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Comment by klempner | Hacker News Reader

The flip side of this is that people who legitimately have ADHD are surely more likely to have it diagnosed if they're having to deal with the added academic difficulty of going through school almost a year earlier than their September born peers.

That is, even in a world with no overdiagnosis of ADHD, we would 100% expect an effect of the sort this article raises.

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The converse is also true. We may be missing diagnosis for people born in September, who may struggle but not quite meet the definitions which often include academic performance.

Even "academic performance" isn't a clear enough predictor. It isn't even a single axis!

I was a perfect student all through grade school; except I had terrible grades in almost every class. Why? Because I almost never did homework. I usually aced tests without even trying, though. And I could always provide meaningful input into class discussions. But that isn't enough for the strict traditional structure of academia.

Teachers would make me stay after school to try to catch up on homework, and I would just wait patiently until it was late enough in the evening that they would give up and let me go home. This was a recurring pattern from 4rth grade all through 12th. I only graduated high school because I finished hundreds of pages of make-up work over the last couple weeks.

The reality is I couldn't do homework. I could focus and sit still, which must have meant I don't have any attention or hyperactivity disorder...

...but that's not what ADHD is. It's an executive functioning disorder.

ADHD is being diagnosed more today because it has been incredibly under-diagnosed in the past. It's still significantly underdiagnosed in adults today.

This largely mirrors my experience. You know how people talk about addiction, and how they are "drawn" to their poison, like by some force? The polar opposite of that is what I felt with homework. Like trying to push two identical magnetic poles together.

> Like trying to push two magnetic poles together

...with atrophied hands.

I knew I could, I knew I should, but I could never do. I could only watch myself, never participate.

It's really validating to have words like "executive dysfunction" to describe this pattern, as opposed to "lazy", "tired", and "unmotivated" - which are all I had growing up.

I think I had the opposite effect whereby ADHD symptoms were created because i was so far ahead of my peers (September birthday) that some cognitive skills never developed properly for lack of challenge. (I have test results that point to very selective cognitive skill gaps which might be attributable to that)

I'm in the same boat - what tests are you referring to? Might be something I can learn about myself there...

I had a full 4 hour neuropsych test done as the result of a concussion. The test I was bad at was where they read you a list of random words and test your ability to retain immediately and after spaced repetitions. The first time I heard it I retained very little but on subsequent repetitions what I did learn I retained. So like a very specific sort of being bad at something. The rest of the tests were all in decently high percentiles.

Could that “gap” have been attributable to the concussion, though?

No the concussion was recent, the problem demonstrated by the tests made a lot of lifelong things make sense.

>where they read you a list of random words and test your ability to retain immediately

Person, woman, man, camera, TV type words? Sounds like other neuro tests.

I've screwed up these tests as I focus on repeating each word in the gap between the next word being said then repeat with the new word being added to the point I've missed the next word.

I've never "liked" this test, as I don't think it's always indicative of what they are trying to make it. This sounds more like interviewing a potential server that isn't allowed to write down the order.

This is called the working memory index score, for what it’s worth.

Sounds like the WAIS-III intelligence test. The state tested me using this as an admission criteria for a summer camp full of gifted children. They accepted two kids from our school which was generally pretty rare, especially considering our school’s socioeconomic level.

If I recall correctly you’re talking about the working memory index. I scored 50th percentile on that portion of the test but top 0.4% overall, which I’ve always felt like reveals something about my “ADHD brain”. It’s definitely not the norm. The administering psychologist seemed super interested in my testing and I asked a lot of questions about the process. She brought me back in for a second day of tests as some of the tests I exceeded the space available. I recall they had a band writing symbol recognition and copying test, and I filled up a page front and back, so she had to come back the next day with more pages to accurately measure me since you aren’t supposed to “ace” a part of an intelligence test.

I often think about it because I often think “well, being 1 in 250 is pretty good, but that also means there’s literally millions of people smarter than me”. Hard work and building good habits like going to bed on time has been key to actually making use of the “raw power” of my brain, and Adderall as an adult has helped a ton with this despite side effects that I try to keep under control (irritability and seeming more ‘robotic’. Every time I try to stop using it I feel like my career slips and I become depressed. The me on Adderall is capable of being a competent software engineering team lead juggling multiple balls in the air. The me without Adderall struggles as a senior software engineer writing code for one project.

I’m excited to take a 2 week break from the meds on vacation later this year though. I constantly feel like I’m “grinding my gears” too hard, so to speak, like the Adderall is adding jet fuel to my engine of a brain and it’s gonna burn me out. It hasn’t happened yet but I really want to avoid tolerance.

I think colechristensen had a test for episodic memory. Such a test is not included in the Wechsler intelligence scales (currently WAIS-IV for adults, WISC-V for older children), but tests for working memory are. Simplified, working memory are that limited number of items you can keep in mind, until you are disturbed or thinks about something else. Episodic memory is what you still remember after your thoughts are disturbed, and what you may remember for 10 minutes or 50 years. Surprisingly, episodic memory is not closely related to IQ and is, thus, not included in intelligence tests. What colechristensen seems to describe is that his learning was hampered by an attention deficit, but he was able to retain the information in his episodic memory when he eventually registered it.

Good point, and also I wonder how many of these diagnoses are deliberately sought by parents aware of the "relative age within school year" phenomenon. Holding kids back a year because of this has become so common that it has a name: redshirting. Having them diagnosed as ADHD and either medicating or holding back seems like a natural extension.

I don't mean to suggest that anyone's faking it BTW. As the authors point out, the real problem here might be underdiagnosis of September children. But parents of August kids might be more than a little predisposed to schedule that doctor visit, listen to that diagnosis, etc. in a way that parents of September kids would not be.

I wonder if it was a less of an issue in the past, because we would make kids with difficulties repeat a year. They would go from youngest to oldest.

I'm sure repeating brings with it all kids of other problems.

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