I think this is a good example of how we mix up concepts: ADHD is just a phenotype. Then, our society classifies it as a condition because it does not go well with current circumstances. Although, both are separate things.
People online assert a lot of things, such as "it's a dysfunction of dopamine pathways", "it's genetic", "it's a sort of autism", "it's a brain chemistry problem". But never anything that looked like a real definition backed by good science.
My own psychiatrist's diagnosis was a bunch of obvious questions that I couldn't answer honestly even if I tried. The conversation boils down to: "I have trouble concentrating and wonder if I have ADHD, I have [common symptoms backed by anecdotal evidence]. - OK, they have to affect your life severely enough to qualify. Do you think they are? - I guess, that's what I'm here to find out. - OK, let's try Ritalin." It was only helpful in that I needed to focus during a semester of studies and the stimulants did it.
It feels like I had a cough, got diagnosed with cough syndrome, and went through cough medications until they started helping the cough, and now I can describe myself as a cough syndrome sufferer. Where's the virus?
- There is no common definition of ADHD, just a list of two hundred unrelated claims made by papers that were found with a search engine. That makes them impossible to compare or relate to each other. This is not a review that concludes anything, just "look at our HUNDREDS of sources!" Basically shock and awe.
- What kind of paper brags about how many continents approved of them? Is this some kind of claim to authority? Why do I care that "366 people" agree with it? In particular, why is this the entirety of their "results" summary?
- The very first highlight is "ADHD occurs in 5.9 % of youth and 2.5 % of adults." I find it ridiculous to dump such a precise number as their main claim when the rates vary so much depending on whether one uses the DSM or ICD, which country one lives in, and which doctor one see. My personal experience with a recently-minted psychiatrist from a reputable university doesn't give me confidence in any kinds of incidence rates either: the state of the art of diagnostic criteria seems to be a questionnaire a 12-year-old could fake.
- In a hypothetical world in which ADHD were known to be an ill-defined "syndrome" with no scientific basis, I would be surprised if "The World Federation of ADHD International Consensus" admitted to it. You don't organize a large international conference to make your subfield less reputable.
To waffle freely:
I believe it's lower than normal background levels of dopamine.
Obligatory disclaimer I am in no way a doctor or scientist. This is probably wrong. Pinches of salt all round. This is a theory I'm kicking around now and then but I don't have the knowledge to confirm/deny the hypothesis yet.
When a normal person tackles a regular task they'll get a little squirt of dopamine leading up to the task (anticipation) and then a corresponding signal when the task is done (I did the thing correctly, woohoo).[0]
When a normal person tackles a task and gets a better than expected result, they get a fresh squirt of dopamine upon completion (Oh wow, that went really well! I should consider doing this again!)
When someone with the ADHD-type brain wiring tackles a regular task they'll get the initial anticipation squirt, but upon completing the task they'll get a lesser amount (in dopamine language: that didn't go as well as I thought it would)
Compound that effect over $age years and you get someone with no real motivation to do anything, often distracted by random things that might be interesting, anxious, depression, imposter syndrome, all that good stuff - they rarely get a "I did good" signal, so nothing feels worth doing and they don't feel like they've had much success in life. Also might explain why a lot of ADHD folks have some sort of dopamine loop going on - alcohol, smoking, drugs, overeating, absolutely covering every meal in salt, etc. Something that brings up their background level of dopamine.
You do get positive effects from this - it's not all doom and gloom! - quick learners, jack of all trades, outside the box thinking, anything that might give a better dopamine response than the day to day routines
Might also explain all the "ADHD people were great as cavemen" stories that pop up now and then - nothing gives more dopamine than "holy fuck, I survived", the modern day doesn't really have many of those moments.
Feels like this would also explain why someone with ADHD can take stimulant medication and not bounce off the walls like a normal person would on the same medication - their background level of dopamine is being brought up to normal levels by the medication which in turn allows the rest of the system works as it does in normal people.
[0]: I actually found this theory while looking into AI stuff, haha: https://deepmind.google/discover/blog/dopamine-and-temporal-...
The quick summary from https://en.wikipedia.org/wiki/Dopamine
> Within the brain, dopamine functions partly as a global reward signal. An initial dopamine response to a rewarding stimulus encodes information about the salience, value, and context of a reward. In the context of reward-related learning, dopamine also functions as a reward prediction error signal, that is, the degree to which the value of a reward is unexpected. According to this hypothesis proposed by Montague, Dayan, and Sejnowski, rewards that are expected do not produce a second phasic dopamine response in certain dopaminergic cells, but rewards that are unexpected, or greater than expected, produce a short-lasting increase in synaptic dopamine, whereas the omission of an expected reward actually causes dopamine release to drop below its background level.
> There is actually no scientific explanation for it.
Yet! :)
It is clearly defined and operationalised for medical diagnostic purposes.
https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_to...
There seems to be a lack of mental health expertise in the hacker community, so feel free to ask any specific questions and I'll do my best to assist you :)
I don't mean the current definition or diagnosis, if diagnoses were locked in forever we'd still be on the first DSM, I mean an actual explanation for the disorder.
Currently it feels like the equivalent of diagnosing diabetes by making a list of symptoms like "dies when eats too much sugar", "went a bit blind with no other explanation", "is super thirsty all the time" and if you tick enough of the boxes they'll try injecting you with insulin and that may or may not treat the symptoms.
Is there an actual diagnosis or agreed upon description that is the equivalent to diabetes' "either the pancreas not producing enough insulin, or the cells of the body becoming unresponsive to the hormone's effects"?
That's what I mean when I say there's no agreed upon diagnosis - yes technically a doctor will say you've got it and yes technically that's a diagnosis but it's still a little archaic in that the diagnosis comes from checking enough boxes from a list of symptoms rather than telling you the actual root cause of the disorder
I have suspected for a while, but since I got good grades as a kid I never got tested.
Smoked and drank for years. Had to quit that. Still smoke weed...
Well shit.
Drugs like Ritalin are an effective dopamine re-uptake inhibitor. Other stimulants may not be.
Just in case any one reading this I the future is self-diagnosed and is considering self-medicating with Amphetamine/Speed!
It is clearly defined and operationalised for medical diagnostic purposes.
https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_to...
It's causes are understood to be a combination of genetic risk factors (its heritable and follows family trees), and environmental factors such as child abuse increase the odds of an ADHD diagnosis being made.
It's worth remembering that ADHD drugs can be an affordance even if we accept a social model of disability and a neurodiverse view of humanity. But the systems we have built drastically exaggerate the degree to which ADHD is "inherently" disabling, e.g. not opening your mail can land you in prison. Yes of course there's more to that than it just being "mail" but the mechanism itself is more dangerous to someone with ADHD traits than someone without them.
The same goes for autism by the way: arguably there are many benefits to autistic traits (which seems odd to explain on a site like this when for the longest time programmers online used to joke that we're all autistic and when the "aspie supremacist movement" is literally a thing) but at the same time it can be extremely disabling simply due to "how we do things", e.g. having to use the phone to book an appointment or being in a noisy office full of other people in order to get paid.
It's interesting to consider not only what we could do to provide affordances and accommodations more equitably but also who else would benefit from this as a kind of inverse collateral damage.
https://www.sciencedirect.com/science/article/pii/S014976342...
I think this is the case for those with severe ADHD. They can't really function at all in modern society, it's a severe impediment.
Vast majority of ADHD (esp. adult adhd cases, where childhood symptoms were not obvious) are nothing like that. I think this is where the idea of it being a phenotype comes in, for the mild/moderate ADHD cases.
https://pubmed.ncbi.nlm.nih.gov/30526189/
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
Even for those who can function in society, ADHD causes greatly increased rates of major depression, suicide, addiction, and accidental death.
Same with ADHD - it an illness and should be treated as such. I likely have undiagnosed ADHD. I'm ill. I need and want treatment (just afraid because of that same ADHD). What's the big deal with calling illness an illness or mental health disorder? Me being ill doesn't make me a lesser human like some apologists of "new normal" try to describe. Just like my rhinitis doesn't make me a lesser human. Both are illnesses, no big deal.
I'm not on medication and have ADHD. You're just essentially calling me disordered, disabled, and untreated. The consequent stigma impacts my social and professional opportunities, and this stigma is justified primarily on the basis that if I just simply hate and disparage who I am enough I might be motivated to take ADHD medications and thus become "better".
I dunno, when you call me less orderly than other people, and less able than other people, but I'm not being described a "lesser"? Utter horseshit. I've heard this sort of rhetoric in disability communities many times before but no, being disabled and disordered is a bad thing. That is WHY Russel Barkley likes calling people disabled and disordered - because that give people an impetus to get "Better".
I simply an intolerant of people using languages that portrays me as less capable, when autism + ADHD has opened up many doors for me that otherwise would have been closed. It's just fucking unfair and defamatory. If people want to be on meds, go on meds, but I don't see why you have to call me "disordered" in the process.
What does impact my professional opportunities is this ADHD illness itself. It makes me really bad at things I'm perfectly capable of doing with good quality and in time, but instead I screw up deadlines and my work suffers a lot.
I'm not sure if meds help or not (but evidence for other people shows that it do), but I know for sure that people without ADHD lead better lives. Better, without any scary quotes. And I also do want to become better and try to medicate this shitty condition.
I eye some risks people with ADHD have, like higher risk for STIs. Sure, Russel Barkley things people with ADHD getting STI's makes them "disabled", but evolution gives a bit two thumbs up to people with ADHD having unprotected sex. Barkley then brags treating ADHD will reduce STIs, by you know, reducing the amount of unprotected sex with multiple partners that they're having. If anything listening to Barkley's advice is likely to make the average person less reproductively successful.
I don't know, I don't like Barkley and his pro-pharma fan club. It's correct that medicating people with ADHD will profoundly change their behaviour. But I don't see any reason to call the prior way people ADHD people behaved as "disordered" and "a disability" and the new way they behave on stimulants to be curing them of a horrible disease or whatever. That description is not scientific - it's subjective what we do or don't consider a disability or disorder. If you prefer life on addy, good for you, keep using addy. I find the entire way we decide to describe behavioural and neurological differences as disabilities and disorders to just be thinly veiled bigotry often taking the form of self-hatred.