and toll of the disease.

Spot on. I wish ADHD had a less cute sounding name, maybe then people would take it more seriously. And it is also a misnomer: it is often about being unable to regulate attention (rather than simply having a lack of it), which leads to mysterious variations in productivity, especially with tasks that are not novel, interesting or challenging.

> normally distributed

IQ arguably follows a normal distribution because such tests are constructed to do so. This leads to the criticism that useful measures of intelligence are excluded because they have a threshold effect which can't be sensibly normalized ( https://en.wikipedia.org/wiki/Intelligence_quotient#Systemat... ).

Disorders typically refer to such threshold effects, where rather than expected variance, there is a distinct anomalous population. ADHD is such a case where there is a threshold, which appears to be most commonly caused by a genetic factor affecting the dopamine transmission system. Although that's not to say the distribution function isn't continuous, and a person's membership in a statistical population isn't arbitrary.

I suspect the rather poor diagnosis situation is going to naturally produce a lot of skepticism. Anyone is going to start questioning things if they see kids with a diagnosis who seem basically normal. And, unfortunately, that does seem to be happening quite often.

> Anyone is going to start questioning things if they see kids with a diagnosis who seem basically normal.

How do _you_ know if they are normal or merely seem normal though? What is your definition of normal here?

Is the diagnosis situation poor? Yes. Do people pick up on that sometimes? Of course. How do I, personally, define normal? Who gives a shit?

> How do I, personally, define normal? Who gives a shit?

If you care enough to leave a comment on HN, please also explain _why_ you think it is poor. Because right now your comments add no substance to the discussion.

We are in a discussion about an article providing strong evidence that diagnosis is poorly done. Do a little research yourself, and you'll find it's hardly the only evidence. Feel free to peruse a good New York Times write up from a while back: https://www.nytimes.com/2013/04/01/health/more-diagnoses-of-...

If they are being successfully medicated they'll seem normal.

And even if unmedicated, they may seem entirely normal, because you're not watching them read the same page of a book 20 times, or doing other things where the condition causes a problem.

Not everyone with ADHD is like an energetic child who's had too much cake.

Maybe the ADHD brain is the normal brain and there is something abnormal about domesticated human brains, the ones that conform to the needs of modern corporations and the schooling system that supports them. Maybe the ADHD brain is a better hunter gatherer / forager brain.

There is a 'hunter vs farmer hypothesis'. It is certainly a cute idea. But even if it is true, the society isn't going back to back to persistence hunting.

There is some real human suffering right now (simply by definition from DSM - if there is no impairment, it is not ADHD).

"I guess I picked the wrong time to be a human being".

So we eliminated the ADHD brains only to found most of our jobs automated and most of our schooling irrelevant.

What's your point here? ADHD brains are still there. You can choose not to medicate yourself if you don't want to.

I'm a little skeptical, because hunting can be extremely boring.

An ADHD hunter would be the guy who gets bored, jumps out of the hiding spot to examine a neat rock, and scares off the approaching deer.

> and scares off the approaching deer

And that's exactly the way early humans hunted. The method is called persistence hunting: https://en.wikipedia.org/wiki/Persistence_hunting

Humans run slowly, but human bodies can dissipate heat very efficiently through sweating, and this makes humans good long-distance runners. AFAIK, humans can outrun most other animal species.

So if I understand it correctly, the hunting method involves scaring your prey, running for a while(yay hyperactivity), using your big brain to figure out where the prey went and running again for a while. Rinse and repeat for many hours, until the prey literally dies from exhaustion.

I imagine persistence hunting as a series of puzzles while you literally can see your reward - no delayed gratification involved.

I have ADHD and hunting and fishing are some of the most engaging things I can think of. Spearfishing can keep me focused for an entire day. I also love working on my equipment and researching hunts. This is all boring to everyone I know. I guess the key thing is that ADHD isn't an inability to engage or focus at all - there's a degree of selection involved.

For what it's worth, I never hop out to examine rocks. Some people with ADHD might suffer from impulsive distracted behavior like that, but certainly not all.

With regards to positive selective pressure, there's also the even simpler explanation that ADHD correlates with a greater number of sexual partners, early parenthood, etc.

Although genetic success doesn't necessarily mean success for people's well-being.

2 - Okay all psychiatric disorders use checklist and interviewing, but that may reflective of a problem with modern psychology.

It's very hard to say with any objectivity how much happiness, calmness, or attention is proper when your life situation may be bad, stressful, or boring.

So even if there is a biological condition that stems from brain differences, what is the R^2 between professional diagnoses of ADHD and actual biological cases of it?

> 2 - Okay all psychiatric disorders use checklist and interviewing, but that may reflective of a problem with modern psychology.

And this problem being what exactly?

> It's very hard to say with any objectivity how much happiness, calmness, or attention is proper when your life situation may be bad, stressful, or boring.

And your solution is what exactly? Do nothing?

The reality is that it's not easy, but certainly not as hard as you make it to be. Most psychiatric diagnoses (including ADHD) have decent inter-rater reliability. They are certainly going to produce some amount of false positives and false negatives. But the moment humanity invent magic test for depression/anxiety/ADHD/etc, psychiatry is switching to it.

> So even if there is a biological condition that stems from brain differences, what is the R^2 between professional diagnoses of ADHD and actual biological cases of it?

Like I mentioned, brain scans are not really used for diagnosing (yet), because they are not sensitive enough to be used for diagnosis. How would you compute R^2 in this situation?

> And this problem being what exactly?

The point is just establishing condition X exists doesn't establish that most people diagnosed with X actually have X (and those who don't, don't).

The burden of proof on the psychiatric community is greater than to prove a condition exists in a biological sense. It is:

1. Prove condition exists. Identify if it is a specific illness or just an extreme on a range

2. Prove that they have a reliable and accurate way to diagnose it and that most physicians in the field agree on their diagnoses (i.e. interviewer intereliability > 90%). In so doing, prove this diagnoses is independent of self-image (e.g. a kid who's told they are distracting all the time may answer that they "can't focus" on a questionnaire because that's what adults tell them).

3. Prove that whatever solutions they are offering are statistically effective at helping the condition described in 2. Administer a post-test on each person receiving treatment to verify that they are indeed helped by whatever drug they are purchasing.

--

The community doesn't meet this standard. And therefore we are right to be skeptical of it, it's half-assed with peoples mental health. I'm more rigorous with my software than they are with mental health.

To answer your question - You'd do a research study on "Brain ADDness" based on size of brain structures. Then you'd give a traditional ADD test to these people. And you'd look at the correlation.