Longitudinal study on the relationship between childhood maltreatment and ADHD
psypost.org
psypost.org
I could go on and on about all the Hell I was put through, but all I can say is that the school system ruined my childhood and teenage years. It wasn't just school. It was my parents, my friends' parents (both to a lesser degree), coaches, etc.. I do not harbor any hatred towards anyone because of it. It was no one's fault -- literally no one knew. I was smart enough to get by, so clear there couldn't be anything wrong with me, right?
If I am being honest, all the issues I faced while younger still affects me to this day. As and adult, I still have virtually no confidence in myself. But how could I? I did/still live my life from one failure to the next. I was not unintelligent, but I'm also nothing to write home about. The world works one way; I work another.
I'll never achieve what I am "capable" of in life. But that's okay, I won't be the next FAANG developer, and maybe it's not all it's cracked up to be. We all die in the end anyway. My goal is to just enjoy my life from here on out. Not sure how, but I'm just taking it each day at a time.
I have no career ambition besides not hating my job. I don't have a dream employer or want to climb up the career ladder to some arbitrary position in which I can retire. I just want to have fun doing what I'm doing and as soon as my job stops being fun to me I quit.
I can't be a failure without expectations of myself. I overachieve just because my bar is so low.
Before being diagnosed with 29 or 28, I had so much anxiety because of this. Not anymore. My goal in life is to get up in the morning and not looking at my watch mumbling "only 8 1/2 hours left" to get myself through the day.
This is a study about a relationship between mental development and abuse, and it's done with a data source skewed towards low-income families with unmarried parents in large cities. Are these families more likely to be abusive or have ADHD in the first place? Less likely?
There's a relevant joke that the results of most psychology studies should have "for college students" appended to it. I think this study needs a similar caveat appended, "Longitudinal study on the relationship between childhood maltreatment and ADHD in low-income unmarried families in large cities."
From https://ffcws.princeton.edu/about
The Future of Families and Child Wellbeing Study (FFCWS) is based on a stratified, multistage sample of 4898 children born in large U.S. cities (population over 200,000) between 1998 and 2000, where births to unmarried mothers were oversampled by a ratio of 3 to 1. This sampling strategy resulted in the inclusion of a large number of Black, Hispanic, and low-income families. Mothers were interviewed shortly after birth and fathers were interviewed at the hospital or by phone. Follow-up interviews were conducted when children were approximately ages 1, 3, 5, 9, 15, and 22 (began late 2020). When weighted, the data are representative of births in large US cities.
Beginning with the baseline interviews in 1998-2000, the core study was originally designed to primarily address four questions of great interest to researchers and policy makers: (1) What are the conditions and capabilities of unmarried parents, especially fathers?; (2) What is the nature of the relationships between unmarried parents?; (3) How do children born into these families fare?; and (4) How do policies and environmental conditions affect families and children?
One of the points he makes is there are twin studies and many of these twin studies that show genetics being a large contributing factor. Unless we believe these twins lived in families that neglected only one child.
He is one of the most respected researchers in this field. Watch at 1.5x speed
I was diagnosed with ADHD a couple years ago and it explained a lot about my life and family. Both of my parents were deeply emotionally disregulated and there was a ton of physical and emotional abuse at home when I was growing up.
Looking back at my parents behavior today, I’m convinced that they would be clinically diagnosed as well. In my case, both things were true and I get the sense that this is a fairly common scenario.
The bottom line is that we have to learn to adapt and cope with living in a world that really wasn’t designed for us, and not understanding myself led to addiction and a ton of other bad stuff. I have to remind myself that hardly any of this information existed 30 years ago and that my parents were trying to cope, just as I am today.
If a child has a fast processing brain eager to learn and crunch problems and a body full of energy, then when one or both of those has nowhere to go, they will act out.
Families have an abundance of mental stimulation cheap right on their phones, TV, etc. That likely makes both parents and kids less likely to move their bodies as much as the body required to generate natural endorphins and balance the needs of the brain. AKA: staring at screens or people all day and not moving as much as your body needs to will make you miserable, regardless of how successful your mental tasks were.
Carbs create more energy for the body and proteins with fat make more food for the brain, if one consumes more of one than they need and less of the other, they will also suffer. If you eat a bunch of carbs you will want to move more and think less.
A child or adult who gets to vary physical and mental exertion will be more focused and able to work. Test that. ADHD symptoms may not show as much in tired bodies telling you if the issue is that or an actual pathology in each person.
I think what you mean is that what physical and mental exertion may do is train your body and increase your stamina which improves your focus long term. Sure it may help develop the neural pathways. Much like learning to read is hard at first but then becomes easy.
Also people with ADHD can hyper-focus on the things that interest them.
I am not sure what you mean by or how you would test varying physical and mental exertion in any reliable way. If we make kids run a mile and then rest and give them a math test what does mean?
1. A lot of physical energy and is forced to sit on a chair 8 hrs a day, they would be miserable without a way to expend that energy. If they get to burn energy before or intermittently during the task, they will focus far more easily.
2. A mind as fast as a Porche and you make them drive behind a Tractor 8 hrs a day (listening to a slow talker describing things they already know), they would not be happy. I think ADHD is really underutilized mental and/or physical processing power.
Some of us think and move like elephants and others like hummingbirds and we have to operate together. The educational system is often designed for the former, not the latter.
But I don’t think effects of ADHD should be limited to “acting out”. And there wasn’t the same abundance of cheap stimulation 30 years ago for me.
I was under the impression that the brain, almost uniquely among human tissues, requires glucose for energy (whereas most other tissues can use ketones). How do carbs create energy "for the body" and not for the brain?
I'm pretty certain this is not correct. I thought that the brain runs almost completely off carbs, and will only in famine mode use protein.
I read this some years back (I want to say wikipedia, but not quite sure) when trying to lose a few kgs and trying to determine what the dieters meant by "ketosis". IIRC, what I found was that switching to a no-carb-at-all diet would force the brain to use protein as a fuel source.
Somehat off-topic, I also found out that the brain uses approx 20% of the energy consumed in a human body, muscle uses about 20% and the liver uses about 15% (might be slightly off on that last one, maybe that was closer to 20% than to 15%).
I reasoned that doubling the amount of work that a body does can, at most, use up only 20% of any extra calories put into the body.
So I ate 20% less, had no hunger pangs and went from 88kgs to 82kg, in what appeared to be almost all fat reduction. That was 16 years ago and I have not exceeded 82kgs since. I'm now 81kgs and fluctuate between 82kg and 81kg.
Of course exercise has quite beneficial properties unrelated to losing weight, but when one exercises one should have those other properties as a goal, not weight reduction as a goal.
In my opinion, Dr. Gabor Mate is much more interested in being a contrarian populist / sensationalist figure than he is in science or scientific proof. His tendency to do things like diagnose Prince Harry with ADHD via a 90 minute livestream doesn't do much to change my mind.
In the case of what we call ADHD, you are effectively saying, that the symptoms most commonly labeled as ADHD have a hereditary cause. I wonder what the environmental angle is here. That is, can what we call ADHD be a response to an environment that is novel or taken as normative, when it is not? If an environment (and I include parents in this) is poorly suited to the child and does not response to the child's objective needs, it would not surprise me if the result is some of the behavior described.
Take alcoholism. It is accepted that alcoholism can have a hereditary component. However, that doesn't mean everyone with this disposition becomes one. Environmental factors play a role in making alcoholism more likely. If your parents drink, or you fall in with a bad crowd that abuses alcohol, the chances that you will succumb to alcoholism increase. That doesn't mean it is deterministic, but if you have a predisposition, then it becomes more difficult to resist the temptation to abuse alcohol when put in a near occasion of sin. And culture can encourage or discourage such near occasions, or valorize or stigmatize the behavior in question. Obesity is another example.
In the case of ADHD, I can imagine several potential factors. An environment that is biased toward a sedentary lifestyle (kids have tons of energy that needs to go somewhere). A hostile school environment that produces a sense of anxiety and alienation, perhaps though the methods of 'school management' and pedagogy employed. A school environment that is abusive, e.g., through bullying, or by punishing reasonable acts of self-defense. Rigidity of the education system (prioritizing following some program above responding to a child's actual particular needs). Indulgence and softness and a lack of reasonable and age-appropriate discipline as a corrective measure. (We are squeamish about it today, but children have not yet developed their reasoning faculties well, and they haven't learned impulse control or disciplining their desires. This means punishment for obstinate bona fide bad behavior must rely on licit means of producing unpleasantness, as these are readily perceived by children and taken to counteract indulgence.) I can imagine some cocktail of these things playing a role. That rates seem to vary by country (for children <6 years of age, compare the US with Poland; for adults, Australia with China) means it is worth considering cultural factors, or else assume the genetic differences across populations play a significant role, and if so, what affected countries could do about it.
Someone causing disruption IS a problem to those around them. Someone in a system that they MUST be in by law who isn't fitting in the system IS a problem for the system and those that run it. Someone consistently having issues integrating with society IS the one with problems integrating with society.
It doesn't mean that society is good, or healthy, or bad, or anything necessarily. It exists though, and every society and social group has rules and norms, and not everyone will fit them comfortably.
In such places, "the nail that sticks out gets hammered down". It has to be for those running the system, especially if there are a lot of nails sticking up, or it quickly becomes unmanageable.
For example, a rape victim screaming every time someone touches her (even a handshake) is disruptive to everyone around her! Which is a problem. And that probably is not helpful to her either.
It doesn't mean she wasn't raped though. Or that her response isn't appropriate by some completely rational definition.
What I think you're referring to is that telling her to shut up, or that it's her problem, or kicking her out of wherever she is that there is disruption, or medicating her into a stupor (or so she is convinced she's actually fine) isn't usually helpful in actually helping said rape victim, at least in the long run. Or Anyone having these types of responses, frankly. Well, except in making them not the active problem for the group. Which is something. This is especially true long term if their reactions are a natural response to trauma and abuse, lack of met needs, or constantly being lied to about something dangerous or bad that is actually happening to them that no one is able or willing to face.
It does (somewhat) help the group deal with a disruption, and get what they need done in the moment. Which has to happen at some point, or everyone is screwed. The wealthier a system or group is, the more they can deal with these kinds of things productively and the less extractive and predatory everything is. But everything has a limit. Most systems have limits which are in actually MUCH less than the system promises/displays because they can't admit or see their actual limits (many different names for this depending on how it presents).
Hiding the fear and trauma CAN protect someone somewhat, for the same reason that herd animals tend to hide injuries. Predators often gravitate to the weak and injured. It's dangerous to do long term though, as the actual injury festers most of the time.
The underlying reality that few are willing to face about all this (IMO) is that if there is nothing people feel they can do about it (either due to lack of tools, lack of resources, of lack of ability/willingness to care), what other choice do they have but to deny it's happening or ignore it, blame the victim, or even penalize the victim for disrupting what they feel they need? Or become a victim themselves as their needs don't get met or they get attacked by the group?
If they're very strong, they might be able to admit the problem and their own weakness/inability to address it - but that often gets used against them in these systems, many times by the victims themselves!
And in such a situation, the victim will either ramp up the disruption until someone prioritizes it - or be smashed down/denied/blamed/scapegoated/medicated/told it's in their head/etc. to control the threat. You see this especially clearly in cults, small towns, companies and gov'ts, etc. Why do you think Gov't whistleblowers have such painful lives? Or LGBTQ folks almost always end up running from small towns the first chance they get?
And the person/people doing that smashed down/denying reality/blaming the victim/medicating them into a stupor will of course rationalize it away 99% of the time. Who wants to (or even can!) admit they are hurting someone because they can't afford to pay attention to them, or are too much of a coward - or will just be killed - to stand up to some stupid rule in their organization or a leader, when by all outside appearances we're historically the wealthiest we've ever been?
But the reality is, we're also the most depleted and confused we've been in a long time in some key areas, and 'help' which comes from a depleted or confused place is destructive for everyone. And is often predatory.
Ultimately, the person who is experiencing it is going to own the consequences regardless of what is done or who helps (or doesn't) and the mindset necessary to actually heal is often one of self sufficiency, knowing ones limits, independence, and holding oneself and others accountable for the results of their actions - so that help can be met appropriately with ownership, actual growth can happen, and perpetrators can be held accountable.
And that isn't easy, or even possible sometimes. and we seem to have been actively discouraging it in society for a long time. Especially since natural reactions to some of this abuse can include reactive abuse, violence, manipulation, and further trauma.
However, anything else can easily end up in co-dependent/narcissistic dynamics (or even full blown psychopathy), more trauma and more abuse.
And so the wheel turns.
> We are squeamish about it today, but children have not yet developed their reasoning faculties well, and they haven't learned impulse control or disciplining their desires. This means punishment for obstinate bona fide bad behavior must rely on licit means of producing unpleasantness, as these are readily perceived by children and taken to counteract indulgence.
What exactly are you advocating for? Corporeal punishment?
If children haven't developed their reasoning faculties well, as you say, and "haven't learned impulse control or to discipline their desires" then what effect do you think any sort of punishment achieves? This is some real third rate logic here.
ADHD is so obviously predominantly genetic that it makes me sick. Get out of here with this "indulgence and softness" nonsense.
If you're trying to say that there isn't a one size fits all way to bring up a child, I will certainly agree with you there. But you're clearly not saying that. Instead you're articulating seemingly smug insight that's actually, and obviously, a thin veil for your endorsement of the beating of children. Your comment makes me feel quite literally sick.
I don’t think this is accurate. I believe he talks about genes being like a loaded gun - they can make you more susceptible but it is the environment that pulls the trigger. There is also a lot of discussion about intergenerational trauma.
I recommend Russell Barkley's youtube videos and books on ADHD if you want to understand the condition and the current research.
Russell Barkley proposes that ADHD is largely inherited through genes, quoted 65%-75%, and the rest is environmental.
The big difference between them is that Gabor focuses on attachment theory and childhood trauma.
Both are beneficial to learn from. It is harmful that the ADHD community does not accept both points of view. Because they complement each other well.
I also have a kid who was diagnosed at a young age. Said kid was also a cheerful, happy little baby that we love dearly and did our best to raise into an amazing young adult.
Which is to say that I'm not arguing against the study, but ADHD doesn't automatically mean neglect, or vice versa.
After all parents are human too and many don't live up to the task, which is a very hard task especially if the child is difficult.
The study doesn't necessarily imply that all ADHD children exhibit those behaviours. The fact that both you and your child don't perhaps is an indication that there may be other confounding genetic factors beyond the main ADHD traits
[1] https://en.m.wikipedia.org/wiki/Refrigerator_mother_theory
Wouldn't the obvious (and slightly glib, but I hope you can see my point) reply to that be "because my parents are wonderful people and we're a tight-knit family"?
Note that they say ADHD symptoms, not necessarily ADHD prevalence. So it could very well be that the only thing they're saying is that ADHD is much more manageable if you have (enjoyed) a good, stable upbringing.
Both were eventually diagnosed with ADHD. Both got on meds. Now we're not constantly stressed every waking second with a chaotic house full of screaming and shit flying everywhere.
We'd have thought we were just the world's worst parents, if we hadn't had a third on whom every approach worked, exactly the way the experts say they should. That's when we were like, "oh, maybe it's not entirely our fault, maybe we should take these kids to a shrink".
We'd read these books on various parenting approaches, try each very earnestly and consistently for months at a time, and not once would any of it look like it did in the book. Nothing worked. Third kid, no ADHD? It all went exactly the way the made-up examples in the books said it should. It was a revelation. "Oh, this is what this stuff's like for most people! Holy shit, this is so easy!"
The model is that there’s a loop of bad behavior -> worse treatment -> worse symptoms -> worse behavior. Taking the kids to a therapist interrupts that cycle. Bad behavior -> more appropriate treatment -> better symptoms -> better behavior.
Meds (& therapy—but if this miss that for a couple weeks, nothing bad immediately happens, while if they miss the meds even one day...) did the trick. Amazing. We can just tell them stuff, and they mostly listen. We can talk to them about something they just, moments ago, did that was wrong, and they know what we're talking about rather than being genuinely confused, and will not just commit to do better, but will actually try and maybe not immediately repeat the behavior, even entire minutes (LOL) later, and almost never start to just absentmindedly do it again while we're still talking to them about it. Punishments or harsh reprimands are (and were, after we caught on to those being not just ineffective, but counter-productive, even in very mild forms) reserved for immediate safety problems that can't wait for a touchy-feely approach, or many-times-repeated bad behavior, and don't usually result in hours of backlash-behavior later, as they used to, and do usually have an overall-positive effect. They notice straightforward natural-consequence-type correction and respond to it, rather than its having zero effect whatsoever.
But, yes, we can add 2 to N for worsening treatment being the opposite of helpful for (at least our) unmedicated very-ADHD kids, for sure. That was definitely something we saw.
Your story isn’t really a counter-antidote all. The study is saying that a feedback loop exists, not that it’s the only variable.
If anything, your anecdote supports the study. A baby had a positive disposition and was treated well, avoiding the feedback loop so much that the management of the symptoms stood out to your doctor.
Yes that's how statistics work
The doctor's question doesn't make sense given the context you've provided. Do you have a career? The fact that you're on Hacker News and can afford to care for a family indicates you've at least managed your symptoms with any number of tools or methods.
So, "why aren't you homeless?" The question answers itself, from all appearances. But if there's something you've left out that could provide missing context, I'd be curious to know.
Also sounds pretty unprofessional for a doctor to say and really strange in that context to the point that I don't really believe the poster's story.
But doctors are people, too, and he and I built an easy, informal rapport. I'm certain he wouldn't have said it if he wasn't sure I'd laugh in response.
The anecdote is true. It really happened. The doctor's comment, while deliberately phrased humorously, was serious. He identified some quite significant symptoms, and was happy for me that I'd managed to do OK in life in spite of them.
Maybe, but even still, this is the type of remark that could easily get a doctor fired. Most people err on the side of caution for remarks that could get them fired, even if they're sure it would come off correctly as a joke.
Being a professional doesn't mean leaving your humor at the door. It does mean tailoring your communication to each patient/client/customer.
The comment is dangerous not because someone might take it badly - but because out of context it sounds like a doctor making fun of a patient for a medical condition. It would be extremely easy for a disgruntled patient to weaponize it (even if the patient knew it was a joke at the time and even found it funny, they can still use it if they are disgruntled for some other reason).
That's not to say professionals can't joke or talk to people like humans, but some jokes are very risky.
I largely made an appointment in the first place because I was weary of using all my mental energy to stay afloat. Not drowning isn't the same as thriving, and I wondered what I could accomplish if I could spend some of those mental cycles on more productive goals. We found some meds that work well for me, and I'm still astonished at the ability to, you know, choose work on the things I want and need to work on. What a different world that is!
writing as someone that might be undiagnosed... thank you for writing this. More encouragement to take action myself.
Can I ask, did you start with your primary care physician and work your way through the system, or did you start with a psychiatrist?
I tried going through my PCP and working my way up but didn't get far with it. My PCP referred me to a psychiatrist who seemed nice but wasn't very helpful. She thought I had difficulty focusing because of anxiety; I thought I was anxious because I had difficulty focusing. Honestly, I felt like she started with a hypothesis and only heard the evidence that supported it. (In fairness, I started with the hypothesis that I had ADHD, so she could probably say exactly the same thing about me.)
A friend of mine had told me about a good experience with an online doctor. After frustration with the previous doc, I made a video chat appointment with his. That one was night and day different. I know, I know: "Oh really? You found an ADHD doctor and they said you had ADHD? I'm shocked!" But the previous doc wasn't willing to try any treatment. The new one gave me a prescription for a low dose of a cheap medicine, and I could tell the difference from the first day.
If you live in California and would like a specific recommendation, let me know. My website's on my profile, and my email's on my website.
I did a quick search and was only able to come up with the abstract for a study that claimed ADHD had a ~4-5x higher prevalence among homeless individuals than non-homeless individuals. The abstract alone indicates a couple potential issues with the study (e.g. subjects were only white men, and they used a population sourced from people who had gotten treatment at a particular medical center), and it doesn't indicate any causation.
I don't really think ADHD meds are regulated to keep people homeless, and I'm not sure about the meth epidemic being related to ADHD, but I don't think it would hurt to get people the treatment they need, whether they can pay for it or not.
What for?
Maybe a bader-meinhoff effect thing for me because I see that my previous comment on HN is also related to this, but I am also an ADHD patient that had similar thoughts until considering a little harder about what that actually means for someone who is neurodivergent. I read a book "The Drama of the Gifted Child" by Alice Miller which gave me an interesting change of perspective on this topic. Her other book "For your own good" is longer but also an interesting deeper dive.
Narcissists are amazing at convincing everyone, especially themselves, that everything is fine when it definitely isn't actually fine (for someone). The gaslighting of everyone around that is required to sustain this is part of what seems to cause the confusion, anxiety, depression, dysregulation, etc.
These symptoms include:
- being unsettled and restless/hyperactive, or extremely checked out (including excessive daydreaming to escape reality). Sometimes flip-flopping.
- difficulty discerning their own actual mental and physical state reliably, which causes issues self-regulating successfully (including swings between emotional dysphoria, numbness, and hyper-aroused emotional and physical states)
- avoidant behavior, often with magical thinking (aka procrastination with 'it will all be just fine')
- either people pleasing (and corresponding boundary issues) or extreme defiance of authority. Sometimes flip-flopping.
- anxiety and depression (often cyclical/flip-flopping)
- constant rumination/distracting self talk
- insomnia and odd physical problems which come and go
- impulsivity
- addictive behaviors
- self esteem issues (of various kinds), and self-blaming.
- a history of unstable relationships, including trauma bonded relationships.
- feelings of alienation
Additionally, trauma bonded folks tend to get into cycles where they can't remember or lose track of the various bad things the abuser did (to survive), often defend the behavior of the abuser to others, and have memory issues and confusion which makes it hard to consistently understand the issues and leave/defend themselves. They are extremely common in these situations as a survival mechanism.
Additionally, I've run across several folks with diagnosed ADHD/ADD that said their family life and childhood was fine or even great - until they actually started looking at what was going on, and then it started to make more sense. All of the close friends I know with ADHD diagnoses had one or both parents that seemed to be presenting with NPD or NPD like symptoms (if you actually looked/knew them), and if you knew what to ask for, a history of emotional abuse or neglect.
Additionally, this background seems to be extremely common among Engineers. A common pattern with ADHD is for folks to lean heavily on the rational mind as a coping method, as they can't trust their emotions, or often have problems trusting people (even those they are supposed to trust, including themselves), and have learned to rely on concrete evidence (instead of gut feel), documentation, rules (either to follow, or to avoid), and pure rationality as a coping mechanism.
Additionally, there is a massive amount of overlap with Complex PTSD, which many folks seem to have taken to refer to as 'childhood PTSD' - as it is due to long term, ongoing exposure to trauma that someone can neither escape nor process successfully, the conditions for which are easier to produce in childhood than in adulthood in the modern world. [https://www.nhs.uk/mental-health/conditions/post-traumatic-s...]
The meds helped them, as before that, they often got really confused as to what was going on, or couldn't feel/tell what they were feeling in a useful way. A common issue with folks being abused by someone with NPD is they get trapped because of the confusion and stress produced by the person with NPD on their target, due to the constant emotional manipulation (and other things) denying the reality they are actually in and what they know to actually be true, along with corresponding punishment (often subtle or indirect) if things start to actually get better for the target.
As to if these are all the same thing or completely different things, or if it's multi-generational abuse showing up, or genetic predispositions to certain types of processing issues related to otherwise normal environments and child rearing? There doesn't seem to be a clear answer.
What does seem to be clear is that ADHD diagnoses have been skyrocketing while clearly narcissistic behavior is also skyrocketing (not necessarily NPD mind you, but definitely narcissistic behaviors and manipulation).
But there may be parts of your life you re-evaluate with time and perspective.
I finally got diagnosed at 30 and the doctor was similarly surprised.