I'm not saying these things don't exist, but much of it seems very difficult to falsify -- which needs to be the gold standard of determining these sort of things; e.g. "By what process can someone reasonably determine that they are NOT neurodivergent?"
It's quite straightforward, albeit involved (as in technically easy, but takes time) to falsify. You have to work with a licensed medical professional who will evaluate traits, strengths, and difficulties, and to what extent they impact functioning as a person in society. Basically, are they "well-adjusted"? If they make it through school, college and adulthood without a ton of struggling, therapy, possibly meds, you can almost certainly rule out neurodivergence (at the very least, it won't be clinically significant )
This is a radically behaviorist interpretation.
A common criticism of the diagnostics for ADHD (and Autism, for that matter) is that it ignores the person’s internal experience.
I was formally diagnosed with ADHD in 2017. I’d been visibly quite successful in that time, but at the expense of my own mental health because I was fighting a constant uphill battle. ADHD was a set of shackles I didn’t even know I had.
Just not happy or healthy or as successful as I could have been.
That is precisely what I mean. You were not naturally "well-adjusted", you just learned to adjust and adapt over time.
It wasn't the best choice of words but I can't edit.
We're just reacting to what appears to be agreement with that approach, even if unintentional.
Agreed. I'm addressing precisely the point in GP comment "neurodiversity is not a falsifiable diagnosis", which is something I feel quite strongly about. Other issues in this complex space that I think also are worth being discussed but I am not trying to get into in this thread:
- overdiagnosis of ADHD/ASD
- underdiagnosis of ADHD/ASD in certain subgroups (especially women/NB, minority, and underprivileged groups)
- ADHD/ASD are/are not on the same spectrum
- drug-seeking behavior for access to stimulant meds
- overmedication, undermedication, and incorrect diagnosis leading to iatrogenic harm (eg giving antipsychotics to a "bipolar" individual whose "bipolar" is realdy emotional lability due to ADHD/ASD
Each one of those topics I could talk about at length. They are related, but distinct.
> If they make it through school, college and adulthood without a ton of struggling
You wrote:
> but at the expense of my own mental health because I was fighting a constant uphill battle.
Gp wrote:
> "By what process can someone reasonably determine that they are NOT neurodivergent?"
I'm using "well-adjusted" here to mean like, naturally well-adjusted - you are able to complete life activities without constantly having to learn strategies and fight the good fight just to do what comes much more freely to neurotypicals.
I.e. being able to socialize well doesn't disqualify you from ASD, because masking is a thing.
A proper licensed professional will ask the right kind of questions to ascertain this. If you are successful but feel like if you stop struggling for a moment, that's a strong indicator.
IMHO, yes, but actually, no? ADHD is marked by executive dysregulation. An immature brain (they say the brain does not mature until the 20s) also shows poor executive control. However, ADHD is detectable as certain processing difficulties within an age cohort.
Similarly, I don't think it's a lack of coping mechanisms. It's very heritable, even controlling for upbringing/habits (I'm adopted by very obviously non-ADHD and disciplined parents - I did not pick up basically any of their coping skills naturally and had to develop my own).
I think it's almost entirely congenital - between genes and gestation, your neurodivergency die is cast at birth (unless acquired via brain injury).
> This was because he had developed a set of very successful coping strategies to make up for his lack of executive function.
I think this takes a special set of conditions, and/or a mild case of it. Some people do learn to cope. I would contend even these folks have indicators of stress/mental health problems, even if non-obvious. Or they just drew the best possible ADHD hand in terms of life events.
This is so easy to game. People read the diagnostic criteria online and echo it back to their doctor for a prescription. Their proof of needing adjustment can be little more than pointing to their grades and attributing their less than stellar academic performance to the list of ADHD symptoms they memorized online. EZ way to get yourself a stimulant subscription. This was particularly common during the pandemic when you could do it entirely online without actually meeting a doctor in person. I saw a lot of people explicitly advocating this sort of deception to get stimulant prescriptions; all described it as very easily done.
I tend to think those drugs should be legal OTC, so part of me thinks "so what?" But the problem is that right now it isn't legal OTC, so the system is giving a leg up to anybody willing to lie to a doctor, while honest people have to make do with lesser PEDs like caffeine.
You can fake chronic back pain, migraines, suicidal tendencies, and so on. That doesn't make any of them any less real.
ADHD may be real, but doctors seem to have a hard time distinguishing people who actually have it from people who just want the drugs and know what to tell the doctor because they watched a bunch of instructional videos about this sort of deception on tiktok.
The 'test' for ADHD boils down to "evaluat[ing] traits, strengths, and difficulties, and to what extent they impact functioning as a person in society. Basically, are they "well-adjusted"?" It's not as though the evaluation is some chemical analysis in a lab, anybody so inclined can be coached to pass this evaluation by telling their doctor the right things.
And morphine is as big - if not bigger - problem than amphetamines.
It’s hard to make it past these hurdles and aren’t on other controlled substances, you are still rolling the dice of getting blacklisted in their systems if you ever get caught selling or testing positive for weed or opioids, etc.
> "By what process can someone reasonably determine that they are NOT neurodivergent?"
You are talking about the opposite detection criteria, false positive vs true negative. I was speaking to "neurodivergence is not falsifiable". You are speaking to "one can fake neurodivergence, esp. to get prescriptions", which, of course, that is definitely a thing.
Of course, if you fake to the doctor that you don't have symptoms, well duh, of course they won't diagnose you. That also has nothing to do with falsifiability. You won't get a correct diagnosis by lying - doctors aren't psychics.
At its very most reduced form, falsifying neurodivergence as a hypothesis means basically demonstrating a single counter-example exists. Can we find someone who made it through high school, learned good study habits on their own, did average to well in college, held down a job, paid the bills, folded their close, made friends and raised a family, all without counseling, special classes, medication, self-medication, masking, hyper-extending themselves (beyond just "working hard"), or burning themselves out just to make ends meet? I think so. Neurodivergence, ADHD, and ASD are falsifiable diagnoses - a true negative result can be obtained.
was a terrible choice of words on my part, but I can't edit now. What I mean here by "well-adjusted" has nothing to do with "appears functional from the outside". I mean "they appear functional and actually are and didn't have to contort themselves to do so".
Does the patient self-medicate with nonmedical stimulants/stimulation? (caffeine, nicotine, other drugs, adrenaline junkie)? Did they have to struggle and claw to overcome executive issues and get some semblance of normalcy? Did they find a particular niche/trade where they can be successful? Do they succeed on the outside but feel burned out constantly inside? Those are not the folks I'm talking about. I'm saying folks who didn't need to go way out of their way to adapt in order to achieve an outward sense of normalcy.
My father is one of the least-ADHD people I know. His life wasn't easy by any means (grew up very poor, had to work his way through high school and college), but also he didn't have any of the kind of turmoil growing up that I see in myself and each and every neurodivergent person I know.
You get diagnosed with it if you tick enough of the boxes of behaviours/dysfunctions associated with it - you can fall short of a diagnosis by one behaviour and still be in a very similar condition to a diagnosed person, or tick enough boxes but fall short based on the diagnosing physicians judgement of severity.
The interesting thing is that despite the condition being composed of a wide gamut of seemingly unrelated behaviour, ~90% of people with ADHD respond extremely well to the same treatment - stimulant medication. We also observed notable neurological similarities in aggregate among people with the condition, but not enough to have much utility as a diagnostic tool.
But doesn't everyone respond extremely well to stimulants? They're some of the most common recreational drugs and neurotypical people seek them out for performance enhancement on cognitive tasks.
Not really - despite their popularity (as you say, heavily sought after), studies have shown that there really isn't a significant cognitive boost for neurotypical folks that take these stimulants[1]. While they have a significant effect for those with ADHD because their brain is not providing the chemicals properly, and these drugs enable that. They aren't boosting cognitive abilities for those with ADHD, they are fixing a problem so that folks with ADHD can think and focus properly.
Didn't spend a ton of time looking up the sources I've read this in, but here is one:
[1] - https://www.mdpi.com/2226-4787/6/3/58
> Studies support that stimulants enhance attention, memory, self-regulation and executive function in individuals with ADHD. Recent research, however, has found that many college students without ADHD report misusing prescription stimulants, primarily to enhance their cognitive abilities.
> ...
> Overall, the present findings indicate dissociation between the effects of Adderall on activation and neurocognition, and more importantly, contrary to common belief, Adderall had little impact on neurocognitive performance in healthy college students.
Anyway thanks for the info, definitely upends an assumption I'd had for years.
The Germans didn't ply their soldiers with speed in WWII because it improved their reflexes or their tactics - they did it so a soldier could fight when his brain would otherwise be mush from not sleeping in days. Anyone can benefit from just having more usable hours in a day.
Honestly I'd say it's the opposite. Stimulants barely touch the sides with me, even the non-prescribed types a younger version of me may or may not have dabbled in were pretty ineffective.
I had read about how stimulants don't do much for the average person and that much of it is placebo. I know they do a lot for me -- well, Modafinil/Armodafinil does, I haven't tried any other because I'm so happy with these.
I feel lucky I have something that works, I don't mind not having a diagnosis. It'd make sourcing them easier and free, but at $2 a pill and with the multiplier effect it has on my productivity, that doesn't even register.
I hope you've found other ways to improve your experience.
Decent pay it was as well, cleared a bunch of the debt I'm lugging around. ADHD tax haha, it is what it is.
Waiting on an appointment to review the meds
It used to be kind of like that for me, though me feeling guilty to let people down usually made me fight to barely make it. It's day and night now, I just sit down in the morning and get to work. It helps that they let me hunt squirrels as long as I make enough progress on the main topics, but even things where the work is super boring you just need to put the hours in is now just "okay, works for me" where it would have been a week of agonizing start, work 30 minutes, pause for 3 hours. I've been more productive in the past two years than I have been in the ten years before that.
The only side-effect is that I feel like I perceive lights and noises as annoying at a lower threshold. I've had that before as well so I'm pretty used to blacking out any LEDs, but it seems to have been increased. Don't know whether that would lessen if I took a break because I haven't for more than a few days.
May I ask about the dosage?
I'm taking 150mg (currently Waklert, but they're all generics) a day, right after getting up.
I’ve also heard that some people with ADHD sleep better on stimulants, which definitely isn’t the case for everyone else.
I wish lmao. I'm on meds and while I can see a difference between non-meds and now I could easily go back to bed after they kick in and sleep the entire day away. Still doing the dosage dance with the doc.
Someone who didn't need them would likely be a little hyper if not bouncing off the walls depending on the dosage.
I definitely get a noticeable feeling of calm/steadiness/"settling" as my stimulants kick in, and yes it would be very easy to go back to bed at that point. My understand is that this is not a typical part of the stimulants experience for people without adhd.
But by "responds well" I meant that they improve focus, energy, motivation, and mood even in non-adhd people, not that they have the same effects. Other comments have addressed that this is at least somewhat a misconception on my part though.
Apologies for the misread too
Possibly related - my PCP gave me a genetic test and it showed that I have some gene configuration that essentially makes me immune to the effects of caffeine. Which makes sense, because I have to drink a boatload to feel anything from it.
This is constantly presented as some sort of ultimate validation of these disorders and every time I read it I'm absolutely baffled. Stimulants used in ADHD medication improve focus and productivity for almost everyone, the fact that they also do it for people with chronic focus/attention issues should be surprising to no one... They're literally performance enhancing drugs.
The most unusual aspect of stimulant treatment for ADHD is for the hyperactive and combined types - stimulants reduce hyperactivity and impulsive behaviour, and people with ADHD on low dose stimulants are less likely to engage in reckless behaviour or develop problems with substance abuse - not things you'd ever say about stimulants and the average person.
You certainly don't get too many neurotypical people finding they can finally nap once they're on low-dose amphetamines.
Kept sending me back to sleep if anything, first day I was on them I had a 16 hour nap.
tl;dr - everyone's probably just doing the best they can.
You can't conclusively prove or disprove that I have ADHD. I may describe my experiences in a way that aligns with such a diagnosis, but for all you can tell I may be a P-zombie merely acting as though I experience things. For what you're able to measure, I may not even have an experience.
You can ask your question without them and it will feel a whole lot less patronizing.
Now, ask yourself -- in a forum that's supposed to be about discussion and answering questions, why do you think it's very important to police how I use punctuation?
Compare:
"I'm skeptical about the prevalence of autism in teens."
"I'm skeptical about the prevalence of "autism" in teens."
The first absolutely conveys your skepticism, but doesn't come with an implied sneer.
I don't know, maybe this feedback isn't useful or you reject it, that's fine too. I just figured you may want to know that the way folks might interpret the quotes might be heavier than you intended.
It's a way to acknowledge that folks with autism, ADHD, schizophrenia, multiple personality disorder, depression, OCD, or other conditions are not neurotypical - they are neurodivergent.
I've rarely met someone who would say they are neurodiverse without a specific underlying condition.
It's a way of creating a category or set without needing to share one's diagnosis. Think of it like saying, "I'm European" vs "I'm Italian".
One problem is that there's a pop culture understanding of ADHD and there's the medical version. Because ADHD is poorly understood and is diagnosed by ticking boxes, I get the feeling that some people just say what they need to say to get the diagnosis/meds/whatever. (I am unmedicated and have been my entire adult life. I felt a bit like a zombie on Adderall, and my heart was constantly racing.)
On the other hand, I do think there's probably a better, deeper explanation that has eluded the professionals. I suspect that ADHD has something to do with a lack of free play for young children. When kids are able to free play, they invent their own games and set their own boundaries and learn to regulate themselves; this does not happen when they are under adults' direction. As a consequence, we see that the US has extremely high ADHD rates in children, whereas in other countries, especially ones where early education consists almost entirely of free play, especially outdoors, is encouraged, the rates are quite low.[0] Further, within the US, we see that children born in August seem to have a higher chance of an ADHD diagnosis than those born in September.[1]
I suspect that the disorder is "real," but with a very strong "nurture" component. In the US over the past 60 years or so, children's lives have become increasingly directed by adults, from time spent in school to time spent in sports or clubs organized by adults to time spent at home doing homework. At the same time, Americans have become increasingly hostile to the idea of children's free play. "Where is that kid's adult?" is something I hear from other parents when I take my kids to the playground.
If I could summarize my own experience, I would say I have trouble self-regulating along the spectrum of being bored or interested in a topic. If I'm bored, or think I will be, I have almost an anxious response; if I'm interested, I may get lost in the task or topic till a phone call from my wife breaks me out of it. For what it's worth, when I'm healthy, I can rarely sleep more than 6 1/2 hours per night.
[0]https://academic.oup.com/shm/article/30/4/767/2919401
[1]https://www.pbs.org/newshour/health/could-being-born-in-augu...
I suspect it's this latter group that social media diagnosis appeals to most - if you're not doing as well as you (or your parents) would like then normally you just have to feel stupid/worthless. These (self) diagnosis provide a level of explanation (and therefore comfort).
I self-diagnosed myself with mild ADD many years ago and even self-medicated (which in terms of productivity worked well). But meeting people with severe ADHD made me reconsider my alleged issues - sure, I can't concentrate for as long as I'd like but these people couldn't sit still for 15 seconds.
> By what process can someone reasonably determine that they are NOT neurodivergent?
Easy: is the severity of the ADHD and Autistic traits you exhibit low enough that they do not impair your ability to function on a day-to-day basis in society? If not, you don't have ADHD or Autism.
What does not impaired look like compared to impaired?
- Struggling to focus on something for minutes or hours, vs. being unable to concentrate on a task.
- Occasionally struggling with overcoming mental hurdles to perform a task vs frequently being incapable - yes, literally incapable, no matter the reward or punishment - of performing a task.
- Focusing on a task you enjoy while still being aware of the state of your body - keeping reasonably hydrated, fed, and use of the facilities - vs. not being aware.
- Occasionally forgetting words - like "watch" - or names, vs frequently.
- An occasionally compromised working memory (typically with an outside trigger like alcohol or lack of sleep), compared to a permanently compromised working memory. Compromised being able to store 4 items in your short term memory when the average for the populace is 7.
- Occasionally forgetting that items and people exist if they are not in your direct sight, versus constantly forgetting, where constantly means remembering is the exception instead of the norm.
One final note - ADHD is not some new disorder unique to the TikTok generation. ADHD has been formally recognized and studied as far back as 1902 by Sir George Frederick Still.
Easy: define "function on a day-to-day basis in society"
https://en.wikipedia.org/wiki/Attention_deficit_hyperactivit...
So the issue isn't so much falsifiability per see but instead the whether you trust the judgement of people who decide what is "normal" or "not normal".
And whether something is clinically useful isn't the standard for defining a condition, because ability to successfully treat a disease isn't a standard in deciding whether something is a disease and because therapy isn't limited to people who have diseases. (Unless professionals are now calling marital problems a disease?)
Lot's of things have negative impacts that aren't considered medical conditions, on the other hand Elan Musk says he has Aspergers. Nobody seems to doubt it. This shows that someone can climb to the top of the social world but still be told they have a disease supposedly associated with "significant negative impact" on social skills.
Narcissists, sociopaths regularly climb up while being impaired and causing damage everyone around. People with OCD or hypochondriac too. Bipolar people the same. That does not make those non existent either.
To me the claim that Musk has Aspergers is like being told an Olympic marathon runner has a leg disability.
Asperger is not something that excludes you from success.
OCD and being bipolar have much graver consequences on your life and success.
It's not the social world. It's the social media world. Big difference.
Michael Jackson was the greatest in his field too, was on all covers and people would faint when they saw him, but was also a social reclusive.
Big phenomenons like this are more an indication of the amount of money being spent in promotion than the social skills of the person being promoted.
Social skills you see them at the micro level , not at the macro level. That is after the halo effect of all the paid for publicity (plus all the abomination that is modern day social media) vanishes.
Once the halo effect vanishes everybody nopes the hell out of Musk life, including his confidantes, children and wives. So he has significant negative impact on social skills.
I think someone can be a bad spouse without necessarily suffering from a social skill disorder. And someone suffering from a social skill disorder can be a good spouse, so I don't know that divorce really tells us much.
It's not about manipulation and more riding an already existing wave. The tsunami of environmentalism, green everything etc.
Real bona fide manipulation is all about convincing people that YOU are the solution to each and every of their problem.
It entails jokes, touching people, pointing at people, blowing kisses, smiling a lot, playing an instrument. Most of all it has to be speeches, delivered from a stage.
Think Obama, Bill Clinton, George Bush, Reagan, Trump...
I can't take Musk seriously because he cannot speak properly. When you are a leader you cannot hide behind the bird app forever. At some point you have to go out there and hold hold the crowd in your palm like the Beatles and Led Zeppelin used to do. That to me is social skill.
As for doubting Elon Musk's claims: I generally don't raise doubts about someone claiming a diagnosis. I know from personal experience how shitty it feels to have the veracity of your suffering questioned like that. And in Musk's case, I have no issue believing he has some interpersonal issues, and asperger's(autism spectrum disorder in DSM-V) could explain that, so I don't see any reason to doubt him in this case.
And again, it's pretty presumptuous to act like we know the whole story with Musk's Aspergers. I don't acutely pay attention to his personal life, and I don't see any reason to make the assumption that the only symptoms he has are ones that have been visible in the media(like the $420 tweet and the "pedo guy" thing). Aspergers is a very real disorder, I've multiple friends with it. People with aspergers can be highly intelligent and successful at what they do, yet feel completely miserable and become increasingly depressed because they struggle to connect with other people, which gets lonely.
The fact of the matter is it is not possible to prove someone is neurotypical or not neurotypical. There is no scientific study that can tell you whether Musk's personal problems are "significant" enough to justify the diagnosis of Aspergers.
I don't know anything about Musk's personal life, but he's clearly suffering a lot less than individual on the autism spectrum who have trouble with basic day to day activities like keeping a job or navigating a normal work related conversation.
Unless neurotypical people are definitionally free from loneliness, depression and social isolation the last sentence of your comment seems like a red herring.
Generally by having a full workup with a psychiatrist. They will do various interviews. Possibly might have to interview parents and teachers in pediatric cases or in adult cases where ADHD was not diagnosed in childhood(childhood onset is a diagnostic requirement for adult ADHD).
In more difficult cases a neuropsychologist might be consulted and can perform various neurological tests to more thoroughly rule out other disorder. There's some promising work on blood biomarkers and brain imaging but nothing in clinical use yet afaik.
What would be the diagnosis for adult-onset ADHD symptoms without a childhood history of those symptoms?
It's probably also possible that childhood ADHD could have been "hiding" in childhood, if say your childhood environment was very ADHD-compatible it might not have been enough of a problem to be detected then, but become a problem in adulthood as your environment and responsibilites change. Probably you could make an argument for a diagnosis of adult ADHD in a case like that if there's at least a family history of ADHD.
So with Autism, probably the most common disqualifier in practice is that the disorder requires childhood presentation and a lot of people don't know this. So somebody will come in, say "oh I wasn't autistic at all as a child, but I felt very autistic as a teenager, so I asked a doctor, and he said I wasn't autistic". People will respond with "oh, doctors don't know anything about autism, they underdiagnose minorities and women all the time, that proves it" and "oh, women actually don't present as autistic in childhood, they can just be masking, but that doesn't mean they aren't actually autistic". This happens EVERY time, especially if a woman is involved, and means that you can't falsify the idea that somebody was autistic in childhood.
I have been banned once for saying that disabled people should doubt other peoples disabilities (on the grounds of preventing exploitation and misallocation of resources), I got told that I was spreading ableist myths that disabled people are responsible for other disabled people lacking resources, that I was reinforcing the ableist myth that disabled people are just exploiting non-disabled people (of course, disabled people do just as much for the able as the able do for them, and thus there is no advantage to faking disability), that it was inappropriate to talk about doubting disabilities on an autism community, and that they wished I had a number of painful disabilities that I couldn't receive pain medication for because I wasn't believed.
It is possible to show symptoms as a child, not get diagnosed as a child, and get diagnosed as an adult. I have zero issue with that. Here's the exact phrasing of the criteria https://www.cdc.gov/ncbddd/autism/hcp-dsm.html
>Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
There's nothing in the diagnosis that says you need to be diagnosed as a child. I adamantly do not believe that's required for a diagnosis in any way shape or form.
Does the psychiatrist conclude the patient doesn't meet the criteria, or does the psychiatrist conclude the patient wasn't self aware enough in childhood to know if they exhibited symptoms so a diagnosis is warranted?
A diagnosis for treatment purposes does not entitle you to government assistance. People are only entitled to government assistance if they meet a "legal" standard about the severity of the illness.
Isn't that called differential diagnosis?
For me they were essentially post-diagnosing childhood ADHD. Not much of my present existence was relevant other than the effects it had on my life now (whether I need meds or not). Sure I could have lied but it would have been a hell of a lie to build and keep straight across my appointments.
I was also asked if I'd heard of ADHD from TikTok.. not sure what the result would have been if I had.
Another thing TikTok does is provide a venue for sharing stories - "you're not alone" - and sharing coping mechanisms. Good things.
In the actual test, you had to watch a square flash on the screen at random intervals and click a clicker if it flashed on the bottom. That's it. It took an hour. Afterward, you get your results based on mistakes and reaction time over time. The data and statistics associated with it are really interesting, too.
People have been talking like this since at least the 90's and always claiming it's a new, recent, thing.
Plus, before it got the name ADD (and after, ADHD), it was studied by the names "Hyperactive child syndrome", "Hyperkinetic reaction of childhood", and a few others.
This has been recognized and studied for over a century.