> ADHD is kind of a weakly differentiated diagnosis that could apply to most people
I don't think this hypothesis would survive a look through the literature on google scholar. ADHD is associated with huge increases in risks of suicide, substance abuse, homelessness, accidents, crime, autoimmune disease, etc etc etc. It's not just "damn I find it hard to focus sometimes".
I have diagnosed ADHD and I agree largely with the person you are responding to.
The claim is not that ADHD is not a set of people with real psychiatric disorders, but it is a loose umbrella for what are actually disparate problems.
I recently learned that my symptoms, to a large extent, can be explained more accurately as POTS or something adjacent, and the meds I guided my psychiatrist towards were far more helpful than the stimulants I was being prescribed. This was a combination of me, reddit, and later LLMs arriving at me-specific diagnoses that go beyond clinical guideline regimes.
> a loose umbrella for what are actually disparate problems
For me, the DSM-V & DIVA criteria are eerily accurate. I was diagnosed as an adult and it felt like a cruel cosmic joke reading through the psychiatrist report and realizing that most of my past and present issues were repeatedly-documented commonalities of a single condition. It was as if my life had just been playing out from a predetermined script.
I fully agree that that many distinct conditions are incorrectly swept under the "ADHD umbrella", but ADHD is not in any way a "loose" description of me.
> more helpful than the stimulants
My currently prescribed stimulants have been the only thing to ever make me feel consistently "okay", after having previously given up on medications ever helping. I'm sure they also enable me to write a few more lines of code per day, but I'd still be taking them even if they made me significantly worse at doing so.
My criticism is not that the criteria don’t apply or that people don’t think they do - but that most people reading it seem to describe what you’re saying.
It seems more like a horoscope to me - everyone can find themselves in the criteria. It’s an observable thing, I’m just not sure I buy its special distinction.
People also used to make the claim that the stimulant drugs had special effects (or even opposite effects) on those with ADHD vs. the non ADHD population which always seemed like bullshit to me, but I don’t see that claim being made here anymore.
Edit: after writing this comments others in the thread started making this claim
> It seems more like a horoscope to me - everyone can find themselves in the criteria. It’s an observable thing, I’m just not sure I buy its special distinction
Do you think the same about conditions like Autism or OCD?
People often say they "are a little bit" OCD or autistic, but it's the degree to which those traits are experienced which is the differentiation. There is also no objective test, it's all "soft" science.
> People also used to make the claim that the stimulant drugs had special effects (or even opposite effects) on those with ADHD vs. the non ADHD population
This is my experience, but I understand that anecdotes aren't good evidence.
FWIW I don’t think the same about autism and OCD (at least not to the same extent). There are some similar problems with the soft diagnosis, but there is more going on there imo.
They both do have problems with variableness (particularly autism), but it’s more distinct from the general public.
My "personal hypothesis" is that the ADHD/Autism/OCD are fundamentally related somehow. The comorbidity between them is much higher than general population incidence, there's large symptom overlap, on a personal level I've found that I relate to and get on along much better with people who have at least one of those conditions, and a good 2/3rds of the people I consider close friends do.
I largely agree with you but it's not quite as generic as horoscopes and similar can be. Let's look at the DSM-V's diagnostic criteria for ADHD:
A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2). B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years. C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities). D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning. E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g. mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
I think E is probably a common miss, and fits with ADHD being over-diagnosed vs. other disorders that can have overlapping symptoms. The differential diagnosis section could perhaps be more detailed. But now briefly looking at A's (1) and (2). (1) Inattention: Six (or more) of the following symptoms have persisted for at least 6 months ... (lists 9 symptoms related to forms of inattention, the most generic of which I think is just f: "Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g. schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers)") (2) Hyperactivity and impulsivity: Six (or more) of the following symptoms .. (lists another 9 symptoms -- I count 3 pretty generic ones in a. (often fidgeting), f. (often talking excessively), and g. (often not waiting for a turn in conversation or completing people's sentences -- common in online meetings)).
While flawed I think this is enough detail to diagnose someone and clearly say "you're different", it's not nearly as broad as a horoscope "this sign is strong" or "that sign is deep" language and similar. The "Often" qualifier does a lot of work. Nevertheless, two people can both be diagnosed with "ADHD" and yet have few to no overlapping diagnostic symptoms.
Yep! A short summary of my n=1 findings (currently very speculative, but also sound I think, am meeting with my cardiologist next week to see what he thinks).
The type of ADHD I have seems to have an "autonomic nervous system impairment" component and a symptom profile overlapping with hyperadrenergic POTS.
1. I respond much better to Guanfacine ER (GFC) than stimulants alone (currently complementing with Vyvanse (LDX) 40mg, but I'd rate the Guanfacine as critical)
2. My blood pressure is very volatile, and GFC is supposed to have an impact but did not in my case, at least initially. I'd take GFC at bedtime and LDX in the morning, and on ChatGPT's suggestion, I asked my psych if I could take them together in the morning. Gamechanger for my blood pressure: the explanation seems to be that LDX makes my sympathetic nervous system extra simulated (on top of a poor baseline), and co-timed GFC balances it out.
3. I have poor cardiac endurance, and I find running nearly impossible. I'm a healthy young male who does weights and all. At ChatGPT's suggestion, I wore a Polar H10 and measured my resting heart rate while sitting, and then while standing still. I get a jump from 80bpm to 115bpm-ish, a strong indicator for something orthostatic.
I'm currently exploring rowing (with a concept2). I don't know why but it has a strong impact on my mental state that goes beyond general exercising: something about the rhythmic entrainment it produces, while being recumbent (good for POTS).
I don't think this hypothesis would survive a look through the literature on google scholar. ADHD is associated with huge increases in risks of suicide, substance abuse, homelessness, accidents, crime, autoimmune disease, etc etc etc. It's not just "damn I find it hard to focus sometimes".