Comment by quacked | Hacker News Reader

Comment by quacked | Hacker News Reader

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I "have" ADHD, although I don't believe in it conceptually and I don't take any drugs for it. I think if you poly-score people on impulse control, attention span, time sensitivity, organic recall of pertinent time-sensitive information, etc. you'll find that if you arrange all the scores from best to worst everyone under the 40th percent mark "has ADHD". Below maybe the 10th percentile you'll find that without stimulants it's unlikely that the person will function well in a task-based time-sensitive environment with delayed feedback loops for task completion.

Accepting the framing that ADHD does exist, it feels like brain damage. Every year growing up, in any group of kids I was among the most immature, the most off-task, the most distracted, and the most forgetful. I am plenty smart, move very quickly, and have accomplished plenty, but my entire life has been defined by being more bored, forgetful, and immature than nearly every single person I've been close to. My wife (performs very well on relevant metrics) says it's extremely noticeable and unusual from the outside. Over time I've learned to heavily lean on coping mechanisms (my phone rings about 35 times per day with timers I snooze tactically, I leave my keys in my bag any time I go places so I can't leave without the bag, etc.) No amount of character development schemes, punishments, shaming, positive skill practicing etc. has changed my natural proclivities in the slightest, although many days of good sleep and diet can sometimes produce a bit of a sustained flow state. Sometimes I wonder if I just lack some kind of ion in my blood.

My coworkers sometimes tell me they feel like they have ADHD. Then I watch them listen to someone talk about a subject they find boring for 5 minutes without drifting off or fidgeting, and then remember off the top of their heads to respond to outstanding emails. Come on guys, if we're going to make up conditions we should at least reserve the label for people that it describes accurately.

> I "have" ADHD, although I don't believe in it conceptually

Congratulations on getting your Doctorate of Psychiatry. Glad you've single handedly debunked a century of study with your belief.

On a more serious note, I'm glad your symptoms are addressable with coping mechanisms. A lot of folks can't. And your "40%" is actually closer to 5%, based on scientists who research and give talks on this mental disorder.

I think their opinion is along the lines of “no one is ‘inflicted’ by ADHD, and there is also no permanent cure for it, because the disorder can simply be redefined as being those who are in the lowest quartile or even the lowest 10% of X, Y, Z cognitive metrics.”

Imagine there were a pill that could boost your IQ score by 25% but in order to receive a prescription you need to have an IQ in the lowest quartile. Such a pill could also help already smart people simply become smarter.

Thats the main contention: there are two groups: (a) people who actually experience debilitating symptoms that significantly impact their life requiring medication, and (b) people who are simply looking for an edge by using medication, perhaps even convinced to do so by ads on TikTok or Instagram under the guise if ADHD.

Edit: The IQ score medication analogy is only meant to be illustrative. I don’t mean to imply that IQ and ADHD are somehow connected.

> because the disorder can simply be redefined

Respectfully, disorder already has a meaning. And it's a meaning enshrined in medicine and law (ADA). "Redefining" disorder does nothing but hurt people who have a disorder.

And ADHD has no correlation with IQ (which I think you know, but it' not just a focus sliding scale either). It's a disorder that encompasses the symptoms of time blindness, a lack of ability to control focus, emotional disregulation, rejection sensitivity dysphoria, reduced working memory, an inability to form habits, and executive dysfunction.

It's also associated with a physical change in the brain.

I added an “edit” to clarify I don’t believe IQ and ADHD are connected.

“Redefining” could have instead said “Reinterpreting”.

The reality is the diagnosis for these disorders are completely subjective. The same logic could be applied to depression and SSRIs. It’s not like a blood test that tells me I have high cholesterol. It takes dozens of hours with a qualified medical professional to seriously diagnose someone with high confidence.

Also agree there are studies correlating it with physical changes in the brain. But those studies aren’t fully fleshed out and not useful for diagnosis. There isn’t a brain scan that can detect ADHD.

> There isn’t a brain scan that can detect ADHD.

I think it's important to note that even if there were, it wouldn't change the inherently arbitrary nature of ADHD diagnoses (as opposed to the more objective presence of a bacterial infection or an ACL tear). Such a brain scan would legitimize the careers of thousands of people and be deeply celebrated by insurers and physicians alike, as it would dramatically simplify the diagnostic procedure, but the scan would still just be "identifying brains that fall into several of these metrics 1-N we wrote down in the DSM". It would be possible to change the DSM such that the brain scan would have to be adjusted as well, which is very difficult to do with other conditions that are more obviously "real".

My two cents, although I admit I've put more like six cents into this thread in total, is that 95% of the suffering that those "with ADHD" experience come from poorly-designed schools and businesses, which keep them captured, tracked, and timed for deeply questionable societal benefits. I'm not about to say you can operate a space station or manufacture semiconductors or supply the US cold stowage network without a good amount of capturing, tracking, and timing, but I am going to say that much of the psychological torment ADHD-havers endure is because they're failing to live up to stupid, useless goals set by people with misguided ideas about why the goals exist.

100% agree.

(I don’t normally reply just to say that, but it felt relevant given the thread)

You misinterpreted the part of the comment you referred to. They aren't referring to redefining the word "disorder", but "the disorder", as in "ADHD". What they were referring to with the definition is how the definition of ADHD is completely arbitrarily defined, as the diagnosis isn't based on any genetic marker.

> ... how the definition of ADHD is completely arbitrarily defined, as the diagnosis isn't based on any genetic marker.

Did you know that 90% of cases of ALS aren't "based on any genetic marker"? Does that mean ALS is "arbitrarily defined"? What does that even mean? Are you saying it isn't real?

I wasn't saying anything from my point of view. I was simply explaining the misinterpretation in the comment above, though I should have said biomarker instead of genetic marker.

> the diagnosis isn't based on any genetic marker

Neither is depression, PTSD, autism, chronic pain, schizophrenia, narcissism, MPD, and so forth. But they all exist. And they can all be debilitating to the point of becoming a disorder. They all have treatments according to their classification.

Being invisible doesn't make it not be a disorder.

We all agree it’s a disorder. No one is debating that.

No one claimed disorders don't exist.

> I think their opinion is along the lines of “no one is ‘inflicted’ by ADHD, and there is also no permanent cure for it, because the disorder can simply be redefined as being those who are in the lowest quartile or even the lowest 10% of X, Y, Z cognitive metrics.”

That's not how ADHD is defined, though.

> Imagine there were a pill that could boost your IQ score by 25% but in order to receive a prescription you need to have an IQ in the lowest quartile. Such a pill could also help already smart people simply become smarter.

Yeah, that's a nice hypothetical but that's not how ADHD meds work; boosting dopamine out of the normal range does not continue to have beneficial impacts to executive function, instead it leads to anxiety, insomnia, aggression, and hallucinations. That's one of the reasons dosing for ADHD meds tends to start on the low end and be carefully titrated up to what works for the individual.

> That's not how ADHD is defined, though.

How is it defined?

> that's not how ADHD meds work

Are you saying no one without ADHD takes prescribed medication?

When I was in college people with prescriptions would sell their pills for $5-10 each (10+ years ago in Boston). That’s $300 for a month supply purchased by fellow students who weren’t diagnosed, but used it to cram for exams and studying and concentrating during exams.

If what you say is true, then the free market (black market) for adderall wouldn’t be so lucrative.

Perhaps you haven’t been exposed to the plethora of Instagram ads convincing kids they have ADD based on a 5 question survey and prescribed without any other criteria besides “is trouble concentrating impacting your work or personal life?” - these days it’s literally that simple, quick telegealth appointment, say concentrating impacts your work life, and there you have it, you officially have ADD.

This thread is going on a ton of tangents. My original point was simply that diagnosis is subjective and relative to the people around you. Second point is the meds will help anyone who takes it with improving concentration and making it possible to increase productivity substantially not just for short bursts but for extended periods of time (months/years). I think both points still stand

(And none of what I’m saying invalidates the seriousness of the disorder for people who “really have it”. I fully believe there are people who find the condition truly debilitating. But there are also loads of people who are diagnosed through instagram or TikTok ads because “concentrating is hard” and “motivation is difficult” and other obvious statements that resonate with a majority of college kids, for example)

Queue https://www.latimes.com/california/story/2024-06-13/teleheal...

Everywhere, all the time, at all age brackets. It's absolutely terrible, having suffered a terrible amphetamine addiction in my past.

Sufferers of real ADHD need to understand that when people critique the guidelines, they're critiquing the fact that this is possible, and its leading to serious problems getting on with life.

> Are you saying no one without ADHD takes prescribed medication?

No, I'm saying that the cognitive effect on function of someone without ADHD taking ADHD medicine isn't the same directionally as that of someone with ADHD taking it, the way the upthread proposed analogy of "a drug that increases IQ score by 25%" but which is only prescribed to those with IQ in the lowest quintile framed the situation. Excess dopamine impairs function in a different way that dopamine deficit, it doesn't increase it beyond what is seen with normal dopamine.

> If what you say is true, then the free market (black market) for adderall wouldn’t be so lucrative.

It is true, but the black market for adderall isn't mostly taking it for the same effect as people with ADHD are (some are, because there are still biases and access issues which prevent or delay diagnoses for people with ADHD, as well as deliberate, government-created supply shortages in the legal market.) But largely are taking it for wakefulness (an effect of dopamine surplus), and because dopamine surplus is part of the brain's reward system such that things which have been experienced which produce it are actively sought out. Again, this is why therapeutic dosages for ADHD are titrated to avoid going overboard.

You should add an email address to your HN profile since HN frowns on replies like (but I’ll post it anyway):

I fully agree with your comment, and good take!

I think they're just in a bubble, gotta remember that in tech the percentage is bound to be a lot higher Then for the general population.

You're also taking that initial statement way too serious, the rest of the comment kinda contextualized it and essentially admitted that it does exist, but that it's more of a range then a binary. And that's in line with the medical science.

I've actually never heard anyone describe it as a binary, but maybe that's just my bubble.

Thanks to another prevalent symptom of ADHD - emotional disregulation - I very well could have overreacted. In my defense, the "It's not a real thing" and "you're just lazy" really get old after the 100th time hearing them this week.

Control over concentration is only one symptom of ADHD, and there are discernible differences that make ADHD brains look different in CT and MRI scans. So it's a bit closer to binary than "everyone in the world is somewhere on the ADHD spectrum".

Plus, the final word in the ADHD acronym is "Disorder" - so if it's not impairing your ability to live and participate in society, by definition you don't have ADHD.

I wouldn't say you overreacted. It's impossible to both convey and read tone over the internet, so there's no way for you to know that I don't mean to be insulting. I also like to write in a polarizing and cynical manner.

Whatever negative label you've had applied to you as a result of ADHD, I likely have had the same applied to me. My choice to not use any stimulants is both indeed a privilege of my "symptoms" not reaching a point where I can't function in day-to-day life, but also an ideological choice, because I have hurt my own career, screwed up projects, and progressed much more slowly than I would have if I were on Adderall or Ritalin or whatever else they're prescribing now.

The reason that I persist with the claim that "ADHD doesn't exist" is exactly what you said here:

> If it's not impairing your ability to live and participate in society, by definition you don't have ADHD.

The problem is not my brain, the problem is the arbitrary demands of society. This is not an emotional attempt to preserve my self-esteem--I like myself just fine and always have--but a pragmatic observation that diagnosing "disorders" with acronyms and developing "treatments" legitimizes the framing that the society that I'm chafing with as a result of having some cognitive deficits relative to the rest of the population is somehow more "real" or "official" or "objective" than I am.

It's like if every day to get to work, you had to walk up huge stairs, and anyone under 5'6" had a tough time getting up the stairs, and then doctors came up with HDS (Height Deficiency Syndrome) and prescribed growth hormones and stilts. You get a bunch of people walking around on stilts telling each other they have HDS. Over time, you barely even need to be examined to get a stilt prescription, they just give you the HDS diagnosis soon as you look like you're not going to pass 5'6" by 18. Now you've got a society that is comfortable with the knowledge that short people have HDS and tall people don't, without thinking about the fact that whoever built the stairs could simply have made smaller stairs that other people could walk up more easily.

I would really prefer that people start wondering en masse if, in the age of incredible technological abundance we currently enjoy, it's really necessary that every industry, even ones that don't require highly time-sensitive detail-oriented work, function with the rigor and precision of a munitions factory.

> the problem is the arbitrary demands of society

Well, society isn't going to change to make 5% of the population with an invisible disorder better.

And I think even given that, the "it's society that's the problem" is still wrong. Because (from another thread), ADHD is more than just a concentration problem. It's a disorder that encompasses the symptoms of time blindness, a lack of ability to control focus, emotional disregulation, rejection sensitivity dysphoria, reduced working memory, an inability to form habits, and executive dysfunction. No number of "hunter gatherer" society norms would explain all of these.

From the guidelines: "don't be snarky".

I disagree strongly with the grandparent comment, but this is about as useful as commenting "Congratulations on getting your Doctorate of Sacred Theology. Glad you've single handedly debunked a millenium of study with your belief" would be when I comment that I'm an atheist.

FWIW, this comment falls afoul of the guidelines as well, and is even less useful since I did follow my opening with a real discussion. To quote the guidelines, report it to the moderators if you feel it's sufficiently problematic.

Have a good one!

I didn't say that your comment was an egregious violation of the guideline - had it been, I'd have reported it instead.

I reminded you that the guideline exists because it's good advice in this case, and had you edited your comment to get rid of the snark (as the guidelines suggest), you could have had a chance of persuading instead of alienating its audience. Too bad.

MRIs show study after study that ADHD is real. Its been shown that ADHD is either the inability or significant reduction of processing dopamine, or the inability or significant increase in dopamine production. That’s all there is to it.

Tell a blind person to simple try harder in seeing, and that you don’t believe being blind is “a thing”.

At its core, ADHD's main mechanistic difference is undeniably an executive function deficit -- the frontal lobe not being activated enough to properly regulate functions of the rest of the brain or exert executive planning and follow-through.

The "paradoxical" effects of ADHD stimulant-type medications is the most direct indicator that this is indeed the case: taking a CNS stimulant normally causes more arousal, agitation, and activity in NT individuals.

But in ADHD individuals, CNS stimulants up-regulate frontal lobe activity, which manifests as a relaxant, since the frontal lobe is doing a better job of regulating and stabilizing the rest of the brain. Executive function also improves considerably.

So the most objectively measurable symptom of ADHD is whether this paradoxical behavioral alteration occurs from taking a CNS stimulant.

You can argue all you like about whether ADHD is within this or that percentile threshold -- but you can't argue with a proven, consistent, clinical result that points strongly to under-functioning of the frontal lobe in individuals with ADHD.

I've experienced this myself. My quality of life is profoundly different after taking Ritalin. I feel more relaxed; the buzzing and noise in my head is significantly reduced. I stop feeling the profound urge to get distracted like Doug the dog from the movie Up: ... "squirrel!"

> The "paradoxical" effects of ADHD stimulant-type medications is the most direct indicator that this is indeed the case: taking a CNS stimulant normally causes more arousal, agitation, and activity in NT individuals. > But in ADHD individuals, CNS stimulants up-regulate frontal lobe activity, which manifests as a relaxant, since the frontal lobe is doing a better job of regulating and stabilizing the rest of the brain. Executive function also improves considerably.

Hence the MASSIVE problem of undiagnosed ADHD that can lead into drug abuse just like with my brother who got hooked on speed and heroin, even built a small business on that, not that that was any good in front of the judge...

Estimates on the drug addicted prison population having ADHD are way above the general population, just think they could have been kept from getting into drugs, committing crimes etc if only they had been diagnosed and treated early enough! Same for people who suffer from depression.

Amen

I don't understand why people consistently seem to think that I am telling people that their experience "isn't real" or that their brains and behavior aren't different from the majority, or that everyone can get around it by "trying harder". None of that is what I'm saying. I could be diagnosed with a real, clinical case of ADHD pretty immediately if I so desired. Going by the dictionary definition, I "have it" and have "had it" for my entire life. My father "has it" to the same degree that I do and is medicated for it. My life has been a great deal harder than it would have been had I taken stimulants.

My point is that, unlike people who have a fracture in their femur vs. people who don't, the "significant reduction" of dopamine processing metric, when codified, is a pretty consistent, smooth line across the population. There are a group of people who are seriously dopamine-processing-reduced, and then a huge grey area with people who kind of are and then kind of aren't, and then there's group of people whose dopamine-processing ability defines the "baseline" against which ADHD is constructed. ADHD is a four letter label that was only invented to help doctors help people deal with difficulties they have with executive functioning, given that modern society demands a baseline of executive function out of citizens if you want to receive food, shelter, salary, and promotions.

In recent years, the "ADHD boundary" has been expanding to capture more people in the grey area as doctors, psychiatrists, and insurers play looser with the definition of ADHD than they did when it was first invented. But at its core, the condition is literally "compared to this other group of people, you have a harder time at certain important tasks than they do". Is that a "real condition" in the same way that COVID-19 is a real condition? I say not; it's a methodological shorthand.

I am very aware that the brains of certain people work differently than others, and that in "ADHD brains" (a group which includes mine) it is possible to use a brain scan to observe differences relative to that "normal group of people". But if you took scans of the "least ADHD" group, you could find that their brains differ as well, and they have certain cognitive advantages compared to the new baseline of middle-ground brains. We could call that "Attention Surplus Normal-activity Advantage". But it would be stupid to label them with ASNA. Everyone would be aware that the four-letter acronym is just an arbitrary shorthand to describe a group of people that can be diagnostically clustered together relative to everyone else. The "advantage" would be exactly as real as the "disorder".

What you’re describing is a spectrum… and I don’t see any problem here. Even blindness is not binary - it too is a spectrum.

People can be 100% blind where they don’t detect bright lights strobing in front of them, all the way to someone who has a mild 0.01 stigmatism.

But from the sounds of it, you don’t like anything that isn’t binary? Sorry, maybe I’m misunderstanding you

> study after study that ADHD is real. Its been shown that ADHD is either the inability or significant reduction of processing dopamine, or the inability or significant increase in dopamine production. That’s all there is to it.

Its not, though, because while the dopamine/norepinephrine chain seems to be the main issue in ADHD, serotonin also seems to be implicated, as low serotonin levels are associated with it and serotonin-targeting interventions also seem to help.

But, yeah, your more general point is correct; ADHD is undeniably a real condition.

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