You've raised some common and valid criticisms of how ADHD is diagnosed.

1. On standardized scales being "meaningless": The term "standardized" here doesn't just mean a consistent set of questions. It means the scoring is normed against a large, representative population. So when a parent says their child "often" loses things, the scale helps a clinician determine if that "often" is statistically significant compared to other children of the same age and gender. It's a tool to quantify subjective reports. You're right that any set of symptoms can be standardized, but these scales are specifically designed to measure the frequency and severity of behaviors outlined in the DSM/ICD criteria. They aren't a standalone test, but one data point in a larger clinical picture. Most psychiatric conditions rely on this kind of structured self-reporting. The people working in this field work very hard to apply statistics properly when designing and running these tests; it's so far from random it's not even funny.

2. On CPTs: I agree that a CPT is an artificial lab scenario. That's a well-known limitation called a lack of "ecological validity." No one claims it perfectly replicates real-world focus. Consensus statements are clear that CPTs are insufficient for diagnosis on their own. Their value isn't in definitively saying "you have ADHD," but in providing an objective measure of things like attention lapses and impulse control that can supplement the subjective reports. If someone's self-report suggests severe inattention but they score perfectly on a CPT, that's a data point a clinician needs to investigate further. It can help in the process of differential diagnosis. The studies you linked highlight its limitations, which is consistent with the consensus view that it's a supplementary, not a primary, tool.

3. On multi-informant reports: You say these are "as subjective as you can get," which is true, they are subjective. The entire point is to gather subjective reports from multiple contexts to see if a pattern emerges. A core criterion for ADHD is that the symptoms cause impairment in two or more settings (e.g., home and school/work). If a child is only described as hyperactive and inattentive in a boring classroom but is a focused and motivated musician at home, a good clinician would question an ADHD diagnosis and look for other factors. The goal is to see if the problem is with the person's underlying regulation skills across environments, not just their "fit" in a single, artificial system.

4. On the DSM and clinical interviews: The word "often" is intentionally not given a hard number because it's relative to a person's developmental stage. "Often" losing homework is different for a 7-year-old than for a 30-year-old. This is where clinical judgment, guided by the DSM criteria, comes in. As for the symptom overlap, you're describing a feature of many polythetic diagnostic systems, not a flaw unique to ADHD. It recognizes that the disorder can manifest differently in different people. The clinician's job isn't just to count symptoms, but to assess the entire pattern, determine the level of impairment, and critically, rule out other potential causes for those symptoms (anxiety, depression, trauma, etc.). The diagnosis is a synthesis of all this information. Again, standardized test scoring DOES have the effect of giving a "definition" to the term "Often", because when thousands of forms are filled in, individuals' different definitions of the term converge in a statistically significant way onto a concept that is meaningfully comparative.

5. Finally, your historical point is interesting. Descriptions of ADHD-like symptoms date back centuries, long before the DSM. Sir Alexander Crichton wrote about "the incapacity of attending" in 1798. The diagnosis wasn't just invented out of thin air in the 20th century. It's a modern label for a pattern of behavior that has been observed for a very long time. The research and technology we have today are being used to better understand its neurobiological underpinnings, not to retroactively justify a "socially agreed upon disorder".

I'm really curious what the next century of study will do to illuminate this condition. I suspect we will have significantly greater understanding of the role of genetics and perhaps, one day, a blood test will diagnose ADHD.

I hold the same criticism for other psychatrist disorders, I am only talking about ADHD because its the one I personally identify with and spent the most time thinking about.

I am not disputing that it's possible to group populations on behavioral traits, long standing emotional states, etc. If you want to say "there are people who feel unmotivated, inattentive in their life and we call that ADHD", fine. However identifying a distinctive cause as a scientific fact is an entirely different matter. I.e, your behavior categorizes you as ADHD by the DSM, we found taking amphetamines often helps people with these complaints is a very different statement than something like "you lose things often BECAUSE you have ADHD"

>but in providing an objective measure of things like attention lapses and impulse control that can supplement the subjective reports.

Stick in me an abstract math class and all my neurons will be firing, put me in accounting and ill fall asleep. How is a simplified messure of attention in a single artificial scenario interesting? These labs are for profit companies trying to make a buck.

>Again, standardized test scoring DOES have the effect of giving a "definition" to the term "Often",

I dont see how this follows. You at best merely have some distribution of how often people feel like they lose things. You have no way of either knowing how often it is people actually lose things or how inattentive they are in conversations, and certainly less so that the patient in front of you is so. I urge you to think about this little more deeply.

Lets take inattentive in conversations for a second. How many conversations does the patient have, with whom? What are the patient's interests versus the type of conversations they have? Are they shy, awkward, or likewise the people around them? How long of not paying attention is considered inattentive? What is the objectively measured norm for all these behaviors? And if you can admit its way too hard to measure, all youre doing is basing your decision on your own and your patients feelings. As a psychiatrist, you have to ask yourself, are you really trying to understand the cause of this patient's inattenttion in conversations, or are you merely looking enough evidence to fit them into a bucket that you already understand? Id have a million questions before I can even answer this question intuitively, nevermind objectively.

And this is besides my greater point here. Per the DSM, it is possible for you to have ADHD and not be found to be inattentive in conversations but often be losing your keys, and for me, vice versa. So were admitting these things can have other factors. For example, I may be losing things simply because my mom never had me clean up after myself and I keep dirty place with too many visual distractions. Maybe I have a job or friends or whatever circumstances that make my life more chaotic. Perhaps going out anywhere makes me nervous so I don't think clearly about grabbing the things I need on the way out. Perhaps Im not as bothered by being inconvenienced so I dont care as much to meticulously think about the things I need.

And you will say "true, but ADHD isnt just losing your keys, its a pattern of related behaviors", and I say what is the belief that these different behaviors aren't independent?

Categorizations can be useful, but by definition are a loss of information. We have learned nothing by attaching a name, except perhaps a feeling that we have something simple we can understand.