Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.
I highly encourage you to browse the Consensus Statement on ADHD, referenced below. It’s a compilation of 202 facts about ADHD, accepted by a global consensus of experts on ADHD.
Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence‑based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
Take a look at studying looking at the consensus on diagnosis. Even among psychatrists the same patient gets diagnosed with different things.
It measures your ability to focus your attention quite objectively and there's statistically significant differences between neurotypical and adhd performance. This test was used during my own diagnosis.
QbTest was retroactively designed specifically to target this subjectively diagnosed ADHD group. This may be evidence that an ADHD diagnosis does differentiate populations based on some criteria, but it says nothing to this differentiation being caused by a singular disorder/pathology
I'd like to see a study of this test done on other comorbidities. I found this for example which finds a weak relation in these tests https://pubmed.ncbi.nlm.nih.gov/38317541/ differentiating between ADHD and depression, anxiety, OCD.
Here is another study. https://pubmed.ncbi.nlm.nih.gov/37800347/ >Conclusions: When used on their own, QbTest scores available to clinicians are not sufficiently accurate in discriminating between ADHD and non-ADHD clinical cases. Therefore, the QbTest should not be used as stand-alone screening or diagnostic tool, or as a triage system for accepting individuals on the waiting-list for clinical services. However, when used as an adjunct to support a full clinical assessment, QbTest can produce efficiencies in the assessment pathway and reduce the time to diagnosis.
I'll also point out few things:
1. Attention/focus is not a simple single metric one can measure and varies entirely on the task/situation at hand. That is a computerized test with no actual risk/reward to a person is not a predictor of attention/focus in general life. Focus/attention is driven largely by the feelings, rewards, risks, outcomes someone sees, those with diagnosed ADHD are already entering this study with an entirely different mental perception/attitude.
2. There is inherent bias present in ADHD patients in they may intentionally fudge their performance to meet their diagnosis. Unlike most disorders, people actually seek an ADHD diagnosis for access to stimulants, and its incredibly easy to understand how to mimic that behavior for these tests.
3. Other computerized tests have existed aiding in diagnosis, so this becomes circular.
To your point 1, that's true. When there's ample motivation/inspiration, which is fickle and as far as I can tell not really up for conscious mutation, hyperfocus can occur in people with ADHD.
2: The test was actually quite long. In my unmedicated graph my attention was pretty high at first, but then I apparently got slowly distracted or disengaged. During the test I didn't feel distracted or disengaged however, and yet it showed quite clearly. Might it be harder than you think for people to "fake" this in a convincing way?
Anyway I do look forward to a better understanding of ADHD rather than "not enough dopamine" which seems to be the leading explanation. And I'm curious how much of a bimodal distribution that spectrum of dopamine deficiency is for humanity, or whether it is even bimodal at all.
I refuse to call it ADHD, as that implies some known pathology. It is imo a social construction. Categorization can be useful for assessment/treatment but it isnt science. Quite frankly I dont care if people were handed amphetamines simply because they wanted to see if it improved their lives.
I will just say, I am disgnosed and take stims and the best and most motivatrd I ever felt was when I was doing some sort of physical activity almost daily, had a challenging rewarding job and friends. I was completely sober and happy, and completely depressed, ADHD like all the years prior. If youre not exercising regularly I highly suggest you try it
That said, there are structured and semi-objective tools that add quantifiable data to the process, even if they can’t stand alone; and, these tools in combination reveal a very real condition that is also highly treatable once diagnosed:
1. Rating scales (e.g. Vanderbilt, CBCL) use structured questionnaires to quantify symptom frequency. They’re subjective (based on parent/teacher/patient report) but standardized. Many mental health conditions are assessed using standardized rating scales [3].
2. Continuous Performance Tests (CPTs) and objective activity measures can quantify attention lapses and hyperactivity. They’re more “objective,” but consensus statements say they’re insufficient for diagnosis _in isolation_ [4]. I did a CPT test and it lit up for ADHD, which was helpful in ruling out other conditions.
3. Multi-informant reports (parents, teachers, patients) are required in good clinical practice to triangulate symptoms across contexts [5]. As I wrote in my first comment, ADHD exists only when the symptoms affect functioning in many areas of life.
4. Experimental methods (like neuroimaging or computerized neurocognitive tests) show promise but aren’t yet validated for clinical use [6].
The core of diagnosis remains a comprehensive clinical interview and history guided by DSM/ICD criteria. This is where “inter-rater variability” arises: different psychiatrists may weigh the same evidence differently. Consensus statements acknowledge this diagnostic variability, which is a limitation of current psychiatric nosology in general (not just ADHD).
So to answer directly: no, there isn’t a single objective test. But there are quantifiable tools that support diagnosis. The diagnosis itself is still fundamentally consensus- and criteria-driven, not biologically “proven.” But this limitation is minor and is common in psychiatry where many real conditions are diagnosed using a combination of approaches because no single test exists (and may never).
[1] Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., Rohde, L. A., Sonuga-Barke, E. J., Tannock, R., & Franke, B. (2021). The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
[2] Kooij, J. J. S., Bijlenga, D., Salerno, L., Jaeschke, R., Bitter, I., Balázs, J., Thome, J., Dom, G., Kasper, S., & Nunes Filipe, C. (2019). Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56, 14–34. https://doi.org/10.1016/j.eurpsy.2018.11.001
[3] Collett, B. R., Ohan, J. L., & Myers, K. M. (2003). Ten-Year Review of Rating Scales. V: Scales Assessing Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 42(9), 1015–1037. https://doi.org/10.1097/01.CHI.0000070245.24125.B6
[4] Hall, C. L., Valentine, A. Z., Groom, M. J., Walker, G. M., Sayal, K., Daley, D., & Hollis, C. (2016). The clinical utility of the Continuous Performance Test and Objective Measures of Activity for diagnosing and monitoring ADHD in children: A systematic review. European Child & Adolescent Psychiatry, 25(7), 677–699. https://doi.org/10.1007/s00787-015-0798-x
[5] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
[6] Cao, Q., Zang, Y., Sun, L., Sui, M., Long, X., Zou, Q., & Wang, Y. (2006). Abnormal neural activity in children with attention deficit hyperactivity disorder: A resting-state functional magnetic resonance imaging study. NeuroReport, 17(10), 1033–1036. https://doi.org/10.1097/01.wnr.0000224769.92454.5d
2. CPT measures attention/focus in an entirely made up lab scenario. Attention and focus are not singular numbers, and are deeply tied to the actual emotions, risks, rewards present in a situation, and cannot be so easily measured. I can see the value of a test that measures noticeable difference between two groups, but that says nothing about the cause of those differences, but simply that we can identify different groups of people. You may also very well be selecting here who are depressed, stressed, low energy, or simply people who see no point in spending energy on a completely meaningless task, etc. In any case, I do not believe the evidence of CPT in differentiation is well established. https://pubmed.ncbi.nlm.nih.gov/38317541/ https://pubmed.ncbi.nlm.nih.gov/37800347/
3. Personal reports of another person's mental state is as subjective as you can get. All were selecting here is people who do not fit the defined, artificially built, educational or work systems. One may even be excellent, motivated student of music but all accounts fail in a classroom setting.
>The core of diagnosis remains a comprehensive clinical interview and history guided by DSM/ICD criteria.
Clinical interviews are guided, and their interpretation is subjective.
DSM is as subjective as you can get. Every single on of the symptoms has the wording "Often", as decided by a person evaluating another person's account of their life. Do you have an objective measure of what "often" means?".
More importantly, a collection of symptoms does not constitute a singular cause. By the admission of the DSM itself, two people with the diagnosis can share only 4 out of the 9 symptoms (me 1-6, you 3,9), meaning every single one of the symptoms has independent causes. How do you know one does not simply have 6 symptoms by caused by entirely different factors? In a population of hundreds of millions, its a guarantee. You could again, define random symptoms, give it a name and have millions of people going "Wow, no way, I meet all of this, I didnt know I have xyz!"
Lastly, I find it really interesting is that the diagnosis of ADHD came far before we had any of this technology and research you point to. Why was it so popularly pushed and accepted then? Is it possible, were simply trying very hard to fit a completely socially agreed upon disorder?
1. On standardized scales being "meaningless": The term "standardized" here doesn't just mean a consistent set of questions. It means the scoring is normed against a large, representative population. So when a parent says their child "often" loses things, the scale helps a clinician determine if that "often" is statistically significant compared to other children of the same age and gender. It's a tool to quantify subjective reports. You're right that any set of symptoms can be standardized, but these scales are specifically designed to measure the frequency and severity of behaviors outlined in the DSM/ICD criteria. They aren't a standalone test, but one data point in a larger clinical picture. Most psychiatric conditions rely on this kind of structured self-reporting. The people working in this field work very hard to apply statistics properly when designing and running these tests; it's so far from random it's not even funny.
2. On CPTs: I agree that a CPT is an artificial lab scenario. That's a well-known limitation called a lack of "ecological validity." No one claims it perfectly replicates real-world focus. Consensus statements are clear that CPTs are insufficient for diagnosis on their own. Their value isn't in definitively saying "you have ADHD," but in providing an objective measure of things like attention lapses and impulse control that can supplement the subjective reports. If someone's self-report suggests severe inattention but they score perfectly on a CPT, that's a data point a clinician needs to investigate further. It can help in the process of differential diagnosis. The studies you linked highlight its limitations, which is consistent with the consensus view that it's a supplementary, not a primary, tool.
3. On multi-informant reports: You say these are "as subjective as you can get," which is true, they are subjective. The entire point is to gather subjective reports from multiple contexts to see if a pattern emerges. A core criterion for ADHD is that the symptoms cause impairment in two or more settings (e.g., home and school/work). If a child is only described as hyperactive and inattentive in a boring classroom but is a focused and motivated musician at home, a good clinician would question an ADHD diagnosis and look for other factors. The goal is to see if the problem is with the person's underlying regulation skills across environments, not just their "fit" in a single, artificial system.
4. On the DSM and clinical interviews: The word "often" is intentionally not given a hard number because it's relative to a person's developmental stage. "Often" losing homework is different for a 7-year-old than for a 30-year-old. This is where clinical judgment, guided by the DSM criteria, comes in. As for the symptom overlap, you're describing a feature of many polythetic diagnostic systems, not a flaw unique to ADHD. It recognizes that the disorder can manifest differently in different people. The clinician's job isn't just to count symptoms, but to assess the entire pattern, determine the level of impairment, and critically, rule out other potential causes for those symptoms (anxiety, depression, trauma, etc.). The diagnosis is a synthesis of all this information. Again, standardized test scoring DOES have the effect of giving a "definition" to the term "Often", because when thousands of forms are filled in, individuals' different definitions of the term converge in a statistically significant way onto a concept that is meaningfully comparative.
5. Finally, your historical point is interesting. Descriptions of ADHD-like symptoms date back centuries, long before the DSM. Sir Alexander Crichton wrote about "the incapacity of attending" in 1798. The diagnosis wasn't just invented out of thin air in the 20th century. It's a modern label for a pattern of behavior that has been observed for a very long time. The research and technology we have today are being used to better understand its neurobiological underpinnings, not to retroactively justify a "socially agreed upon disorder".
I'm really curious what the next century of study will do to illuminate this condition. I suspect we will have significantly greater understanding of the role of genetics and perhaps, one day, a blood test will diagnose ADHD.
I am not disputing that it's possible to group populations on behavioral traits, long standing emotional states, etc. If you want to say "there are people who feel unmotivated, inattentive in their life and we call that ADHD", fine. However identifying a distinctive cause as a scientific fact is an entirely different matter. I.e, your behavior categorizes you as ADHD by the DSM, we found taking amphetamines often helps people with these complaints is a very different statement than something like "you lose things often BECAUSE you have ADHD"
>but in providing an objective measure of things like attention lapses and impulse control that can supplement the subjective reports.
Stick in me an abstract math class and all my neurons will be firing, put me in accounting and ill fall asleep. How is a simplified messure of attention in a single artificial scenario interesting? These labs are for profit companies trying to make a buck.
>Again, standardized test scoring DOES have the effect of giving a "definition" to the term "Often",
I dont see how this follows. You at best merely have some distribution of how often people feel like they lose things. You have no way of either knowing how often it is people actually lose things or how inattentive they are in conversations, and certainly less so that the patient in front of you is so. I urge you to think about this little more deeply.
Lets take inattentive in conversations for a second. How many conversations does the patient have, with whom? What are the patient's interests versus the type of conversations they have? Are they shy, awkward, or likewise the people around them? How long of not paying attention is considered inattentive? What is the objectively measured norm for all these behaviors? And if you can admit its way too hard to measure, all youre doing is basing your decision on your own and your patients feelings. As a psychiatrist, you have to ask yourself, are you really trying to understand the cause of this patient's inattenttion in conversations, or are you merely looking enough evidence to fit them into a bucket that you already understand? Id have a million questions before I can even answer this question intuitively, nevermind objectively.
And this is besides my greater point here. Per the DSM, it is possible for you to have ADHD and not be found to be inattentive in conversations but often be losing your keys, and for me, vice versa. So were admitting these things can have other factors. For example, I may be losing things simply because my mom never had me clean up after myself and I keep dirty place with too many visual distractions. Maybe I have a job or friends or whatever circumstances that make my life more chaotic. Perhaps going out anywhere makes me nervous so I don't think clearly about grabbing the things I need on the way out. Perhaps Im not as bothered by being inconvenienced so I dont care as much to meticulously think about the things I need.
And you will say "true, but ADHD isnt just losing your keys, its a pattern of related behaviors", and I say what is the belief that these different behaviors aren't independent?
Categorizations can be useful, but by definition are a loss of information. We have learned nothing by attaching a name, except perhaps a feeling that we have something simple we can understand.
They claim there are observable differences, but none of these alone can be used for diagnosis.
> The diagnosis of ADHD has been criticized as being subjective because it is not based on a biological test. This criticism is unfounded. ADHD meets standard criteria for validity of a mental disorder established by Robins and Guze (Faraone, 2005; 1970). The disorder is considered valid because: 1) well-trained professionals in a variety of settings and cultures agree on its presence or absence using well-defined criteria and 2) the diagnosis is useful for predicting a) additional problems the patient may have (e.g., difficulties learning in school); b) future patient outcomes (e.g., risk for future drug abuse); c) response to treatment (e.g., medications and psychological treatments); and d) features that indicate a consistent set of causes for the disorder (e.g., findings from genetics or brain imaging)
I don’t find this very persuasive and it’s a problem in the field generally.
Mostly, unfortunately, funded by Pharmaceutical companies - ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic ( https://www.amazon.com/ADHD-Nation-Children-American-Epidemi... ):
> More than 1 in 7 American children get diagnosed with ADHD—three times what experts have said is appropriate—meaning that millions of kids are misdiagnosed and taking medications such as Adderall or Concerta for a psychiatric condition they probably do not have. The numbers rise every year. And still, many experts and drug companies deny any cause for concern. In fact, they say that adults and the rest of the world should embrace ADHD and that its medications will transform their lives.
Of course they do. They're stimulants, that's what they do. Some people just need them to be closer to normal, or whatever's considered normal in post-Industrial society. Modafinil promotes wakefulness in everyone, not just narcolpetics. Anxiolytics calm down everyone, not just the anxious, and psilocybin makes everyone feel euphoric, not just the depressed. It would be weird if stimulants only had an effect of ADHD patients.
> and ADHD is kind of a weakly differentiated diagnosis that could apply to most people.
I don't think we really understand it yet, but it's not something most people have. As the article mentions, people ADHD have a higher rate of transportation accidents, lower life expectancy, higher crime rates, higher addiction rates, etc. The differences show up in brain scans, performance tests, genetic biomarkers, heritability/twin studies, etc. Whether you think of it as a disability, or brain type, or whatever - ADHD is something real.
> Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.
Yes, and this is possibly why 35-55% of adults with ADHD smoke today, compared to 19% of the population. Studies have shown that nicotine is helpful for everyone but particularly helpful for those with ADHD. Nicotine-derived formulations are still being explored.
One example of this actually happening is the concept of a "stimulant nap" in people with ADHD, where stimulants actually make them sleepier. Also manifesting as "I tried coke once, it didn't do anything, I just felt sleepy"
Terrible source but it's a pretty common thing: https://www.reddit.com/r/ADHD/comments/hkkyjl/you_know_your_...
Someone with ADHD taking a large dose will therefore feel the same as someone without ADHD taking a small(er) dose.
Methylphenidate improves sleep in people with ADHD: https://pmc.ncbi.nlm.nih.gov/articles/PMC2276739/
> Compared to [non-adhd] controls untreated [adhd] patients showed increased nocturnal activity, reduced sleep efficiency, more nocturnal awakenings and reduced percentage of REM sleep. Treatment [of those with adhd] with methylphenidate resulted in increased sleep efficiency as well as a subjective feeling of improved restorative value of sleep.
I can't find a corresponding paper studying the effect of stimulants on sleep in healthy adults. I would assume it hasn't been studied because it's common knowledge and it's not worth the risk of making healthy people take stimulants. I also don't think that's the part you were disputing.
Here is more detailed data [https://www.researchgate.net/publication/45708101_Role_of_Ab...].
It doesn’t happen to everyone with ADHD, but the majority.
The effect itself was prominent/notable as early as WW1, as the drugs were widely used by all parties to help fight fatigue and drowsiness. However, a small percentage of the population would end up with the opposite effect - ending up tired, even sleepy, and often calmer instead of more alert.
It took awhile however, before wider implications of sub-population differences in drug effects like this were studied or applied.
Medical and psychological professionals are VERY confident that ADHD is a real condition—on par with the confidence they have in diagnoses like major depressive disorder or generalized anxiety disorder.
Across psychiatry, ADHD, depression, and anxiety are all among the best-documented psychiatric conditions. There is more skepticism about disorders with fuzzier boundaries (e.g., “personality disorders” or “internet addiction”), but ADHD is NOT in that category.
I believe ADHD is stigmatized in our culture because our modern world makes us all feel distracted at times; therefore, it seems like people with the diagnosis are perhaps getting a “free ride” by blaming their poor behavior on a “condition”. But ADHD is so much more than just having a hard time focusing because of social media and phones. It manifests as a spectrum of extreme challenges that lead over time to sufferers having a significantly harder time navigating life than people without ADHD.
Merely having a hard time concentrating does not make you an ADHD candidate. You must experience a range of symptoms that interfere materially in multiple areas of life.
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Reference
[1] Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience and Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
I found out that i have ADHD through a process of dealing with a hearing issue - I have something called auditory processing disorder (APD), which means while I have excellent hearing, my brain has difficulty processing speech in high noise environments, especially with multiple people or frequencies that correlate to women. ADHD and autism spectrum disorders are highly correlated with it.
A friend who is an audiologist was out with me at an event and basically spotted the adaptations that I had adopted subconsciously over my life (I’m in my 40s). I then got tested and confirmed. It’s likely a result of many consecutive ear infections I had as a kid.
When reading up on APD, the literature describes stories of various people… and it was like looking back on a story of my life. The ADHD correlation is thought to be related because of the way the brain develops (or doesn’t) in the presence or absence of stimuli.
I say this because it would be easy to dismiss my scenario. By most measurements I’m successful and doing great. But had I known or maybe been treated in the past, certain difficult aspects of my life would have likely been managed better or avoided. Brains are complex, and it’s important not to dismiss that problems that people have.
If it bugs you, a good audiologist or instrumentation specialist can measure the frequencies impacted and mitigate it with hearing aids. I tried it, and i would best describe it like transitioning from 1080p to 4k. The gotcha is the hearing aids are expensive and it is difficult to get a diagnosis that insurance will cover as it’s technically not a hearing loss.
Annoyingly, this can also affect video calls when people don’t speak clearly.
I don't think this hypothesis would survive a look through the literature on google scholar. ADHD is associated with huge increases in risks of suicide, substance abuse, homelessness, accidents, crime, autoimmune disease, etc etc etc. It's not just "damn I find it hard to focus sometimes".
The claim is not that ADHD is not a set of people with real psychiatric disorders, but it is a loose umbrella for what are actually disparate problems.
I recently learned that my symptoms, to a large extent, can be explained more accurately as POTS or something adjacent, and the meds I guided my psychiatrist towards were far more helpful than the stimulants I was being prescribed. This was a combination of me, reddit, and later LLMs arriving at me-specific diagnoses that go beyond clinical guideline regimes.
For me, the DSM-V & DIVA criteria are eerily accurate. I was diagnosed as an adult and it felt like a cruel cosmic joke reading through the psychiatrist report and realizing that most of my past and present issues were repeatedly-documented commonalities of a single condition. It was as if my life had just been playing out from a predetermined script.
I fully agree that that many distinct conditions are incorrectly swept under the "ADHD umbrella", but ADHD is not in any way a "loose" description of me.
> more helpful than the stimulants
My currently prescribed stimulants have been the only thing to ever make me feel consistently "okay", after having previously given up on medications ever helping. I'm sure they also enable me to write a few more lines of code per day, but I'd still be taking them even if they made me significantly worse at doing so.
It seems more like a horoscope to me - everyone can find themselves in the criteria. It’s an observable thing, I’m just not sure I buy its special distinction.
People also used to make the claim that the stimulant drugs had special effects (or even opposite effects) on those with ADHD vs. the non ADHD population which always seemed like bullshit to me, but I don’t see that claim being made here anymore.
Edit: after writing this comments others in the thread started making this claim
Do you think the same about conditions like Autism or OCD?
People often say they "are a little bit" OCD or autistic, but it's the degree to which those traits are experienced which is the differentiation. There is also no objective test, it's all "soft" science.
> People also used to make the claim that the stimulant drugs had special effects (or even opposite effects) on those with ADHD vs. the non ADHD population
This is my experience, but I understand that anecdotes aren't good evidence.
They both do have problems with variableness (particularly autism), but it’s more distinct from the general public.
A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2). B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years. C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities). D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning. E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g. mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
I think E is probably a common miss, and fits with ADHD being over-diagnosed vs. other disorders that can have overlapping symptoms. The differential diagnosis section could perhaps be more detailed. But now briefly looking at A's (1) and (2). (1) Inattention: Six (or more) of the following symptoms have persisted for at least 6 months ... (lists 9 symptoms related to forms of inattention, the most generic of which I think is just f: "Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g. schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers)") (2) Hyperactivity and impulsivity: Six (or more) of the following symptoms .. (lists another 9 symptoms -- I count 3 pretty generic ones in a. (often fidgeting), f. (often talking excessively), and g. (often not waiting for a turn in conversation or completing people's sentences -- common in online meetings)).
While flawed I think this is enough detail to diagnose someone and clearly say "you're different", it's not nearly as broad as a horoscope "this sign is strong" or "that sign is deep" language and similar. The "Often" qualifier does a lot of work. Nevertheless, two people can both be diagnosed with "ADHD" and yet have few to no overlapping diagnostic symptoms.
The type of ADHD I have seems to have an "autonomic nervous system impairment" component and a symptom profile overlapping with hyperadrenergic POTS.
1. I respond much better to Guanfacine ER (GFC) than stimulants alone (currently complementing with Vyvanse (LDX) 40mg, but I'd rate the Guanfacine as critical)
2. My blood pressure is very volatile, and GFC is supposed to have an impact but did not in my case, at least initially. I'd take GFC at bedtime and LDX in the morning, and on ChatGPT's suggestion, I asked my psych if I could take them together in the morning. Gamechanger for my blood pressure: the explanation seems to be that LDX makes my sympathetic nervous system extra simulated (on top of a poor baseline), and co-timed GFC balances it out.
3. I have poor cardiac endurance, and I find running nearly impossible. I'm a healthy young male who does weights and all. At ChatGPT's suggestion, I wore a Polar H10 and measured my resting heart rate while sitting, and then while standing still. I get a jump from 80bpm to 115bpm-ish, a strong indicator for something orthostatic.
I'm currently exploring rowing (with a concept2). I don't know why but it has a strong impact on my mental state that goes beyond general exercising: something about the rhythmic entrainment it produces, while being recumbent (good for POTS).
I've been taking nicotine patches for half a year now, with great success (and it is available OTC unlike other stimulants). Nicotine in itself isn't toxic at these doses (7, 14, 21mg), it's a cool life hack :-).
I sometimes realize in the afternoon that I forgot to change my patch in the morning because I'm a bit drowsy (a feeling not unlike being uncaffeinated when you're used to drinking coffee). AFAIK the withdrawal symptoms fade out in at most a week.
It's not, the problem is that it sounds like it because ~everyone faces some (way) lesser version of the struggles ADHD people face literally every day, many of whom probably do have some subclinical degree of executive dysfunction.
My personal thumb rule is that somebody is capable of finishing school, autonomously managing their living conditions, finding and keeping a job, and having at least a modicum of social life at the same time, they're high-functioning enough that they almost definitely don't have ADHD, or only some ultra-light version of it.
I think ADHD is a spectrum, which includes those with "ultra-light" symptoms as well. Whether those in the lower-end of the spectrum need stimulant medication is a different matter.
I was “functional” through a four month long psychotic break in which I was constantly one mistake from people finding out I wasn’t human and killing me. (I’m fine now. No lasting trauma fortunately.)
How someone looks from the outside isn’t a good measure of their mental health. How many people have been depressed and killed themselves without any obvious warnings?
Anecdotally, 100mg of caffeine combined with 200mg of L-theanine makes me maybe 25% as productive as I am on 5mg of Adderall, which is actually enough for me to function most days.
I regularly have people doubt my diagnosis to this day. If we talk about it more, a lot of them _continue_ to doubt me even after I explain masking.
Again, it's not just your belief -- I grew up hearing radio jockeys calling ADHD "bad parenting disease" -- but this belief is harmful. It ostracizes people and discourages help for a disability that causes measurable harm.
[0]: Which requires it to be affecting your life -- NOT that you actually do or don't have it and are dealing with it okay. Diagnostic criteria is that it must be hindering you in a job/school/relationships/etc.
what does that mean? most people have more than 99% identical genes yet we are not clones.
most people don't have a perfect BMI of 23.5 (or whatever is the middle), yet there are clear pathologies on the BMI spectrum, no?
most people could better manage their lives and emotions but most people don't have that severe problems.
the usual diagnostic criteria simply does not apply for most people. the cutoff is pretty high. (problems in multiple spheres of life present before the age of ~14 -- though there's brain damage induced ADHD too)
but of course most people would benefit from some of the ADHD management strategies (which is better time management, planning, organizing things and consistently putting them into their assigned place, cognitive reframing of pervasive bad thoughts, getting a coach, etc.), but at the same time most people would not benefit from being on the usual ADHD meds (maybe they would benefit from some much smaller doses)
This is a good overview of the literature: https://www.frontiersin.org/journals/neuroscience/articles/1...