NIH Researchers Identify Brain Connections Associated with ADHD in Youth
nimh.nih.gov
nimh.nih.gov
So... ADHD is a symptom of an overly integrated brain.
Not going to lie - I've always been kind of fond of my mild ADHD. There's something enjoyable about being interested in everything going on around you (or in your head). It just happens to be a liability in schools or jobs where you're only supposed to be doing "just this one thing".
Things that come to mind are data science/analysis, debugging and fixing outages (finalizing follow up RFO might be hardest part ), security/hacking (hopefully white hat)...
And basically whatever else one personally finds interesting to dig into deep and/or wide.
Most jobs would not afford me this, but I lucked into a great role that plays into it rather than fights it.
Where you intentionally have more than 1 thing/project going on, so you can procrastinate on nr1 while you work on nr2 ...etc.
And for going in deep and long - it really needs to be something personally interesting.
Or someone else has a better was to get into hyperfocus flow/zone?
This is not a good understanding of ADHD. People with ADHD have hyperfocus tendencies, and this in fact can apply to their job while they ignore everything else.
That is to say extremely successful people might be that way BECAUSE of their ADHD, not in spite of it. A programmer who devotes the majority of their life to learning their craft, or an artist who spends all their attention on their next (or first) hit album.
But it's an even worse understanding of what high-paying jobs actually require.
A mathematical example would be right around the point where one finds that the delightfully focused exploration/experimentation afforded by ADHD which carried you to self-discovery of, say, why SIN relates to COS through their derivatives, or through the Pythagorean theorem, doesn't actually get you very far in calculus unless you intend to re-invent, at great personal cost and to no practical advantage, a lot of very well-known wheels.
Instead you need that hard-won scaffolding of rote memorization, the almost muscle-memory capacity for sight-recognition of a couple dozen identities and theorems and familiar problem forms, to get much further.
Spontaneous yawning when you're wide awake and actively interested in what you're reading or learning is for me a telltale sign that I have reached the point where I'll I have to tack a frustrating zigzag course _against_ the ADHD winds instead of sailing with them.
The big problem with hyperfocus: you don't control what you focus on, or when. You can't turn it on for the big project, or turn it off when you're hyperfocused on a dumb distraction. Even ordinary focus (non-hyper) comes and goes at inconvenient times.
(I'm not sure if this is what you're saying, but hyperfocus isn't a fixation on a field of study or area of work. That sounds more like an autistic special interest, although many people with ADHD also have autism. Hyperfocus is more like being "in the zone", on a scale of hours.)
Some ADHD people find great success in the workplace, because of or in spite of ADHD. But non-traditional career paths have a ton of ADHD people for a reason.
Perhaps there's some evolutionary advantage to these 'mental disorders' that'll make sense when they're more fully formed in another few hundred years.
- Obsidian for knowledge management to help with the forgetfulness - Todoist to get the daily stuff done and personal project management - Timetree to coordinate with my wife and be able to plan ahead more than a week - any alarm app for the critical stuff the next day
My wonder is when does it to go from a kid just being a kid to a child actually affected by ADHD. Often times it's described as just not being able to pay attention but in my personal experience I remember finding it hard to focus as a child.
The drugs also scare me. I remember taking Adderall in college to help study for tests and crunch on projects but I distinctly remember anytime I took one I always wondered how people could take it every day, Adderall (and Vyvance) were amazing drugs for helping to stay focused, but wow did they f** me up, I remember it always felt great at first and by the end of the study session I couldn't imagine how people could take it every day because of the side effects (especially the lack of hunger). Adults taking the drug is one thing but the idea of giving something like that to a child profoundly scares me.
The second D - disorder. When it affects the kid's ability to learn, socialise, etc
Behavior patterns that were once totally normal may get in the way of living the kind of life that some parents have come to expect of their kids—running from school to dance to piano to soccer to tutors to therapy to whatever. Are these kids disordered because they can't keep up, or are the demands unreasonable?
Decent enough in school but dropped out of college twice. Fell into an entry level IT job with loads of scripts, processes, and procedures but the more I progressed the more autonomy I was given and the worse I performed.
Was mostly terrible but occasionally amazing (enough to keep my job at least) for ~10 years then bumped into the ADHD symptoms at some point, got myself checked out, got the diagnosis.
Doing pretty well now (tho never perfect) with medication and a stint of cognitive behavioural therapy to help set up my own structure. Getting there!
I originally went for help with low confidence which expanded out to digging into and addressing self-esteem, confidence, social anxiety, procrastination, and perfectionism.
If I'd taken one general thing from it though it's "do I have evidence or is this an assumption?" - if I have no evidence (that I'm terrible at my job, I did bad, that guy hates me, etc) then I should reevaluate if it's even accurate before doing anything with the thought
Writing things down when things go wrong was a big part of it too - what's the situation, what led to the situation, is it possible to view the situation in a better light, if not how can I fix the situation, if I can't fix things myself is there anyone that can help me with this situation rather than wallowing in it. That sort of thing.
As I say I imagine it'll differ from person to person so other people may have an entirely different experience with it, I'm not sure. Definitely worked for my systems/coding flavoured brain though, really was like debugging faults in a program. Figure out the underlying issue, try a fix, did it work? y/n? If no, try another fix. If yes, work on the next problem.
Where are you? I can't think of a single place in Europe where medication alone is the treatment standard for ADHD.
Looking back on my own life (diagnosed early 30s, but part of the process was looking at how I was in school): I struggled to keep up with the bare basics outside of lessons - getting ready for school on time, remembering books, remembering to tell my parents I/they needed to do stuff on specific dates, doing (small amounts of) homework.
On the social front - Billy no mates until college (where I met people who were as weird as me), constantly bullied for reasons I couldn't figure out, could not work out how people managed to make friends. Felt like I'd missed the day of school where they taught everyone how to socialise and be normal. It was also like my prime directive was "don't speak unless spoken to" haha. So damn quiet.
Unless someone directly invited me or gave me permission to do an activity that activity was just for other people, not for me. Dancing, sports, and pianos weren't even on the table lol.
Regardless, yes it is often described by others and those who are not diagnosed with ADHD as " just not being able to focus". This simplification misses out on a whole scala of symptoms and experiences.
As for the medication, it is true that it is sometimes mis/abused by some students. One thing to realize is that for those who have ADHD drugs and the stuff may have completely different effects on the person. Uppers making some people sleepy for example. Lastly children are often not given those drugs you mention but alternative without those side effects.
> I've always been a cautious skeptic of ADHD in children. On the one hand I know ADHD is a thing and that it legitimately affects some children ...
They explicitly say that they know it affects some children, but they're concerned that it's overdiagnosed because the symptoms have overlap with normal child development. This isn't some kind of uninformed conspiracy theory, it's a legitimate concern shared by experts in the field [0].
My fear isn't that experts get confused and mix up real ADHD with normal childhood, my fear is that parents expect too much of their kids and convince their family doctor (who isn't an expert) to diagnose the child and prescribe Adderall. That fear is totally compatible with ADHD also being a real thing that actually needs treatment in other children.
It positively changed my life and I am quite happy that a "simple family doctor" can prescribe amphetamines if he thinks that it's appropriate.
Taking prescription medication without a prescription or the condition it's meant to treat and then using its effects on you to decry its use by those with both seems like bad faith.
That is either extremely ignorant or bad faith. Either way it's below HN's standards.
There are no objective biological diagnostic criteria for anything in the DSM.
"psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests" -Allen Frances, The New Crisis of Confidence in Psychiatric Diagnosis
People say the same thing about God.
Measurability is a fundamental requirement of science for something to be tested or studied systematically.
Slow release and a therapeutic dose is significantly different than slamming back meds in school like that. Therapeutic dose means you can’t even tell you took the med, until you either stop or look back at the day and record how much you were able to achieve.
Yes, some doctors are bad and calculate a dosage based on weight or other arbitrary means. Good doctors and psychiatrists start you on the lowest dose and slowly titrate you up based on DSM guidelines.
Lastly, medication for ADHD is something that makes all the actual effective treatments do-able. It’s a first step not a crux.
This is a nuance that is lost on a lot of people. Medication needs to be taken in conjunction with re-learning how to study/organize/prioritize. This actually allows for new neuro-pathways to be forged and reinforced in the brain, which actually fixes many of the negative effects of ADHD, lessening the need for medication over time for many people. This effect is easy to observe in children because their brains are still extremely very plastic, but it also causes people to question why we need to prescribe medication if kids just end up “growing out of it”.
I suspect you might also have parents who kinda like the idea that there child's behaviour can be explained by ADHD. My sister's kid often gets in trouble at school for example, and whenever this happens she will try to excuse it by saying she has ADHD. I'm not at all convinced given that imo it's far easier to explain the misbehaviour with bad parenting.
It works differently in people with the disorder. I took Adderall as a child and as an adult for adhd. It didn't get me wired nor did I have withdrawal symptoms, I simply felt more centered and capable of starting tasks. I know that we can only draw on our own experiences to judge things, but understand that people with this disorder experience the drug completely differently than you did.
My brother has been known to take adderall recreationally. Apparently he would crush it up and snort it. He definitely gets a high from it. I’m not sure how much the difference in our experience is due to the delivery method versus differences in how our bodies processed it.
ADHD is not just labelling children with being disordered for being children. It’s labelling like the most inattentive, dysregulated, and hyperactive 5% or so of children. Children that act like 5 year olds when their peers act like 7 year olds. ADHD has been observed for centuries as well. ADHD in women tends to be diagnosed later in life and if you study certain subpopulations of women like teen mothers you will trip over ADHD and the diagnostic gap narrows with age.
There’s also evidence like.. from the OP where we can observe neurological differences. I think my main problem with ADHD is labelling something that’s probably evolutionarily adaptive (People with ADHD love having unprotected sex early in life) as a disorder and deficit, but this gets into the philosophy of medicine.
Dr. Russell Barkley is a good source of information and champion of the scientific mainstream view of ADHD.
ADHD includes many other things like weak short-term memory, defunct perception of time, hard to control hyperfocus, overwhelming inner monologue, and executive dysfunction that makes some tasks physically impossible to start even when the person wants to do them. And it comes with a bunch of other comorbidities. Doctors diagnosing ADHD also have obligation to exclude other causes of the symptoms, like bipolar.
The stimulant medication does not actually cause stimulation in people with ADHD. When people have a deficit/insensitivity to the neurotransmitters, the meds merely bring them up from a dysfunctional level where the brain lacked ability to function properly to the normal-ish level.
Rejection Sensitivity and Emotional Disregulation
I have always been paralyzed by being afraid of failure (rejection), and that has kept me from pursuing a lot of things in the past
And I've always been prone to anger outbursts, even over seemingly trivial silly things. It has damaged so many of my relationships and overall left me pretty lonely throughout my life. And when the dust settles I'm sitting there thinking "Why was I so angry about that thing. I don't even care that much about it"
My ADHD diagnosis and medication, starting in my early 30s, has almost entirely turned my life around
I fairly certain I have either ADHD, autism, or probably both, and have existing diagnosis pointing to being "neuroatypical". But coming up with exact diagnosis seems to be pretty difficult, because many other diagnosis can explain specific symptoms.
I would say, though, that ADHD medication can help with rejection sensitivity disorder and help regulate some emotional stress on top of the more well-known ADHD symptoms. Practically speaking, it doesn't matter where it comes from if it can be treated.
For ADHD in particular I think you have to zero in on executive function. It does bring along a lot of friends, but poor executive function is absolutely the keystone of any ADHD diagnosis
If you don't struggle with that, then you can probably safely eliminate it as a suspect... Or at least put it much lower on the list
I'm sure that people like the root of this thread mean well, but at the same time that attitude is exactly what kept me from receiving treatment or care when I was younger.
I’m not the parent but since no one answered: I was diagnosed in early childhood but only started meds around 21 years old (the first time I took Adderall was the first time I wrote an outline for a paper) and I’ve been on it nearly continuously for 13 years now, almost at the maximum dose. So far, no side effects at all of long-term use other than a learned behavior of building anxiety and stress every month around the time of getting my perception due to the war on drug style of regulation. I have only rarely had short term side effects when only taking extended release Adderall.
On your concern generally, I’m not a doctor but I’m not sure long-term effects should be a big concern without some known contraindication. To my recollection, none but my current doctor have given much discussion to long term effects of Adderall, if at all. My current doctor (who I believe had finished residency shortly before I started seeing him) was concerned about long term (heart) effects and I asked him for some links to info/studies. He sent me a webmd link to an article discussing a paper examining cardiac events in Canadian patients over 65 recently starting Adderall, which found no increased risk of cardiac events vs those not starting/taking Adderall. I don’t think there were conflicts of interest declared but it seemed like some authors had some association with the Shire pharmaceutical company. For context I’m mid 30’s, American, and have been taking Adderall as a long-term patient so I was confused about why he would send that but he didn’t expand on it when pressed. Research I did on my own only led me to studies showing that people with ADHD are twice as likely to of die in an accident as non-adhd counterparts, which I had never heard from any doctor and I believe is the leading cause of death in my age group.
As another note, my uncle was prescribed Concerta for an off-label use and quickly started having suicidal thoughts and stopped using it. Work with a physician who feels like a good match with you so you can be candid with them.
I lucked into SWE being a hyperfocus of sorts, so luckily work isn’t awful if I’m not on meds, but holy cow is anything else just complete drudgery. Feels like everything is behind a wall of “startup energy” that is so hard to get through, especially without external accountability.
Rejection sensitivity is also part of it for me. I felt like I could never think fast or organized enough in the moment when talking (I would lose my train of thought in the middle of sentences), so I would get anxious coming in and try and plan, but there’s only so much you can plan for, and it just is a bad cycle to get in. Therapy and internalizing things don’t actually have that high stakes is helpful but only mostly a fix.
I have to say the first time I took I suddenly felt very calm. Noises from neighboring apartments, dogs barking, children outside playing ceased to be annoying distractions.
I took 5mg to be precautious. And spent hours doing an overdue cleaning my room / apartment. And i felt ok doing it when normally i'd feel irritated. Normally i'd have trouble deciding where to start this, but with this i just started.
I started properly paying bills. To be clear i had the money to pay these bills. But i would always tend to leave them until I was getting notices to remind me.
Vyvanse was interesting though. It made me a lot more assertive, when most people would describe me as the opposite. I liked that but it was double edged sword. I stopped because I was working as sales assistant in a shop and I found I was getting just a bit too angry at belligerent customers.
Obviously we don’t give kids the doses college students might take for cramming. Stimulant sensitivity varies quite widely in the population—a dosage that might be appropriate for a particular child may make an adult feel “wired.” But there’s a lot of science showing that Adderall in appropriate doses is neither habit forming nor do people develop a resistance to it (which is what typically causes escalating usage).
That's the multi-billion dollar question. From grades K-3, my son got straight A's and was a typical "boy" in the classroom. Occasionally not the best at paying attention, but no big deal.
Fourth grade was another story. He'd come home exhausted, and cry himself into a nap nearly every day. Not coincidentally, that's what the academics shifted from pure memory, associative reasoning, and recall to tasks that also required planning and executive function. That, plus the expectations of better ability to sit still and pay attention were just too much.
We eventually paid the big $$$ for a full, two-day neuro-psych evaluation. It was eye-opening for both my wife and I. For me, it showed how differently my son's brain was working, and for my wife it shined a light on her undiagnosed ADHD.
We did resist giving our son medication, and waited until he decided that he wanted to try it (16 years). It made an amazing difference in his ability to study and stay on task, but it did come with the weight loss and a serious 4-6pm crash every day, though those effects seemed to mitigate over time.
I sincerely think this is a good thing to do and gives people a healthier relationship to mental health than being coerced into taking drugs with harsh side-effects.
You're not guaranteed side effects. If you do experience them, you'd normally get different medication options.
Also, you can have discussion about it and the effects. If you end up anywhere close to coercing regardless of side effects, it's not the drugs that are the problem.
"Not guaranteed side-effects" is also something that's technically true, but essentially bullshit. Here's a study [1] where 71 children were studied. How many children had adverse effects? 71. This is how children are often convinced to take drugs. They are misled by people who either do or should know better, rather than being told in a more honest way "well yes if you start on methylphenidate you will have side-effects, but the pros outweigh the cons for many children". This might not be coercion, but it is manipulation. This destroys their trust in the mental health system.
What actually happens is you take the drug, you get side-effects, and you are asked if you can tolerate them. If you can't tolerate them, you'll likely switch from methylphenidate to amphetamine or vice versa, and then see if you can tolerate those or one of the many IR and XR variations or various slightly different drugs. If you can't, it's onto Strattera. Then onto guanfacine/clondine (which can also be stacked with stimulants). Then it's to off-label stuff like Wellbutrin which seldom works. Then if you've done everything you might, in some places, be offered a chance to take desoxyn.
>If you end up anywhere close to coercing regardless of side effects, it's not the drugs that are the problem.
Well, my own childhood was filled with manipulation, coercion, and perjury which were all done to subject me to medical treatments that otherwise I would have never have willingly done or been eligible for. All four of these things involved my parents and a board certified psychiatrist. Maybe I just had a fucked up childhood, but just in case I didn't, I praise people like the above poster when they show respect for their Childs autonomy. I never had a chance to develop a healthy relationship with the mental health system, so I praise parents who give their child that oppertunity. When it's so easy to just go, well my child's disabled, they don't really know what's going on, I'll just manipulate and coerce them and they'll thank me one day.
When that happens, it might not be the drugs that are the problem, but your child may associate drugs with coercion, with manipulation, with non-consent. Useful wonderful miraculous drugs become a scapegoat for a problem adults caused, to your child's detriment.
The kicker is:
> Effect sizes were small (largest peak d, 0.15).
To put that into language more people here would understand, it's like publishing a paper where your classifier gets 52% accuracy on a binary task (this is the zeroth order equivalent of a Cohen's d of 0.15), but you run it over so many ADHD patients that your confidence interval for that 52% accuracy is very small. Most people would still ignore it because it's likely still noise from other small confounds.
That is a paper that you should not put your name on. I certainly would not. Their effects are also more like 0.11 not 0.15; the largest peak misrepresents all of the rest of the results.
What they did is aggregate so much data that even a small inconsequential difference between groups that may account for nothing at all, that would go away with slightly different controls for confounds, becomes statistically significant.
A lot of the comments here drawing conclusions like, ADHD is about an overly integrated brain or whatever are really frightening. This means nothing. Science communication at its worst.
>What they did is aggregate so much data that even a small inconsequential difference between groups that may account for nothing at all, that would go away with slightly different controls for confounds, becomes statistically significant.
>A lot of the comments here drawing conclusions like, ADHD is about an overly integrated brain or whatever are really frightening. This means nothing. Science communication at its worst.
Here are the paper's authors' affiliations:
Office of the Clinical Director, NIMH, Bethesda, Md. (Norman, Shaw); Section on Neurobehavioral and Clinical Research, Social and Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, Md. (Sudre, Price, Shaw).
It's hard for me to believe that the authors should not have put their name on this paper.
Do you have a background and credentials as valid?
I do. But we live in a world where people write you letters for promotion, review your grants, etc. Using your own name to say these things in public is bad for your career. So I'd rather not.
Plenty has been said in scientific publications about how junk like this leads to most papers being false, how we shouldn't do statistics this way, etc. Scientists know, but it hasn't been communicated to the public yet.
That being said, the beauty of science is that you don't need to see my CV.
A basic understanding of what Cohen's d is, or a simple translation (with some heavy assumptions) into accuracy as I provided, is enough to see that the paper is total trash. They found nothing, but they found it at huge scale, so the p value was very small.
By no-op I mean that it contributes nothing and means nothing. It's a waste of time for everyone. In a world were bean-counting publications wasn't how science was measured, I'm sure the authors would never have considered even writing this up worthwhile, never mind submitting it.
The term comes from assembly which often has a no-op instruction https://en.wikipedia.org/wiki/NOP_(code) Something that does nothing (although, that nothing may be critical depending on the instruction set).
ChatGPT gave me a more balanced view to understand OP's criticisms. Sharing if anyone would like to read a more dispassionate (machine) version.
> Effect sizes were small (largest peak d, 0.15).
It also doesn't look like they considered what effect a daily prescription of ADHD medications might have on brain connections versus the inherent condition itself.