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…
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.
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.
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).
Good to know that neurotypical people mostly likely test differently than I did.
But then I worried if my system worked, I would be misdiagnosed.
It didn’t work. I was 98th percentile.
Thanks for sharing this!
Yeah man I can go ahead and let you know early if you want.
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.
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.
In the US, at least, it ranges from difficult to straightforward, but that's not true everywhere
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.)
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.
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...
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...
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.
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 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.
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.
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.
And brilliant picture.
ADHD is way more complex than just an attention issue, I mean just the amount of average daydreaming and "rumination" and the constant multi-threading of thoughts... is just next level, I believe it's not properly explained to outsiders that might just think that X guy just have a hard time going in the flow but in reality it's much more catastrophic than this and will create many more mental health issues if left unmanaged.
Most ADHD people that have jumped on some sort of strong treatment (stimulants in general) are discovering a new world in pretty much 1 hour, the first time the mind goes "quiet" is incredible. I advise everyone to read more on this website https://www.adxs.org/en - it's also friendly to scrape to be used with LLMs.
ADHD isn't a good thing to have imo, it's a serious dysfunction and it's sad to see that it's being romanticized lately in social media or plainly discredited by some people/media, and while treated ADHD can make you productive "all the time", you end up addicted and pretty much permanently require drugs to function well.
To that point, I'm going push back on this language just a bit:
> you end up addicted and pretty much permanently require drugs to function well
That is negatively framing medication, which if taken properly as prescribed is no different than any other medication someone might take to help with a chronic health condition. It slightly encourages and leans into the idea that ADHD is "fixable" without medication and so taking medication is a problem (or due to a weakness, etc).
I'm not discounting the value of other forms of non-medical treatment, but in many case medication IS appropriate as part of the overall treatment that a person requires to manage their ADHD. We should not use language that stigmatizes treatment that should be between a person and their doctor.
in reality, if the side effects are minimal and you function better on it, it's a sip of water and a pill a day and that's largely it for health outcomes. most drug interventions are generally extremely well-studied with very large sample sizes. there's a reason why clinical research is considered gold-standard - the regulatory requirements to even get a drug to market is monumental and some of the most rigorously audited and vetted processes in the world
the ironic thing is that most of the big pharma detractors are also ingesting dozens of supplements, the vast majority of which have little to no good empirical evidence backing them (and very small effect sizes to boot) along with even less regulatory oversight for issues like contamination, formulation, or if it even contains the active ingredient. which isn't to say that 'big pharma' doesn't often pursue avenues for profitability reasons instead of the public good but that's not the typical critique that an anti-empiricist brings most times
The difference the medication makes is similarly revelatory to putting on eyeglasses. Of course you never want to take them off.
There's no withdrawal symptoms, per se, for most people, the addiction is purely psychological from "trying to drive with only 3 tires sucks"
The actual meaning is more complex, involving inability to stop, negative effects on your life, etc. - none of which apply to wearing your glasses or breathing.
If you can be behaviorally addicted to gambling, or even more aptly eating, you can be behaviorally addicted to medication that doesn't give you any physiological dependency.
> The DSM-5 has re-classified the condition [ed: gambling addiction] as an addictive disorder, with those affected exhibiting many similarities to those with substance use disorder. They both activate a reward mechanism in the brain, causing dopamine release to reinforce repetitive behavior. Both often lead to loss of control.
Edit: to engage more substantively, imagine if your glasses gave you, say, mild skin irritation that progressively got worse with wear, but you chose to mitigate that and wear them anyway. I would rate it at that level.
People with ADHD are often amused by referring to amphetamines as a "hard drug" since it has practically none of the typical hard drug effects on them.
I'm on stimulants and I agree that the post you responded to needed reframing. But I think we do ourselves and anyone else who isn't "normal" in body or mind a huge disservice just focusing on acceptance of treatment when there are larger societal changes that could be made.
On its own, its not "a serious dysfunction". Within the context of operating within the current societal setup for a paycheck that provides basic survival needs, yeah.
It allows me to sit down and do 'something' without being taken completely off task for the rest of the day because someone kept knocking on the door or reading a hostile/complaint email. What that 'something' is is not always 'productive' but now I can do it without everyday things or upcoming events throwing me in a completely different direction.
Meds helps with the alignment issue. If you are taking meds and its making you "productive all the time" and you find yourself addicted to it, I suggest talking to your doctor about that. I had to work with CBT just to form a habit of remembering to take the medication, and it took a few years before I finally started to remember regularly. I still forget on days that dont fit into that routine
No? First, even when I was taking it almost every day for three years, I kept forgetting to take it. Today, my last refill was in February this year.
I recommend against raw-dogging reality with ADHD without meds. At least so you have baseline "this is what normal feels like"
Consider the subreddit r/stopspeeding, a recovery community for people addicted to stimulants. Many, many users share similar stories of being prescribed a stimulant medication for ADHD, then beginning to abuse it. Many of these people really do have ADHD, but find that their lives are better without stimulant medication.
The author of the article is contributing to this by using their medical diagnosis to "outsmart" the system for writing material. Presenting a proper ADHD assessment as merely an online test just adds fuel to the fire (and if this is the only interaction they had I am skeptical of the assessment procedure).
> and while treated ADHD can make you productive "all the time", you end up addicted and pretty much permanently require drugs to function well
That's an unfair and sweeping characterization of the immediate therapeutic benefits and long-term health outcomes of individuals.
I don’t think I was trying to “outsmart” anything, I’m just a naturally curious person