Reverse engineering my ADHD test
nullpt.rs
nullpt.rs
Thanks friends.
I thought I was bad at lots of things other people were good at, because I was more disciplined and saw the bigger picture. So I only worked on important things. Things that could matter to millions of people, or still be relevant in 100 years.
And all the side quests and rabbit holes were obviously for recharging, expanding my biological-being-on-an-odd-planet situational awareness, or benefited me as self-improvement challenges. All in service of the important things.
How would tracking the day of the week, doing homework on something I could learn later if/when I ever needed it, or mowing the lawn, help me accomplish anything important?
Wasting brain space on those kinds of things would be dysfunction. I actively culled such dreck!
Now I know my self-narrative was Stockholm Syndrome coping.
But I still don't mow lawns, and if the blinds are drawn when I finish a big task, I couldn't guess if it was am or pm better than a coin toss. My day metric is when Amazon Prime's "Your Orders" list, tells me I am a day closer to getting a crafting item I ordered for a project I may never get to.
I feel like it is very disrespectful, especially when the conversation is about something completely different. Also, I'm not a medical professional, and it is possible that their ADHD-like symptoms are caused by something else.
That being said, if they ask if I think they have ADHD, or any other form of neurodivergence, I will say yes.
Don't accuse them of being ADHD, or insist too strongly
If you do bring it up, I would say make sure to really emphasize that you don't think they need fixing. It's something that might help them overcome their own struggles, not something to make them a better person for others, you know?
Everything I am really good at, I am really bad at, depending on context and the wobbly compass that governs my internal motivation.
It is definitely not all bad. Without my hyperfocus, my life would be unrecognizable. I would be unrecognizable. Hyperfocus is core to so many things I am good at, care about, and have achieved.
My ever optimistic self would fail and fail and fail, create a system, fail, create another system, fail, .... at seemingly easy things.
As soon as I had a rational reason for otherwise inexplicable challenges, enormous amounts of stress evaporated.
Now I know what things are a lost cause: So I get help, delegate, find another way. Being bad at something, and recognizing it, is not the same as failing.
I once had a close friend ask if I had [other syndrome], and my answer was "I have all the symptoms but don't care to seek a diagnosis."
It was a very polite way to inform me, and a polite way for me to say that I was happy living my life the way I want to live it.
As someone with peer reviewed ADHD but not official diagnosis, what are friends gonna do about it? They can tell you, you're always late and it's annoying but that's about it. At some point it becomes just who you are as a person, part of your character sheet. If you're not planning to change and it's mostly under control (have job, life, etc), does it even matter to put a label on the thing?
I feel like a diagnosis in my 20's would've been useful. Now it's like I got me my coping strategies and they work pretty well. If I do or don't have ADHD doesn't really change anything.
And for anyone else reading, the leading symptom of adult-diagnosed adhd is saying and thinking things like "I don't get it, ADD can't be real, that's just how everyone is"
This is what I told myself before I started taking medication around age 30. But ultimately my coping strategies felt flimsy, and I felt like my life could fall apart at any second.
Getting medicated and getting therapy has improved my life and evened out my emotional state an incredible amount. I still feel like me, just with a bit more stability and consistency.
I don’t think it’s ever too late to start medication. If you think there’s a benefit to it, it’s worth trying out.
At one time it was Jolt Cola ("all the sugar and twice the caffeine!"), then energy drinks came along. I can drink 10 a day, because I genuinely function better that way.
But Adderall works really well now, and unlike caffeine, it doesn't set me up to lose sleep.
I did that for a bit, for the same reason. now couple of years developed issues with high blood pressure, so be carefull with that approach.
I know to people without this problem it probably sounds very childish and silly, but it's a real problem. I lack a lot of the inner social calibration of what is a big problem and what is not so I very often have social issues because I say something hurtful (unintentionally) and don't realize why it's a big problem. Then I say other stuff that other people are actually fine (or mostly fine) with but I stress out about it and agonize and isolate myself.
I also identify with being super hard on myself. For a recent example I replaced a door in my house recently. I had never done this before. I bought a power routing saw and cut the hinge mortises myself. Two of them were basically perfect, one of them was a bit jagged and it was off by 2 millimeters when I went to hang the door. I spent the next four hours pissed off at myself for fucking up the door!
After doing a franky great job for my first ever attempt at hanging a door, and never using a routing saw before. :/
That's not normal levels of self criticism
There might be some hope in deep learning, particularly in observing eye movement components to deliver reliable biomarkers in the future, but I’m not so confident any time soon.
It’s dreadful and fascinating at the same time that defining and testing for ADS has been so elusive for so long…
In a 2024 meta-analysis of MRI/fMRI machine-learning studies for ADHD, the average pooled sensitivity was 74% (the ability to correctly identify people who actually have ADHD) and the average pooled specificity was 75% (the ability to correctly identify people who do not have ADHD), that also means that there is a 26% false-negative rate (miss/Type II error) and a 25% false-positive rate (accidental diagnosis/Type I error) [https://doi.org/10.1016/j.jad.2024.03.111].
Though there is no set standards but under 80% is pretty low for a clinically useful test but can still be used in some conditions such as to supplement diagnosis. To give some numbers the rapid antigen covid tests had 72% sensitivity and 98.9% specificity. (note the lower sensitivity was acceptable at the time but the CDC guideline was for symptomatic people to retest 48 hours. Viral load and other staging factors could all confound.) [https://doi.org/10.1371/journal.pmed.1004011]
https://www.youtube.com/watch?v=BzhbAK1pdPM&list=PLzBixSjmbc...
IMO "Humans do this because [made up scenarios how it helped them survive]" is trash in its own rights, and not because it is not falsifiable. Not useful, not insightful, not anything.
2. Assuming it really is: Why would this make it unlikely to be encoded on a single gene? As a layman, the only condition I'm aware of with this "downside but also upside" quality is sickle cell anaemia (downside is anaemia, upside is increased resistance to malaria), which is decided by a single nucleotide change on chromosome 11.
Essentially all traits that you might think of as "traits" and not "features of the species" have downsides and also upsides. Where there's any significant imbalance, the genes for that trait will be purged from the gene pool (if the trait is basically all negatives) or sweep to become universal (if all positives).
In fact Darwin's theory of evolution is kind of outdated as well. We now understand genetic drift and things like the neutral theory of molecular evolution from moto kimura and the nearly neutral theory of evolution from tomoko ohta may give some sort of explanation to polygenic nature of adhd.
Though, with ADHD, I think it's definitely more than that. It doesn't just make it hard to focus, it makes it hard to focus on what you need to, until the moment that it is obviously now or never. Focus, though - there's tons of that, flitting about, and sometimes grabbing you up and running away with you - sometimes for months. I would imagine that there are a lot of novel discoveries attributable to it.
Also, having different sleeping patterns can mean that the people with ADHD are likely better equipped to keep a fire burning overnight and possibly be alert for predators.
Per the DSM-5, one of the core symptoms of ADHD:
"often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
I am not aware of any data that supports being interested in a task lessens the likelihood of making mistakes. If you have any data, I will gladly read it.
There are some cool studies done where people with a without ADHD are tasked to forage berries. The people with ADHD do better and adhere to foraging patterns which existing theories suggest would be more optimal.
A lot of the studies like that indicate the individual with the condition might benefit more from ADHD than the group they’re in, but I’m not sure that studies have explored group benefits very much.
There’s an often cited paper in which nomadic men who carry a certain ADHD-related allele (DRD4-7R, a dopamine reception variant with ADHD traits and novelty seeking) tend to have better nutritional status. I can’t recall much about it or how high quality it is.
With your foraging example, it does make me think ADHD is a small group/individual optimisation. Prioritising high vigilance and individual productivity over social cohesion.
I speak with no authority. I don’t even know how such a theory could be tested.
What do you think nutritional stunting means?
It would make sense to me that evolutionary there would be different mental development paths depending on the requirements of their situation.
This is coming from my understanding that ADHD is more prevalent in stressful upbringings.
That would normally be called "learning". Also a pretty conventional idea.
With learning, though, you'd want to explain why something becomes immune to further learning at a certain point.
Or maybe it’s learnt like you say, I think both areas would be worthy of researching.
Like being physically weak is not an advantage in white collar jobs.
So there is still room for complete failure in life, and maybe its a lot of luck/environment that some ADHD people succeed naturally.
- Clinical Interview
- Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV)
- Wechsler Memory Scale – Fourth Edition (WMS-IV)
- Conners Continuous Performance Test – Third Edition (CPT-3)
- Delis-Kaplan Executive Functioning System, selected subtests
- Wisconsin Card Sorting Test (WCST)
Are you familiar with any of those? I did some research after receiving my report and apparently the combination of tests listed above are well-respected, about as good as it gets. I’m curious what your take is.
The subjective part of the assessment was actually the clinician making sense of the data. My cognitive assessment (IQ and its subtypes) scored fairly high, I averaged something like 115 (84th percentile). But my memory assessment scores (audio/visual memory/working memory, immediate/delayed memory) tanked tremendously, I averaged around 90 (30th percentile).
My positive diagnosis was based on the variability of scores and the clear cognition-memory gap. The results made sense, aligned with my experience in life (I fell asleep in almost every lecture in college, sustaining attention while taking notes was a heavy audio-visual working memory exercise for me).
I personally haven’t adopted any of this as my identity but it opened a door to do some metacognition and reflect on how I interface with the world. Also the stimulant medication didn’t magically fix everything, sometimes the hyper focus is worse, but there was one HUGE benefit that I didn’t realize I was missing - emotional regulation. I’m a heavy ruminator and pretty much suffered in silence most of my life, my inner dialog is much more organized and calm, and I can comb through my thoughts easier now.
P.S. I cannot recommend enough - check out “HealthyGamerGG” on YouTube. He does some deep dives on ADHD and other diagnoses. Classically trained psychiatrist with something like 5 years of training as a Buddhist monk. Very insightful guy who’s both data-driven and spiritual, helping a lot of people.
I'm not OP but that seems like a very respectable diagnostic track. No test is 100% reliable, so you'd want multiple tests. Even then the results can realistically only be interpreted by a psychologist that is familiar with your situation (hence the clinical interview). So this seems perfectly proper.
> Also the stimulant medication didn’t magically fix everything
Sadly there is no medication that fixes adhd. The only thing these medication does is make it easier to deal with by alleviating (some of) the symptoms. Personally I've noticed from my medication (methylphenidate) that it make it easier to stay focused on whatever task I'm doing, but if that happens to be scrolling reddit, I can still waste hours, perhaps even more since I would have otherwise distracted myself from reddit long before. So it's not perfect, but it does enable me to concentrate 8h+ at work, and that's ultimately the main benefit it brings me.
The more common view is that because prevalence of attentional deficit in autism is so high, it's rare to find someone with autism who isn't also able to fit an ADHD diagnosis. This might mean a shared common ancestor as it were, or perhaps autism has attentional deficit as an intrinsic part of the disorder rather than people with autism also often having ADHD.
The other direction is the amount of people who have ADHD who also have autism. In this case, while the overlap is higher than the general population, it is easy to find people with ADHD who do not meet the diagnostic criteria for autism.
Put more simply, people with ADHD aren't necessarily autistic, but people with autism are usually ADHD.
Uh, what? How exactly could treatment be more distinct than ADHD people being indicated for a highly-regulated drug like amphetamines, which are extremely effective to the point of being life-changing treatment? Meanwhile nobody would consider prescribing Adderall to treat autism. What a bizarre conflation of two completely different disorders.
We don't really know what mental disorders are and so we don't have objective diagnostic tests for them. [1]
We just have treatments that sometimes work for some people (and with the replication crisis[2] that sometimes is probably a lower value than expected).
The one I did (QbCheck) was a similar setup but you were presented with shapes on the screen, either a square or a circle, and either blue or red. All you had to do was press the spacebar when the shape on the screen was the same shape and colour as the previous one. No sound distracitons (or maybe I just had the volume muted.)
You also had to do the test on a laptop with a forward facing camera so the software could track eye movement.
I remember starting the test and thinking "This is exactly what my brain is wired for, I'm going to be awesome at this test!"
Within a minute my mind had already moved on to "I wonder how they score this test? I guess they're looking at accuracy, reaction times, how those trend over time, whether the accuracy/reactions goes up/down if they show the same shape/colour more than twice in a row?" etc...
It didn't take long for me to then get jolted into a "wait, did I just zone out a bit there and miss one?"
Then I became overly conscious of my eyes wandering around and not looking at the screen.
Then my mind moved on to "what if I'm too good at this and it means I won't get a diagnosis?"
Soon it was "When will this ever end? This must have been going on for ages!" only to find it had only been about 3 minutes.
The test took 20 minutes or so and I was mentally exhausted by the end of it.
My actual ADHD diagnosis was backed up by an 80 minute interview, basically doing the DSM-5 questions but linking it all back to childhood experiences too. I've no idea how much weight the QbCheck test had.
Glad I got the diagnosis, I've been masking both for years (diagnosed in my late 40s) but just got burnt out doing so. Medication helps but isn't perfect and since I'm probably AuDHD I find the ADHD medication amplifies some of the Autism traits and makes me into a bit of an emotional zombie, but that seems to be better than having zero motivation (aside from stress/deadlines and serious consequences).
I'm still quite bitter about this because it then took me another two years to work up the motivation to go get retested (this time somewhere that doesn't use snake oil), followed by an additional year to work up the motivation to sort out coordinating with my GP to get on meds. That's three years I could have been a functioning human being.
Did confirm that I have very above average reaction times though.
https://m.youtube.com/watch?v=W99n083E0IA&pp=ygUeZnJlYWtzIGd...
Good to know that neurotypical people mostly likely test differently than I did.
My one surprise from this article is that "play a web game for 18 minutes" in an uncontrolled environment was considered enough testing for a diagnosis!
For our autism assessment a couple months ago, our therapist (whom we've been seeing for about a year at that point?) had us take one or two relatively short multiple choice assessments or the like and that was enough to diagnose us as on the spectrum. Did you know: Not all autistics struggle with eye contact? Some of us (ourselves included) are actually pretty good at it. One reason it's called a spectrum!
The previous time with our mental health professionals factored into their diagnoses, though, not just the tests. The takeaway: Book a therapist and psychiatrist both if you don't already and get those balls rolling.
But then I worried if my system worked, I would be misdiagnosed.
It didn’t work. I was 98th percentile.
Thanks for sharing this!
I am having a really difficult time finding a reputable psychiatrist to assess adult ADHD. I called 15 places and only heard back from one. I scheduled an appointment. They had 1/5 stars, gave me a 30 year old 1 page questionnaire, and asked to see my childhood report card. I did not see them again.
Yesterday I got a callback from an office offering this online test but nothing else? It all smells fishy.
Did anyone have to cross state lines to find a reputable psychiatrist?
Because for some, an "ADHD" is like playing up a symptom to get "Medical Marijuana." It makes it hard to differentiate between people who have a legitimate need for treatment, and people who just want uppers. (There's a joke that if you want a prescription, just look for a 1-star doctor and make sure to accept the vaccinations so they can bill for more.)
Have you asked your general practitioner for help finding a psychiatrist?
The proctor noted my restless legs, frequent posture shifts, and "tendancy to tap the table when not responding to the stimuli" (this was a strategy I had come up with to create something to do in response to "doing nothing", as it made a sort of rhythm that gave me something to do). I then realized that the test meant very little, but the proctor was watching and diagnosing me durng the test.
Also, congratulations, once you figure it out your life is going to change for the better in a way you can't currently understand (literally, lacking the brain regions and/or development for it, take it from me), but the process can kinda suck a lot, so stick with it, it's worth it in the end, wherever you end up.
He says while commenting on HN as CI runs...
Given the overlap between ADHD and video games, I'm not convinced of the accuracy. It felt like a lame rhythm minigame to me.
I don't think the research is solid, my guess is these tests are convenient for insurance and liability paperwork since stimulants are controlled substances.
Yeah man I can go ahead and let you know early if you want.
It turns out, there are other conditions out there that can appear to be be ADHD. If a trained therapist can confuse them, outside observers certainly can too, so it is possible that "very ADHD-acting" person you know might not have it.
(Or, especially for females, the reverse can be true, as not everyone with ADHD manifests with the same trademark hyperactivity.)
So the first rule of getting attention for your paper is to re-define common terms...
Executive dysfunction, especially that which was not impairing as a child, has a lot of potential causes. Anxiety, depression (yes, ADHD can cause these, but these can also cause executive dysfunction in people without ADHD), OCD, Bipolar (manic people in particular often attribute worsening of hyperactivity and distractability to ADHD instead of mania), Schizophrenia pretty much universally is related to cognitive symptoms and lowered motivation even when not psychotic, and borderline personality disorder can cause changes in interests and identity.
For many of these conditions, stimulants can act as a band aid on something else. It can superficially make people feel better (of course, it's speed), but it can distract from other symptoms that are impairing functioning, and prevent people from seeking long term solutions.
I recognize that non-medical options should always be front line approaches but there can be a chicken and egg effect as to making that happen.
In my youth I adhered to a "better living through chemistry (wink wink)", I do now too (rip Mitch Hedburg) but the wink wink part is very rare and disciplined and now it's all about pharma and supplements to wring what I can out of what I've got left.
That's not to say I'm not on the medication train (despite moaning about medications a lot). I do personally avoid taking any controlled substances. This is easy because I hate how stimulants make me feel, but in general I worry about the effects of having a direct reward signal from taking a pill.
I honestly would try to stick to materials written by mental health professionals and possibly talking to a therapist (your company might have an EAP that can help with this) over interacting with any online community I'm aware of on this matter.
I find online mental health communities tend to be "if I have a hammer, everything is a nail," and aren't open to other explanations for any traits or struggles. They also tend to suck in the people who aren't doing better with treatment, while the people who found systems that work for them leave for greener pastures. On the opposite side there are communities that are anti-psychiatry and refuse to consider medical treatments. In general these spaces tend to be very black and white.
I do like the Astral Codex Ten open threads as a space that's relatively neutral on the topic, though they lean very biohacker in a way that gets ahead of the science.
This sometimes solves the problem by itself, or it reduces the levels of stimulants needed.
So, uh, ... a whole textbook. And I probably forgot some.
Well I only know that because I skipped to the end. Then, while scrolling up I realised I missed the whole side-quest about promising to not cheat the test again, taking the test again, but then "accidentally" finding an exploit the system, and then cheating the test again, but this time cheating even more to see the results.
Then, scrolling up more I see that this whole thing started with seeing stars and then buying a telescope on amazon (probably at 3am).
And here I am commenting on HN instead of replying to an email...
The other thing is, ADHD in my mind is really a syndrome that starts with a symptom - inattention - that can be caused by so, so many things.
I have both, because of course I do, I had a medical problem that exacerbated my ADHD to a significant, significant degree (it's amazing I was able to be a software engineer for so long without treatment). So don't just tunnel vision in... as we tend to be prone to do. Get the whole workup with an experienced clinician, it's so lifechanging it's hard to describe.
You wrote "the test is quick, easy, and painless" but I also want to note that it's not always. Depending on your country, parents, specific doctor, etc it can be very difficult to get a proper diagnosis and help. In some places a big criteria is diagnosis during childhood so if you're 30 or 40 you might have no chance. Or a chance but it depends on your parents retroactively answering a questionnaire, or finding an old report card with the right words.
As you said it's life changing to get the right help and I encourage everyone to pursue this.
Btw no criticism implied on my end, I'm just now constitutionally incapable of not telling people they should get screened. Hmmm I wonder why I have difficulty resisting that urge...
The chance to be diagnosed with an appropriate gate varies greatly based on where you live and which doctor you can see and more. It can be anything from a 5 minute conversation, to 6 months of inconvenience, to no chance of even existing in your lifetime, to suck it up and don't ask because your career will end.
It’s funny, I went to therapy a lot of times before I found someone I could stick with, and if I were to give my past self a list of what I’ve gotten from therapy, I think I would’ve been unimpressed. Nevertheless, I’ve noticed that I’m more confident and calmer, and it has definitely improved my relationships.
There’s a kind of virtuous cycle that happens where you replace a grumpy mindset where you’re always mad at yourself for not meeting other peoples’ expectations and always mad at other people for making your life hard, with a confident mindset where you understand yourself, are therefore comfortable relating to other people about your abilities and needs, and can focus on putting yourself in situations where you’ll be successful.
It was sort of fun, we talked about how Arthur Schawlow (who co-invented the laser and won the Nobel prize) was banned from driving on Stanford campus and had to be chauffeured. And I finally understood what he was talking about; you can access this perspective for anybody by constructing such a narrative. What if everybody’s a misunderstood genius at something? Why not? How would you live in such a world? One insight among many.
It's even beyond that, in my opinion. What if everyone had perfect health, physically and mentally, and had been educated to the absolutely top tier of their ability to accept? Perfect, individual tutoring? Excellent nutrition?
How much better off would the world be if we framed everything in terms of helping everyone be their best, every day, in every way? How much of the trouble in the world is the result of just... accidental awfulness, that we collectively could just choose to stop?
It makes me very sad that we live in a world where potential Nobel winners are dying of easily preventable causes, or working dead-end jobs.
The quick answer:
Understanding neurobiology and the meta-cognition about the why of certain behavioural patterns and experiences is extremely helpful to just calm down and "forgive" myself, and not judge myself so harshly. It's as if I can optimise my life by leaning on my strengths and importantly recognising and dealing with my weaknesses. Just the awareness lets me catch myself getting into patterns, and act on them sometimes, and just let myself be the other times without any guilt. This insight brings peace more than you think. I can now organise my inner dialog and enjoy the diverse thoughts while also being aware of my impact on people in my life.
I was skeptical of the meds myself. I spoke with about 20 people through AHD support groups and group sessions. The drugs are mostly a trial and error affair with side-effects and altered behaviour. My subtle lifestyle changes - keeping one true todo list, always logging down my thoughts and taking comfort in the fact that they are jotted down so that I dont have to keep going down that thought and actually get up and go catch the train etc already gave me the biggest benefits. Then I wanted to see for myself what the drugs could actually do. At the end of it I may choose to take them or not. After 8 months of slow analytical trial and error with a very helpful psychiatrist who understood where I am coming from, I now take a very small dose of Elvanse(Vyvanse) + Guanfacine on some days of the week where I feel like I could use the help. They are not life-changing. They nudge me into being more capable of being me. My wife can notice the regulation the drugs let me have - A win for me. My kid has a better relationship with me than before - A win for me. Could I do without? Sure. But, I choose to have that little support to manage myself to get to who I want to be around my family without losing who I am. To each their own.
Longer background:
Despite reading about and knowing the symptoms of ADHD, and being told by a professional 10 years ago that I should consider getting formally diagnosed, I thought to myself - "Hey, I am smart. I feel happy and satisfied. I dont have any problem. I'm good as I am. I dont need to do anything about it." and promptly kept sweeping any thoughts about it under the proverbial rug.
Until, I started seeing my son develop in front of me. Seeing all those symptoms - impulsivity, hyper-focus on few things and inattentive to most others, emotional regulation issues, extreme reasoning abilities in some areas while being "immature" in other areas. This was me growing up. Being smart and intelligent, but longing to fit in, struggling to deal with the mundane. So, I decided to get diagnosed properly. Basically, I could hide behind my smartness and the ability to manage my symptoms until it just myself in my life, and then my wife, and then my son, but when the second one came along, I couldn't manage anymore and the overwhelm started to show the real patterns.
It takes courage to be honest and vulnerable.
The medication unlocks your ability to learn the skills you need to cope with the problems you have, and therapy gives you the outside feedback you need to escape your own brain trying its hardest to mess things up and hide the mess.
Imagine if every 10 seconds this guy was in your body taking over your hands for a second or two: https://www.youtube.com/watch?v=GguQu5Iderg
Huh? You don't have to be tested as-a-child, you don't have to call up your fourth grade teacher. You can self report your subjective experience.
"Did you have these problems as a child? Have you always had trouble doing your homework? Did stressing out about homework enable you to do the homework?"
They ask the question a few different ways typically.
I get it, perhaps it is different in your area, but I get the impression that an adult ADHD diagnosis is far from impossible.
If you search (eg reddit) for ADHD adult diagnosis, it is filled with horror stories. There's even lots of posts of people diagnosed and medicated for 20+ years that move to another country and can't get a prescription. Or you get a prescription, but the pharmacy won't dispense it or insurance won't pay for it. A typical post on these topics also has one or more people responding "I'm in the same place and it was easy" but also has one or more people responding "I'm in the same place and I tried for 3 years before giving up". By the way, it's also common for women to have more trouble getting a diagnosis compared to male siblings and friends with the same symptoms.
In the US, at least, it ranges from difficult to straightforward, but that's not true everywhere
Can't speak for the whole of the continent but UK here and I got my ADHD diagnosis a few years shy of 50 years old. Wasn't tricky at all, just a long-ish (8 month) wait for a non-private diagnosis (not full NHS but via an outsourced provider via Right-To-Choose).
When going through the DSM-5 questions (during an ~80 minute interview) I was asked to give examples from both current life experience and from childhood, and that was enough.
If you try to do it through the public system it's very difficult to even get an appointment because there's months long waiting lists. Basically if you have a job and function somewhat OK in normal life you won't be diagnosed in the public system. If you do get through it can be a long process where they want to interview your parents etc to determine if you had symptoms as a child. But you can also get a diagnosis through private practitioners and some of them function almost like diagnosis mills. A couple of video interviews and tests and you are done.
People would say "just ask for it" but I remember having to try and do these tests like look at these abstract shapes and what not. It was multiple sessions I eventually ran out of insurance so yeah I just abandoned it. I don't like the side effect of shrinkage down there when you're on uppers.
That’s something some people with ADHD need to hear to be ok with taking what is a powerful drug. A comorbidity of ADHD is substance abuse, and stimulants are very rewarding neuobiologically speaking (because they, especially amphetamine, promote dopamine release and persistence in the reward areas near the brainstem, as opposed to non-stimulants like Strattera which does effect dopamine reuptake but only in the prefrontal cortex, the primary area of impairment in ADHD [it does this by exploiting the fact that the NET is used for Dopamine reuptake exclusively in the PFC]), especially when treated like a recreational substance to be taken freely in a dose designed to be fun.
There is a lot of variety in people with ADHD, but I think that perception is more due to how the drugs work when taken medicinally vs recreationally and individual propensity for abuse.
Good test, though—very effective.
https://embrace-autism.com/autism-tests/ also implements a bunch of open access tests.
I wish I could find it again and run it across some cohorts, because it was quite fascinating to feel my brain suffer more on the horizontal arrows.
In general, if you are in the industry, save yourself (and your kids) some trouble and get diagnosed before it becomes a problem.
Add: I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
And in the most interesting cases, you can find a lot of value in both - stimulants keeps you going, guanfacine gives you perspective and the ability to unclench.
Edit: And this is me trying to restrain myself so I don't look like someone starting a cult...
I have been screened a few times for ADHD and each time was found to obviously have it.
Ritalin does not make me feel calmer. I have been told by those close to me that there are externally visible improvements in my behavior. At doses to reach that effect, it also impacts my sleep quality enough that I don't take it.
Adderall causes mild symptoms of psychosis and mania before it has any theraputic effect.
Dexmethylphenidate (aka Focalin) has identical theraputic effects to ritalin, but slightly reduced side-effects.
Methylphenidates can be quite numbing (zombifying) in my group of ADHD friends but dex seems to have a more consistenly helpful effect. The unfortunate caveat for me is that I personally seem predisposed to pelvic floor/urinary issues, which you'll find anecdotal evidence of being exacerbated by amphetamines (research seems yet to catch up), but aside from that the theraputic effects, particularly in emotional regulation seem so far unmatched.
It's unfortunate we have such a tentative model of how our body and, particularly, our minds work so drug treatments often require a trial and error process.
I found methylphenidate-based drugs to be useless after a few days.
Have you tried pure lis or dexamphetamine? I know dex can be prescribed without the mixture, maybe lis can too. I keep meaning to ask my doctor about it.
The other issue I find is tolerance, though even with this I'm still far more focused than when I'm not taking adderall. It really is amazing how much better it makes me feel. I find no problem with addiction whatsoever -- if I forget to take it, then I just have full blown ADHD, but I'm no worse off. I also find it's more effective if I minimize coffee, but I haven't yet cut coffee entirely. (I find caffeine is vastly more addictive than amphetamines.)
Strattera was subtle, but I had clearly improved feedback at work, a cleaner apartment, and no side effects.
Qelbree caused a lot of nausea.
Intuniv caused lightheadedness and got me an unnecessary cardiac workup.
Wellbutrin doesn't have as much ADHD efficacy as Strattera (my doc won't let me take both at the same time), but it improved my seasonal depression and motivation significantly. I had some irritability for the first few days after a dose increase, but otherwise the only side effect is reduced hunger and I also stopped asking people for cigarettes or zyns when I'm drunk.
I was able to laser focus and jam through things but the side effects were not worth it and I backed off. I've yet to find a magic pill that does that without the side effects.
I was diagnosed with Shiftwork Disorder at one point in time and was prescribed Modafinil and it was incredible for the most part and had zero side-effects, but my doctor wont prescribe it for ADHD. One down-side to Modafinil is that I could get stuck on an unproductive task and would realize in hindsight that I had just been hyper-attentative to this unimportant task for hours.
I think many prescribers give ADHD adults a high dose too soon causing side-effects. In my experience, it's best to start with a low dose and slowly increase as necessary. The myth is ADHD responds quickly, but observing hundreds of patients it takes months, not days, for benefit of treatment to develop. There's wisdom in the phrase, "start low and go slow".
I have had bad reactions to every stimulant I tried since I developed bipolar 1 in my late teens (had taken them as a child for ADHD).
I had a good response to strattera, but there's a variety of them out there.
Yeah, it's basically why I don't bother with it. I know it works, but trading one set of problems that I know how deal with for a different set of problems that needs more meds isn't appealing at all.
So they can't test by response, because everyone would be like "yeah I can focus better", you have to test with the drug on, and the drug off, to see whether the "horsepower increase" is worth the fuel price. Increasingly strained metaphors are my strength.
In ADHD (and most conditions) diagnosis by medication response is not acceptable. Response to drugs is highly variable and fails criteria for acceptable tests. Also drugs can produce side-effects. According to professional standards, it's unethical to expose people to nontrivial risks without good cause.
My diagnosis came after I had multiple tests and interviews in a 2 month period, including interviews with my mother and my partner. Sure I was also diagnosed with autism, but the final report given to me was so complete and descriptive of my pains, symptoms and the impact on my day-to-day functioning that it just couldn't be made with a single interview.
But for your specific brain it does make enough and it will fight to maintain that via homeostasis (usually by creating more dopamine vacuums/re-uptakes that stick around a long time...there is good science on this).
So you become dependent on the medication and tolerance can occur making your situation worse than it was in the end.
ADHD-as-a-diagnosis is just a clever way to make the government okay with prescribing stimulant medication to "people who it can help" and having someone safely monitor its usage, and to assure the government that we won't end up with too large of percentage of the population taking it.
This is just my story but before ADHD diagnosis and medication I was unemployed, on food stamps, in an abusive relationship, and struggling with alcoholism. After taking medication for a couple years I'm in a healthy relationship, making good money in a stable job, and on the wagon. The medication prescribed helped so much with my impulse control issues that it literally changed my life.
I hope I am addicted to it so I don't forget
Those are some possible outcomes, yes, but it is not a black/white thing, and that is actually WHY it's important to work with a qualified doctor to monitor medication, effects, dosage and so on, and make adjustments as necessary.
Different medications work very differently as it relates to dopamine, uptake, production, etc. And there are also non-stimulant medications that may be effective for some folks.
As an example, President JFK received regular injections containing high doses of amphetamines from his personal physician.
Then the risk of abuse and side-effects in the population were observed and it was banned.
Did JFK have ADHD? No, it just helped him with energy levels. Like it would anyone.
There are no conclusive bio-markers for ADHD. Therefore its not possible to say who doesn't have it and should not get stimulant medication.
The only commonality is that there is an impairment. It's not possible to say: this person has difficulty focusing and has ADHD but this person has difficulty focusing but doesn't have ADHD.
The board of psychiatrists who decide what symptoms constitute it just essentially make it up.
The only thing that is real and measurable is the level of impairment to someone's life.
Stimulant medications works, but it would work for anyone regardless of an ADHD cause. ADHD is like a catch-all for people who can't focus that doesn't match any other condition that could be resolved differently.
Stimulant medication definitely carries risks and health impacts. This is black and white.
And while the authors made a lot of claims, and cited some other studies, they don't really, IMO, prove their point in any scientifically valid way, or even as a solid, well-formed argument. Add in that the authors are sociologists, not neuroscientists or psychiatrists/psychologists, and it makes me question both their claims and understanding of the topic.
I did catch that one of their main points (that you mentioned as well) boils down to not having a physical test or clear biomarker. But that applies to nearly all psychiatric conditions. Saying the absence of those kinds of tests is the same as the absence of a real condition ignores the research that has been done demonstrating functional impairment (including twin studies, some indications of genetic heritability). The paper presents a specific sociological viewpoint, and that isn't the current scientific consensus.
Like I said, probably not gonna convince you, just dropping this for others that might see the essay link and think it might actually provide validity when it does not. That essay does not really make significant arguments against ADHD.
It does present good warnings to be aware of pressures that would distort diagnosis and I do think there is good reason to be cautious about over diagnosing, or diagnosing by unqualified personnel, both of which do happen of course. But the article goes too far beyond that.
International Consensus Statement on ADHD: https://www.russellbarkley.org/factsheets/Consensus2002.pdf
The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder: https://pubmed.ncbi.nlm.nih.gov/33549739/
The person with only 5 doesn't have it?
This is not science.
Change the diagnostic criteria to a blood test or brain scan and then we are in the realm of proper science. But until then the burden of proof should be on the ADHD community not on those trying to dispute it. It's like having to use proper science to disprove something that is not conclusively proved in science.
It's fine to publish all this science and evidence, but it all comes back to the diagnostic criteria which is so wishy washy. The diagnostic criteria has evolved from a completely arbitrary definition. There is no reason the DSM stuff should be used at all, and trying to find science to support a diagnostic criteria that was arbitrary to begin with is silly.
That's why, after all this, the main point I make is that the boundary between ADHD and non-ADHD is arbitrary and will always be and its more about having a disorder to point to to be able to prescribe stimulants to "people it would help".
Mark my words: there will never be a biomarker or test used to diagnose this condition because it would only reduce the number of people who can access treatment.
It's an elaborate exercise on how to be allowed to use a scheduled medication as treatment. If the government didn't ban drugs then all this ADHD diagnosis stuff wouldn't exist at all. It would be the reverse exercise: which people should not be allowed it because they abuse it and it negatively impacts them.
Completely disagree with your conspiracy theory about the drugs. That's just laughable. Obviously need to prevent abuse, but there are both legitimate uses of and reasons to restrict general use of the drugs. Not to mention there are non-stimulant drugs as well, which kinda stomps on that argument.
> not how most psychiatric conditions are diagnosed
Psychiatry as a whole is questionable. https://en.wikipedia.org/wiki/Psychiatry#Controversy_and_cri...
Read about the history of the DSM regarding ADHD. You can look at all the versions/volumes and how and why it evolved over time. Ask yourself if you think it is actually good science.
Along those lines, I do appreciate this conversation. I do like questioning what I believe, and I had to steelman some of the views you put forth and then see where they then didn't hold up. I do that while being willing to change my own mind if that is where the evidence leads, but the research presented didn't hold up to scrutiny. So while I definitely disagree with you, I do so from a place of appreciation for pushing me to do more digging into this things and whether *I* should hold the beliefs that I do.
Me too :)
I like discussions like these because its always an opportunity to absorb more information.
But also seems very much like a software dev, so does seem to reinforce the stereo type.
I have some really interesting, but lengthy text that's really important for me to read for class. No cell phone, cleaned my room, put on specialized focus music, jot down all my random thoughts on a notepad, got myself a cup of coffee and made sure I eliminated all distractions.
I then proceed to read the first two or three sentences before I realized I have been mindlessly scanning the text with my eyes like I'm reading, but instead I am doing the equivalent of watching a movie. I'm 100% zoned out and in la la land.
I realize this, so I stop, refocus, repeat. I realize I did it again, stop, refocus and try reading out loud. I'm annoyed because I'm saying the words out loud but not comprehending it.
I meditate for 30 seconds to calm my mind, try to refocus and repeat. I finally get through it after about 30 minutes.
Here's how my personal experience looks with medication:
I pick up the damn paper, read it and summarize it with notes in 5 minutes.
Understandably people want to help when they see someone struggling with the same things they did, and I'm not suggesting that you don't seek out professionals if you think you might have a disorder, but we need to stop labeling completely normal behaviour as problematic.
Just like people without various disorders can't relate well to those with e.g. ADHD, people with the these disorders also understand neurotypical behaviour way less than they think they do. A large number seems to struggle with separating "normal" quirks of the brains and their diagnoses.
Also, just because it seems like a simple lack of focus to you externally, that does not mean the person does not have a disorder.
And brilliant picture.