Brain scans reveal 3 ADHD subtypes | Hacker News Reader

Brain scans reveal 3 ADHD subtypes

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138 pointsbrandonb127 comments

It reminds me that ADHD is really not that useful of a name, executive function disorder would be a more accurate name from when I was looking into ADHD in the past. It's not about attention deficit per se, as that's downstream of struggling with executive functioning. At least it's the definition that lines up with my experience best (I have ADHD). I'll make lists in order to keep track of important tasks (which in theory would help with attention deficit) but then I'll sit down to do the things on the list and... can't. It's such a hard thing to explain, but no amount of attention hacks can get me over the hump of doing the tasks I'm dreading. That seems much more related to executive functioning.

For me it’s that as soon as I intend to begin a task, I start thinking about every step, and everything that might go wrong at every step, and planning contingencies for every hypothetical problem, and on and on.

So suddenly the task seems totally overwhelming, when I could just… not do it. So I find a time later I can attempt it and after a few times it is no longer novel and I forget about it.

If anything is hyper-active, it’s the executive function part of my brain that is driven to plan out every tiny, hypothetical detail before I can start.

What’s missing is the reward and internal incentives for doing things when there are other things that do feel good to do (that aren’t what I need to do).

I'm the same way and I've found there's no real way around it. I've found it's actually a really useful way of thinking for complex projects and planning and prioritization, but bad for getting things done. The only things that work for me to manage this:

1. Relentlessly make distractions high friction. Block websites, go to the office if you get distracted at home, etc.

2. Use time-based daily planning instead of goal-based (stuff like pomodoro helps). If I put "create work plan for project Z" on my to-do list, it is ambiguous and I will put it off forever. If I just say "Spend 25 minutes on work plan for project Z, no pressure on outcome/output", I make tons of progress (and often can continue the task for a while)

3. music

4. the obvious diet/sleep/meds advice

I, too, experience that. I am anxious and I overthink and I am avoidant. Vyvanse helped a ton, but it was producing health complications, so I am taking something else that's not as good.

It's not a substitue for counseling, but consider talking to your favorite LLM chatbot. It will provide generic advice, but it will probably work 80% of the time. Sometimes being told what to do is good enough of a kickstart.

Or I can give you the crappy advice that works. "Just start."

Look up "mental rehearsals" I think it's called. You do like 2 dry runs in your head. First, you let your mind kind of do what you're already doing, imagine obstacles and challenges along the path to completion. Second, try your hardest to picture yourself calmly overcoming each of those obstacles through to completion. It makes it seem more attainable.

This is a great insight, I wonder if that's a sign of Innatentive type ADHD. But I would say that the process of thinking of other things that also need to be done, is not done by the executive function part of the brain. The executive disfunction is the decision not to begin the task.

I experience the same thing very frequently. I likened it to activation energy in a reaction, that no matter what I did I couldn't create the required electrochemical bias in my brain needed to put ideas into action. It's like being stranded in your own mind, you know what you need to do, but the 'go' just never arrives.

I eventually discovered that the adrenaline response from extreme stress ('if I don't get this fucking thing done by 7:30am I'm fired' kind of thing) allows me to lock in and do the thing.

>I eventually discovered that the adrenaline response from extreme stress ('if I don't get this fucking thing done by 7:30am I'm fired' kind of thing) allows me to lock in and do the thing.

I went the other way. I knew from the start that this "trick" helped me work. It took until my 30s to learn that that's ADHD and that I can skip the stress with medication. God knows how many years of life I've robbed myself of with the stress spikes.

Yep, same, except I was like 40. Couldn't believe it took me that long.

For me, the side effects of the medication are intolerable. I wish there was a way to get that starting impulse without stimulants or SNRIs which kill my libido

If it helps, another trick I used to use was external help. As in, calling a colleague and starting in pair programming or simply discussing or whatever. Having eyes on me had the same effect as the looming deadline without the stress.

You have to learn to be super trigger happy with it, otherwise you fall in the trap of 'I've been inactive for too long, I can't call and reveal that I haven't started'.

> 'I've been inactive for too long, I can't call and reveal that I haven't started'.

Dang. That's a huge part of my problem over the years. Nicely articulated.

A phrase I've heard is to "put it into existence."

By sharing the idea with somebody else, even just communicating your intention, it becomes partially reified, better-anchored to things outside yourself.

  that I can skip the stress with medication

You're lucky. In many countries any helpful ADHD medication is illegal.

Yes, I agree, I'm lucky that legality was never a concern.

I'm covered by public healthcare so access to medication is stable and costs literal cents. My only complain is that ADHD is not at all known here so it took time and luck to get a diagnosis, because the possibility wasn't in my radar.

It was a surprise to visit London recently and see the amount of ADHD-related ads everywhere (books,clinics, etc).

interesting. the meds help me in many ways, but often I still need that activation energy to kick things off

>interesting. the meds help me in many ways, but often I still need that activation energy to kick things off

Similar problem here. ADHD meds have different thresholds for allievation of ADHD symptoms and for negative effects.

Usually the bigger the dose, the more symptoms allievated, but the higher the chance of side effects.

In my specific case, methylphenidate had too much side effects, but was the one that helped the most with focus/task prioritization/task recall.

Lisdextroamphetamine on the other hand has much less side effects (sweating, emotional detachment), but doesn't help that much with task recall and prioritization. But still helps with anxiety, emotional deregulation (being too emotional, too fast, over non issues and taking long to calm down) and general focus/working memory.

Funny that people talk here about looking at ADHD more like executive function disorder. Because I first came upon that idea in Thomas E. Browns video seminars. And he wrote a book on that in 2005 - Attention Deficit Disorder: The Unfocused Mind in Children and Adults.

I actually used material from his book, Outside the Box: Rethinking ADD/ADHD in Children and Adults, to help get diagnosed. I already had one negative diagnosis behind me. And in that book Brown has a lot on clinical requirements for diagnosis) and how research data shows that it's wrong.

He also has books on high functioning ADHD+ASD, like Smart but Stuck and ADHD and Asperger Syndrome in Smart Kids and Adults: Twelve Stories of Struggle, Support, and Treatment. Tho the last two are more about using specific cases as examples of how you don't have to be "stupid" to have ADHD. Because to quote the first diagnostician, "you sure do have a lot of ADHD symptoms, but I've never seen anybody with ADHD who has such high scores on the iq tests". Too bad that being good at guessing a pattern in a picture doesn't correspond to life success.

We need two kinds of managers. Normal managers that manages normal people and ADHD managers that manage the ADHD folk.

The ADHD manager has one extra responsibility. Make the thing due 1 week earlier.

That wouldn't work (for me, at least). As soon as I figured out the pattern, I'd know I had a week after the 'deadline' and then the pressure is off until that week is passed/nearly up

That's been my experience with tricks. I'll think of some clever trick to work around my ADHD, and it'll work great for about two weeks. Then after that I'll start anticipating it and working around it. The self-defeating nature of ADHD might be one of the most frustrating things.

Everything is due NOW, seems to work best for me. Just a list to make empty, so I can sleep. Give me deadlines, or ask for estimates, and the task is doomed.

I wonder if ADHD people thrive more in those environments where it's always "this was needed yesterday" get it done NOW!

I use the same analogy explaining to people what my meds do. They’re a catalyst in that they lower the activation energy of doing anything other than doomscrolling

> It's not about attention deficit per se

I've always considered it Too Much Attention Disorder.

The way I like to think about it is that neurotypical people have a beam of light shining out in front of them, wherever they turn their head the light shines and that's where their attention is. Nothing else distracts them from where the light is shining.

With ADHD (for me at least) it's like 50 beams of light scanning the entire room constantly for 'something'. This is too much attention to things that I'm not really interested in, but can distract me from anything I'm trying to do or wan't to do.

For things that I am really interested in (like writing code) the 50 beams of light all manage to synchronise and focus in the same place and that's hyperfocus.

Attention means an ability to ignore unimportant things. This is why the disorder is attention deficit - your ability to ignore distractions is diminished.

It's a confounding definition for me because of the inherent ambiguity, along the lines of a double negative. A disorder of ignoring, what does that tell us about what we attend to?

I often like to point out that we are completely blind to the most common thing around us, nitrogen gas. This blindness is good, because it allows us to attend to everything else, instead of stumbling around through a fog and over cliffs and into the maws of ambush predators.

While it's usually part of a rant about false color pictures in astronomy, it applies cognitively too. It's about the signal to noise ratio, and what constitutes signal versus noise can change in an instant.

Yea, ADHD attention is a like targeting system that has only one setting - it's constantly seeking the most stimulating activity nearby and never stops - sometimes the most engaging feeling activity even changes from minute to minute.

But the hyper-focus can be magical when it targets the task you need to do!

Indeed, I wouldn’t give up hyperfocus for anything. When it kicks in, it genuinely feels like a super power. It’s pretty much given me a career; but also just pure enjoyment from creating and making.

That’s such a beautiful way of putting it

I find similar behaviour in myself, particularly that dreading a task makes it significantly more difficult to start. I find that if I can manage to do just a little bit, even just open the application and maybe look around a bit at what I need to do, it really gets the momentum going for me.

Do you think there's anything that differentiates what we might call "general task dread" that perhaps anyone experiences to a certain degree from a more broad executive function disorder? Or is it that dreading leading to task paralysis is one of many symptoms of an executive function disorder?

How are you for task completion? For me, transferring a load of laundry from the washer to dryer is not an atomic operation. There is ample room to get derailed and wander off during the twenty seconds it should take. It can be interrupted by almost anything. Oh, I forgot to send that message. Oh, I forgot to check for the parcel. Oh, I need to go to the store today still. And I will walk away and forget to come back and finish.

I love moving all my laundry to the dryer and forgetting to start the dryer. Probably happens once or twice a month.

Pretty good. I don't find I get derailed by other tasks but I do find others related to what I'm doing like "Oh, dishwasher's done, let's empty it, but oh wait let's clean the counter first" and then end up cleaning the sink and emptying the garbage as well

I think the frequency and level of impairment is what differentiates normal executive dysfunction from an executive functioning disorder.

Perhaps a bit rhetorical, but how often does this task dread occur? Does it also ever occur for things you want to do, not just obligated to do?

For me, I experience this issue for many tasks everyday. Then again, I have never had a normal executive functioning, so I cannot claim to know what it is like for normies.

I’ll also add that ADHD is more than just executive dysfunction too.

I'm really bad at it for things that aren't novel or really interesting, especially repetitive tasks, like doing illustrations for a customer for example, I know what to do, I've done it hundreds of times, but I'd just rather be doing something else. It does also happen for things I want to do but only usually if it's something I'm not confident about. Like I want to do a really comprehensive gardening setup this year, I've done all the research and planning, I just have no experience sewing seeds or growing vines, or how to setup indoor seed hatching, and I'm just dreading the whole starting process and have put it off too long- I should've started mid-April.

In my mental model of ADHD, executive functioning is at the center of an hourglass-shaped graph. The bottom half consists of multiple "internal" layers/systems (neurological, psychological), in which some deficiency or deficiencies cause a lack of executive functioning (arrows point up from layers down below upwards to the central element of "executive functioning" to visualize the direction of causation). The upper half shows the outward facing layers/system behavior, social relationships, skills; the arrows point only upwards. I don't have any scientific source for this graph, but I never experienced any "ADHD"-related problem that I couldn't understand through this lens. Happy to share my sketch if anyone is interested.

Please do! This is very original and maybe most interesting conceptualisation in this thread.

Someone else who describes it like I do. You sit down to do a task, and there's an "invisible wall" between you and the objective. You physically CAN'T type on the keyboard if it pertains to the task at hand. You get up to go on a walk, and all of a sudden CANNOT WAIT to get back home to start the task. It sounds like the most enjoyable thing ever! Until... you get home and are greeted by the "invisible wall" again...

When I was a teenager, this would sometimes get so extremely bad that I could only describe the feeling of forcing yourself to push through this wall as almost painful.

My body would tense up to the point of shaking and I could feel my brain absolutely SCREAMING "NO. NO. NO."

As they often say, ADHD is about having _too much_ attention and not being able to control it.

Yeah, it’s a common topic of discussion in the various adhd discussion groups across the internet. Unfortunately changing the name would have some unintended effects because a bunch of regulations and other things are using the current denomination

Executive function problems are symptoms of ADHD, therefore renaming it as executive function disorder would omit the root cause. Dr. Edward Hallowell proposes Variable Attention Stimulus Trait (VAST) as a better name.

Ah man I feel you. What helped a bit for me is relentlessly trying to get your career focused on only fun things. It's a long term strategy, but I am now a not-so-successful-yet entrepreneur but I do love about 95% of what I do and that makes me do things fast and without it feeling like effort.

>What helped a bit for me is relentlessly trying to get your career focused on only fun things.

That's what I did.

But now AI is threatening to ruin that.

The world is what it is, change is the only constant. Improvise, Adapt, Overcome. It is a mantra that brings positive outcomes. Try to love something in the improvise/adapt/overcome process that like or may learn to like, with time. Don't drop your own agency in a world filled with agents.

You can do it.

I always picture it like trying to force and hold a strong magnet flush against the like pole of another. It seems like it will be easy at first, but the closer they get, the harder it becomes and just as you are about to manage it, they fly apart and the magnet gets stuck to an even stronger one nearby.

You manage to pry them apart, but it goes flying through the air and only to get stuck on an even stronger magnet still. And on it goes, over and over, until the magnet is stuck on the biggest, strongest magnet.

Your attention is constantly being repelled from less engaging activities to more highly engaging activities, and eventually you land on whatever the most engaging activity is nearby. Sometimes without even realizing it

It was even called "minimal brain damage" at one point early on!

I'm also reminded that "Obsessive-Compulsive Disorder" and "Obsessive-Compulsive Personality Disorder" are different in kind but necessarily in magnitude.

The former comcerns more localized obsessions and the latter is more of a global "default state of perfectionism".

It’s that I try and then can’t. When stuck in bed I can feel this momentum building in my head to push for movement and the a surge of will and then nothing. I didn’t reach the threshold of exerting my will and now I’m waiting for the next wave.

Guess we’ll see how my diagnosis goes.

to me it is definitely "attention deficit", and it is a deficit in attention in two distinct ways:

1) it's a deficit in that i can't put my attention where i want to put it when i want to put it there. this is definitely "attention deficit" to me.

2) when my attention wants to focus on something on its own somehow, i can't prevent it from putting its attention on that; that thing becomes my main focus for some amount of time that I can't really control. that's also definitely "attention deficit" to me, but in another way than the first way.

How are you dealing with that executive dysfunction in the end?

> Some physicians and researchers have argued for years that emotional dysregulation is not peripheral to ADHD but a central, overlooked part of the condition. Yet this symptom does not appear in the formal diagnostic criteria for ADHD in the manual that doctors use to classify mental disorders. That gap has left clinicians without a clear way to categorize what they’re seeing: Are these children best understood as having severe anxiety, as being on the autism spectrum, or as something else entirely? Or does ADHD itself need to be more broadly defined?

Again and again and again. Psychiatry is an epistemic mess.

Psychiatrists are touristic guides of the Paris catacombs that orient themselves with a map of the subway.

"With DSM-V, psychiatry firmly regressed to early 19th-century medical practice. Despite the fact that we know the origins of many of the problems it identifies, its diagnoses describe surface phenomena but completely ignore the underlying causes. Even before DSM-V was released, the American Journal of Psychiatry published the results of validity tests of various new diagnoses which indicated that the DSM largely lacks what, in the world of science is known as, 'reliability', that is, the ability to produce consistent, replicable results. In other words, it lacks scientific validity." ― Bessel Van Der Kolk, M.D.

That’s because psychiatry is intended to revert people to the cultural average so that they fit in and don’t have a bad time

Literally the key defining feature of whether something is a disorder is whether it “impedes” your life, and that could be literally anything

That "something else entirely" for me was trauma. which has no search hits in this comment thread so far.

I was given an ADHD diagnosis as a child before it was in vogue. From my (admittedly) biased perspective I was given this as a result of hyperactivity which might have stabilized on its own given enough time, but my caretakers reacting poorly to my early behavior caused long-lasting traumatic symptoms which happen to line up with many symptoms of ADHD. So I just assumed that ADHD was the case the whole time. I started to suspect something was off when stimulants did not help my problems, but unfortunately it was not enough to escape the sphere of trying to solve my issues with ineffective ADHD-centric solutions until long into my adulthood.

Childhood trauma on top of misdiagnosis on top of continuing familial issues was an awful combination for me and I can't say that I've made that much progress from therapy, only that at this point I can survive with full awareness of the reality of how I was treated. It felt like I had been living in an alternate reality for decades and now I can't stop thinking about what I've found out.

I’m sorry you went through all that; it sounds really difficult. I can relate, having come from a similar background and situation. However, I wasn’t actually diagnosed with adhd until well into adulthood. The meds have helped, but I also have been given other emotional deregulation diagnoses, and I’ve been wondering if it’s all one thing. This article and your experiences add to that perception, for me.

Regarding progress in therapy, it’s a lot of work for sure. I would recommend looking into brainspotting (1) - it’s been hugely helpful for processing trauma, for me. YMMV

Thank you for sharing!

(1) brainspotting.com

> emotional dysregulation

Not having enough sex is hard to formalize as a diagnostic criterium.

Joke aside (which is on me), I have doubts that it's about psychiatry being an epistemic mess. And when I say "that it's (not) about", I mean that it's not (or is) relevant to the framing of the problem.

a) it's only been almost 200 hundred years, most of which were spend building crowd control rather than exploring minds, so it's not an issue of semantics and 'mental' x 'neural' topologies defined in as unambiguous terms as possible. psychology drew lines for the wrong reasons but men, who build and still run the field, are, ... well ... not very manly, are they? nobody is, these days. Some mafia says jump & people jump, you read it in studies and subtext all the time, and in real life, just look at the the amounts of highly functioning autistic people just rolling with the rules of conformity in 'realms' with 'grander'--meaning, in context, requiring high education (not the half baked kind)--purpose. It's weird.

b) "regulation" implies continuity, which requires literally no more than 2 things:

1. learning a few rules, which is an active thing, much easier for ADHD and other people than the thing they have no control over whatsoever, which is

2. brain circuits that don't (or do) constantly break continuity of ... all the things that return thoughts and emotions even though the "main" function isn't done, or any (or only some) of the concurrent, async functions called by the "main" function are or are not done, (yet), all while all the 'context and reality and "presence" sustaining functions' are just stable enough ... (minus that cool part of the CNS that does it's thing no matter what)

All that said, I have to check the study in detail. We should never forget that the personalities of parents (and other involved parties) play a 1337% more important role than the subtype of ADHD or whatever symptoms a person "shows".

Does anyone have experience with the emotional dysregulatiom bit and what that looks like as an adult?

I have friends with adhd tell me that I have it, but my parents have suggested there was nothing present to indicate I had it as a child, which seems to be a binary input for diagnosis.

But I do seem to way overreact to the silliest things. For example, if my toddler trips and falls, my mind immediately races to "they definitely knocked all their teeth out and will be in pain and will have dentures forever and will never enjoy life again", and that seems to short circuit my reaction into a total panic/meltdown before I've even looked at the kid's face (which never hit the ground). And the advice of the internet such as deep breathing, stepping away, etc. is totally unhelpful as it seems my reaction is instantaneous. Then there's the crash and shame that follows it once the initial surge passes, which feels like my brain is lurching forward in my skull when I can feel it happening or stop it. And then I vow to never do it again, but then it happens.

I seem to mostly exist as a normal human otherwise. I can hyperfocus on coding, but that could just be normal focus because that's what I do all day.

My suspicion is that I have depression since the symptoms are overlapped, and I've never scored below a 20 on the phq-9.

Recently when I've crashed, I've started considering seeing a psychiatrist, but my motivation seems to run out quickly after I start considering it or looking them up. I also don't want to be involuntarily detained and lose my tsa precheck.

Edit: Not sure this is relevant, but I do tend to hit/slap my face when I get in these overwhelmed states, which my wife has pointed out is not normal nor okay.

Preface: I'm sorry to hear that you've been experiencing this. Please try and see a doctor and/or a mental health professional in order to explain what's been going on. I realize that prioritizing self-care becomes even more difficult when you are dealing with a toddler. However your physical & mental health is super important to your child's wellbeing.

What you're describing sounds like an 'intrusive thought'. There are a number of causes for intrusive thoughts including depression (as you mentioned). My best friend has these. It got a lot worse after the birth of their kid. Sometimes an intrusive thought would linger for a week. Things like their toddler getting near a street corner and then an intrusive thought of them getting into an accident with a car.

If what you're experiencing turns out to be intrusive thoughts, there are a number of therapies that can attempt to make these more manageable and give you a greater degree of control over your state of mind. I wish you the best!

Thanks for the reply. I've read about intrusive thoughts but discounted that as an outcome because it sounds like intrusive thoughts are generally unwanted and I haven't seen the outsized response documented alongside them. But I could be wrong; I haven't delved into them deeply.

It seemed to me that these could be more related to an "all or nothing" thought pattern because, while the teeth-impact situation is definitely not preferable, the same thought pattern seems to allow me to make more comprehensive and secure software: my thoughts tend towards worst-case scenarios, often discounting completely the probability of that outcome compared to others.

That pattern does seem to present in other areas of my life. I'm currently going through an existential crisis because I never took e&m in school, and now I feel like a fraud so am reworking my way though Stewart's Calculus to be followed by linear algebra, diff eq, etc. through numerical analysis, pdes, advanced calc, etc. so that I can go and redo all of physics through theoretical astrophysics, because anything else would be abject failure. And I am completely worthless, but maybe this will push me into only the mostly worthless category.

And I'm doing this despite what I should be doing, ML engineering and agentic orchestration development, which would be relevant to my actual field and almost necessary given our paradigm shift, because I've now warped my perspective into determining this is a necessary prerequisite. And I can type this and acknowledge this is seemingly irrational, but also the amount of "I need to kill myself if I don't accomplish this" emotional throughput is closer to a firehouse than a drip. Meanwhile all I actually want to do is sit down and work my way through "Cpp Concurrency in Action", because I've also decided I'm a worthless fraud if I only specialize in garbage collected languages.

Idk. Maybe I should see someone. So far I've just been trying to grind all that out in my extremely limited free time with two toddlers and work and a dog while affording wife a nonzero amount of attention.

Edit: I forgot I also am planning to work through ochem because I've also never taken that and am definitely a loser that should be killed unless I can prove any sense of merit by mastering it (though that is admittedly less of a priority).

> which seems to be a binary input for diagnosis.

Talk to a doctor about any diagnoses.

Yeah. But it seems to be something I should do but never actually do, so I figured I'd ask randoms if they had a similar experience so I could try to use that data as evidence to convince my actual self to finally go through the "schedule an appointment" process.

I think this is me. I was diagnosed with “regular” ADHD a few years ago, but I’ve had issues with rejection sensitive dysphoria my whole life. As a kid I would have a lot of meltdowns when I couldn’t get something right on the first try or made any kind of mistake.

The meltdowns stopped, but I still have issues spiralling into thoughts of failure and being a horrible person when I feel like I’ve disappointed family or friends.

Guanfacine has helped though. Tried a bunch of medications and this is the only one that seems to have made an impact.

Hey, you've basically described me to a tee as a boy. I had the exact same temperament: meltdowns when I thought I disappointed people, putting myself down all the time for failures and mistakes. My parents weren't even particularly strict.

Glad I wasn't just a weird, overly sensitive kid.

"Glad I wasn't just a weird, overly sensitive kid."

Oh we are, just we have neurological reasons for it :D

Might be worth giving Qelbree a shot as well. I switched to it last year and...yeah, it' was a complete game changer. Hard to get insurance to cover, but it's been well worth it.

Do you have to take it everyday?

I recall someone posting that the human brain is essentially "overclocked". I don't recall if that was the phrasing but the gist was that our level of intelligence can only exist by skirting the fringes of sanity. Like some set of dynamic differential equations where, if you bump a coefficient, it spins off into chaos.

Perhaps this Brave New World, as opposed to the more agrarian one our species had been accustomed to, pushes many of us over that threshold.

https://en.wikipedia.org/wiki/Critical_brain_hypothesis

Given that this includes rat and mouse studies, it seems like this theory is more around the idea that criticality is a characteristic of how brains work in general, not that human brains hit criticality as a peculiarity of our particularly high intelligence

So that article does not support the "overclocked" thesis, rather that this critical state is needed for optimal performance. I do agree with the original sentiment, that we are not exactly well adapted to our environment. Or our environment to us, cause this is the main point I think that is missing from this discourse about adhd or other modern frequent mental conditions: too high expectations. Cause of our inherent human narcissism we think we are more attentive and logical than we actually are, so naturally those with lower attention become noticeable first. Or whatever other metric we are measuring leading to whatever condition (depression, autism, ...). At least that mechanism seems underreported in the public. Anyone familiar with how this is viewed on in academia?

> I don't recall if that was the phrasing but the gist was that our level of intelligence can only exist by skirting the fringes of sanity.

https://www.sciencedirect.com/science/article/pii/S014976342...

No science to back this but my first diagnosis was explained similarly. The claim was that the brain consumed all the neurotransmitter chemicals quickly and runs out. Amphetamines speed up production, so you have any instead of none. Idk how correct that is but it seems to work.

Melissa DelBello, a professor of psychiatry and pediatrics at the University of Cincinnati, said that while brain imaging holds promise, it is still impractical to conduct such scans broadly in clinical settings because they are too expensive and not yet precise enough at the level of the individual.

As if questionnaires and slot-machine prescription medicine treatments are accurate. I don't want to generalize for lack of statistical data, but reports of psychiatrists 'just phoning it in' while providing little actual patient engagement are widespread.

One thing that I can’t seem to parse from the article is why the researchers assume that this is an unresearched part of ADHD and not a different disorder entirely. I’m sure they have their reasons, but I don’t think it’s written in the article.

To me it seems that if it’s not „treatable“ the same way ADHD is, I’m not sure if it’s useful to categorize it as such. On the other hand, I’m happy if kids with this disorder can get a diagnosis and treatment that actually helps them sometime in the future due to this research.

You have a set of diagnosis criteria, and matching those criteria gets you the ADHD diagnosis. This study takes people who fit the diagnosis, and says there's a test you can do to split those people into three groups.

But yes, once they have a better understanding of what that difference means, the next step might well be to split the ADHD diagnosis into two separate disorders, or even that, like cancer, ADHD is actually a whole range of separate but related conditions.

Diabetes has a similar issue, with type 1 and type 2 having very different causes and pathologies.

> why the researchers assume that this is an unresearched part of ADHD and not a different disorder entirely

Whether or not the extreme dysregulation is a different disorder in its own right or not, is not relevant here. They are grouping ADHD matches; clinically recognized ADHD presentations plus MRI recognized ADHD which have a distinct brain sub-pattern occurring in people that have the same distinct behavioral traits. ADHD frequently has co-occurring conditions.

"Identifying “specific subtypes” of ADHD will make it easier to treat these children effectively". Having a more objective way to diagnosis for things like that seems to be the focus of the approach. They expect it to keep evolving, so I wouldn't say they are assuming anything about absolute labels -- just grouping what they now know to be true, that certain external traits match certain distinct brain patterns that are within the larger adhd brain structure.

Also, I think it's not that it is "not treatable" as ADHD, it's that ADHD can be treated in many different ways and currently the wide variety of responses to such is still a black box. Adderall instant release could briefly make me tired, I would sometimes break off a small piece and use it as a sleep aid. Some other `treatments` (I prefer societal alignment coping aid) resulted in what seemed like an expensive joke. Subtypes may eventually be able to show which options work best for which types and to start there first, instead of the current default iteration.

This link adds more about their research. https://medicalxpress.com/news/2026-03-distinct-adhd-biotype...

It is a good point and I also struggled with that bit somewhat. It is different in so many ways, have different symptoms, does not respond (as well) to the same medication, and affect different parts of the brain. The jump from there to "subtype" was not too logical for me ...

  I was surprised by how cleanly our results came together,” said Pan, a neuroimaging expert with the West China Hospital of Sichuan University and the Turner Institute for Brain and Mental Health at Monash University in Australia. “We used no clinical information whatsoever in the clustering, and yet the three biotypes that emerged mapped well onto clinically recognized ADHD presentations.

Really cool that this worked out. Now I want to get my brain scanned...

It's not really usable for assessing individuals. The "biotype" explains roughly 1% of variation in symptoms.

same. any way to do this without being part of some clinical trial? my shit is busted it'd be nice to understand how feel like that would be meaningful in awareness

I'm a little confused. ADD & ADHD started as children's issues, if I understand it. Adults had already developed beyond it (was where I thought it started). Then later it got combined into only "ADHD" and adults where recognized (not sure which was first). This article only speaks of children. Has it reverted back to children only? I got diagnosed, only a few years ago.

It does look like they are going the right direction. I year or more ago, I looked up my symptoms on the WHO list of diagnosis and most were on both the ADHD and the spectrum list. I don't believe I've ever had a thorough diagnosis, so I was trying to understand better where I might fit. All I ended up with is that there were a lot of symptoms that border lined.

It felt like it was a bit under defined, like IBS (which I was falsely diagnosed with once) because they just didn't know another one that fit. Anyway, I would love more understanding. The "beyond" is common in people I've spoken with, so is the emotional dysregulation...

ADHD is interesting. I think ADHD is mainly an executive dysfunction and reward centre dysfunction, from my own experience.

And a bit of nature, a bit of nurture.

It’s a real double edged sword for me.

On one hand relationships and “boring” tasks feel insurmountable. When I say boring I don’t even mean boring in the traditional sense, I just mean “not novel” - so even something like playing my favourite ever video game gets extremely difficult once the novelty is gone.

On the other hand, as a software developer, working on novel concepts or exploring novel concepts or ideas is basically like crack-cocaine, I literally can’t stop or put them down.

Double edged sword is struggling with most basic tasks, but excelling at the peripheries.

When you put it that way this might be one of the greatest disabilities ever. Humans that don’t complete things they begin and chase novelty are hard to respect because it’s common and trite. Persevering through failure and the hard bits is essentially the crux of achievement, productivity and success.

Well, I’ve been persevering through the hard bits for 42 years, and still struggle with it. It’s not about chasing novelty, it’s about novelty being many many times more attractive than it is for others.

I don’t agree as greatest disability ever as in “most-disabling” I’d say it’s the greatest potential modifier disability there is.

Some scenarios I loathe having it, but when I’m in the flow state I love it.

It’s made my life-path very non-standard (huge swings up and down), but it’s also created insane opportunities (when paired with high-drive and completing things/discipline)

I personally don’t consider it a disability in my case, but I’m definitely at a disadvantage in a typical work environment compared to my peers. So I understand completely why it’s generally classed as a disability in today’s society and societal expectations.

Like autism, it can produce insane outcomes (think savants etc), and if you can find the right environment for you, you can outperform more neurotypical peers.

I for instance finish all my software projects, because I force myself through discipline. My work output is probably the same or slightly less-good than my peers. But my personal projects where I have full creative control of the outcomes I’d say far exceeds my peers.

I mean in my own case, I’ve achieved far more than my friends and peers - whether that be in business success or other creative areas, but at massive cost - they have much more stability than me, whereas my path is a very non-linear path. I either do exceptionally well or exceptionally shit, no in-between, very black and white

How do you manage to finish things? After a while, for me, the novelty high wears out, and instead it becomes a wall. Some project require something silly, like sending 1 email to be completed, and it becomes an impossible task

I force myself to do one project at a time, and don’t let myself pick up a new project until I’ve finished the current one.

I actually have realised I can’t juggle more than 1 major thing in life at a time.

So I just do work, gym, and 1 project at a time . My life is simple. If I’m doing a oroject, I don’t read books or play games for instance

Haha, this made me chuckle so much. That's basically how it goes for me also. Even asking myself, why don't you just do it, then doing something else, feeling guilty about not sending the mail first.

The thing is most people get into a flow state and then persevere through when it’s not enjoyable anymore. If you’re just capable of the first part what’s the point.

It’s great that you can get through the entirety of something because I think that deserves a high form of respect.

> I’d say it’s the greatest potential modifier disability there is

What a great way to describe it.

How are you dealing with the executive dysfunction part?

https://archive.ph/iAqUj

They've basically "reinvented" DSM-IV ADHD-PH, -PI, and -C more or less, but at least someone's examined the organ responsible rather than treat it like a magical black box.

I think the article was honing in on emotional dysregulation which iirc isn't a big component of the DSM-IV definition.

Anyone know to what paper this article refers? I don't have WaPo

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...

I’ve always found the evolutionary biology lens very compelling for ADHD — consider hunters and gatherers. Hunters benefit greatly from the ability to quickly and sharply shift attention in an instant. They thrive at night and can hyper-focus on the thrill of the hunt. As civilization progressed, society was optimized for the majority (gatherers), and the hunters are marked as “disordered” for systemic incompatibilities.

I'm always sceptical of studies which look at a single diagnosis rather than pooling multiple related diagnoses, because the boundaries between them are so fuzzy

Here's a similar study from some years back which doesn't have that flaw: https://pmc.ncbi.nlm.nih.gov/articles/PMC6880188/

https://en.wikipedia.org/wiki/Attention_Is_All_You_Need ;-)

Funny how "attention" in transformers (a.k.a LLMs these days) can help overcome the activation energy barrier due to attention deficit in humans.

The DSM seems pretty far behind the research by now, but I'd be surprised if emotional dysregulation was not mentioned in the next one.

Another interesting thing that's not in the DSM - very high likelihood of balance / motor control problems (clumsiness, falling).

I've described the field of Psychiatry as trying to describe a building, using only its shadow (projection from high dimensional space to 2d space), with only a handful of choices for the building type. Ultimately only the building (the patient) really knows the full scope of complexity, but a doctor has to be careful in how they get info out.

I don't have a solution, as its an inherently hard problem with a lot of risks (like giving medicine to the wrong person). But I also think this desire to have nice categories for things can be counterproductive in a lot of cases.

I personally think rebranding aspergers + Autism to the autism spectrum was a mistake, as there's a huge difference between someone who's really good at their job but weird and despises certain workplace nonsense - and someone who can't take care of themselves.

ADHD is another great example of a bucket that makes non sense. We were evolved to be hunter gatherers that get many hours of walking or running, and other physical activity every day. Then we act surprised when 11 year olds don't want to sit still 6 hours a day, or getting people like me to write a JIRA ticket is like pulling teeth.

I think separating out these large categories into smaller ones is a good step, but ultimately I think the categories are a counterproductive solution to our human urge to find a logical explanation to things.

Merging autism and aspergers was not a mistake. There wasn't at the time enough science to separate them.

There are separations to be made within autism, absolutely 100%, but the separations they hade made were also definitely 100% wrong.

> “They are simmering volcanoes basically,” Rosen said. “When things go wrong, they explode. These are kids who will have hour-long meltdowns, throw things and hit and break things.”

...

> For children with this extreme form of ADHD, standard behavioral strategies may fall short. DelBello said that widely used approaches such as positive reinforcement — like giving prizes or other trinkets, or extra recess for good behavior — do not always have the intended effect.

I'm a former foster parent who adopted kids from foster care. Two of them were diagnosed with RAD[1]. This "extreme form" of ADHD aligns with both my personal experience of RAD and a subset of the symptoms described by clinicians. Attachment issues in general are either commonly comorbid with, or misdiagnosed as ADHD and ODD[2] (the latter of which also somewhat matches the symptoms from TFA).

I don't really have a point here, just an observation I wanted to make.

1: https://en.wikipedia.org/wiki/Reactive_attachment_disorder

2: https://en.wikipedia.org/wiki/Oppositional_defiant_disorder

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