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How well defined is ADHD?

8 Post author: jsalvatier 15 November 2012 11:34PM

I've long had attention and focus problems, but never explored the possibility that I have ADHD till recently. I understand that it's a standard term, but I'm still a bit suspicious; Psychiatry doesn't seem like the most reliable field.

Are there good reasons for picking out the behaviors associated with ADHD and giving them a name? Obviously this is a different question than whether ADHD is a 'disorder' or 'disease', and whether ADHD medication is good or bad for people.    

Answers that would satisfy me

 

  • Behaviors associated with ADHD strongly cluster
  • Analyzing questionnaires of attention and focus behaviors with faction analysis naturally produces an 'ADHD dimension' that explains a lot of variance (similar methodology to identifying Big 5 personality traits). 
  • ADHD diagnosis a strong predictor of anything interesting (income or grades or some contrived but interesting lab test)?
  • Something else along these lines.

 

Comments (32)

Comment author: [deleted] 16 November 2012 01:53:08AM 7 points [-]

I was diagnosed with ADHD as a child.

I know very little of physchology, but the behavioural differences between (young) me and other people were noticably significant to anyone in the room. The medication (ritalin) they prescribed had a strong regulatory effect that made me more "normal". I stopped taking it in high school.

I am now sentient enough to reflect on my internal experience, and recently I took my chldhood ritalin dose. The effect is quite noticable; when I took it, I was able to focus for hours on one thing without getting distracted, which I can never otherwise do. I've heard that non-ADHD people do not have such an effect from ritalin. If they did, ritalin would be a major improvement to most people's lives.

Alas I have not found the conscientiousness to actually talk to a doctor and get back on ritalin.

anecdotes for you...

Comment author: ewang 16 November 2012 01:58:53AM 2 points [-]

I've heard another anecdote from someone with ADHD that ritalin helps you focus at the cost of YOUR SOUL.

Comment author: [deleted] 16 November 2012 04:44:15PM 7 points [-]

I've heard such things. I noticed a possible drop in creativity.

As jsalvatier said, nice to have the option. Sometimes I need to get shit done, not have a "soul".

If it was a permanant choice that would be different.

Comment author: jsalvatier 16 November 2012 06:36:49AM 7 points [-]

Nice to have the option, though.

Comment author: Kindly 16 November 2012 04:38:25AM 1 point [-]

Dun dun dun.

Comment author: DaFranker 16 November 2012 03:38:49PM 0 points [-]

Eh, if it gives the effects described in the grandparent on a consistent basis and I happen to have ADHD, I would gladly trade off the very low expected cost of my soul (since I have a very low P on it existing in the first place) for the large increase in mental superpowers.

Comment author: BlazeOrangeDeer 18 November 2012 08:26:04AM 2 points [-]

Remember that the "soul" you are giving up isn't really the Cartesian dualist version. It matches better to certain emotional or social states that many people prefer to experience.

Comment author: jsalvatier 27 November 2012 12:29:25AM *  1 point [-]

Two papers may be of interest:

  • Both ADHD diagnosis and no ADHD diagnosis people get increased focus with low doses of stimulants (link).
  • The correlation between ADHD diagnosis and low-conscientiousness is high.
Comment author: falenas108 16 November 2012 05:06:07AM 0 points [-]

I was "prescribed" with ADD as a child and given ritalin, but I'm not sure if I actually had it. As a data point, it allowed me to focus on whatever my teacher said with almost no effort.

As a more general point, some kids in college take ritalin to help them in classes. This would indicate that it does cause that behavior in a significant portion of the population.

Comment author: wedrifid 16 November 2012 06:32:15AM 4 points [-]

I was "prescribed" with ADD as a child and given ritalin

I think you may have been "diagnosed" with ADD and "prescribed" ritalin.

Comment author: falenas108 16 November 2012 02:33:58PM 0 points [-]

Whoops, yeah.

Comment author: Kawoomba 16 November 2012 07:05:02AM *  4 points [-]

The "Controversies" section of the wiki article you linked is a good starting point.

Quotes:

"Debates center around key controversial issues; whether ADHD is a disability or merely a neurological description, the cause of the disorder, the changing of the diagnostic criteria, the rapid increase in diagnosis of ADHD, and the use of stimulants to treat the disorder."

"[D]iagnosis is more likely to be made in the younger children within a grade; the authors propose that such a misdiagnosis of ADHD within a grade may be due to different states of maturity (...) children born in December (the youngest) 39% more likely to be diagnosed with ADHD than those born in January (the oldest)."

It's en vogue, and the diagnostic criteria are sufficiently vague to ensure that if you want a diagnosis of ADHD, you'll probably be able to see yourself in such a light that you satisfy them. This introspective process may be affected by mental resilience. Self-perception is crucial for such topics. Take a subjectively healthy person to rigorous psych evaluations and watch the diagnoses roll in. Whether we say "he has X, because the criteria were met" or "he's healthy, since he doesn't mind much" depends mainly on how well that person copes with the various stressors and expectations associated with the human condition, particularly in modern times. Some people like having a diagnosis as a coping mechanism, some don't (I'm excluding severe cases).

In short, for the majority of the usual stressed out first world population, including run-of-the-mill ADHD cases, whether you get the diagnosis or not is a choice you make.

I've interned at a psych clinic where anyone unfortunate enough to walk on the street after heavy drinking wouldn't leave without being diagnosed with paranoid schizophrenia. There's go-to diagnoses subject to cultural trends and trends within the medical community. I count most cases of ADHD (that I know of) among those.

Comment author: zntneo 19 November 2012 03:11:16PM 1 point [-]

You might also get diagnosed with things out of the blue. I have dealt with depression MST of my life and one Dr tried to say I had psychosis. I am pretty sure he was wrong.

Comment author: Ishaan 27 November 2013 01:30:09AM *  3 points [-]

ADHD diagnosis a strong predictor of anything interesting (income or grades or some contrived but interesting lab test)?

This is one of those scenarios where there are so many examples that it's difficult to pick one. I'll just link this meta one at random - there's no specific reason why I chose that one, there are so many others.

In general, any cognitive test which involves sustained attention (working memory tests require a lot of focus) will have a robust effect.

There's all sorts of effects with GPA, dropout rates, crime rates, unemployment rates, and other life outcomes...just do a quick google.scholar search for any of these.

I would say that, of the various mental illnesses I've researched, ADHD is actually particularly well defined and well understood. Relatively speaking, when compared to other common mental illnesses, it's a straightforward deficit (Difficulty with attention and inhibition) with a straightforward biological mechanism (hypoarousal in the prefrontal cortex) and treatment (stimulants to increase arousal).

(Also, I think this belongs in discussion - not because it's bad or anything, but because it's primarily a request for information rather than an informative article that everyone benefits from viewing.)

Comment author: buybuydandavis 16 November 2012 02:50:58AM 2 points [-]

Actually, there are a whole bunch of distinctions within ADHD.

First, there's the common ADD versus ADHD. But a Dr. Amen makes multiple distinctions beyond that. He's got six types. In terms of satisfying your standards for ADHD being real, he classifies based on SPECT imaging and behavior, claiming correlation, though I can't remember the specifics now.

I'd say that the brain can screw up in lots of ways, and lots of those ways get called ADHD, but I would expect fuzzy and sometimes contradictory classifications because most are based on behavior, and not on detailed white box measurement of what is going on in the brain. Different ways of sub optimal function will get boxed together based on some behavior, but then unboxed with finer parsing of the behavior.

http://www.amenclinics.com/conditions/adhd-add

I was diagnosed, or at least given the option of trying medication once. Adderall didn't do anything for me. But I read up a bunch, as we are wont to do around here. One theory not generally advertised is that ADHD is about having too low a basal level of activity in the prefrontal lobe, so that you're too easily distracted by acute stimuli.

Comment author: wedrifid 16 November 2012 03:03:29AM 0 points [-]

One theory not generally advertised is that ADHD is about having too low a basal level of activity in the prefrontal lobe, so that you're too easily distracted by acute stimuli.

Not generally advertised? Isn't that the most basic mainstream theory? I mean... that's the whole point of hammering the frontal lobe with stimulants!

Comment author: buybuydandavis 16 November 2012 03:44:59AM 2 points [-]

The distinction between basal and phasic levels isn't well advertised.

Comment author: wedrifid 16 November 2012 04:11:40AM 1 point [-]

The distinction between basal and phasic levels isn't well advertised.

Ahh, I think I understand. Would you care to give some elaboration on what you mean by "phasic" to ensure we are on the same page?

Comment author: jsalvatier 16 November 2012 06:41:12AM 6 points [-]

And for those of us who don't know anything about this.

Comment author: novalis 16 November 2012 10:42:17AM 1 point [-]

My suggestion: Find a psychiatrist who is willing to let you experiment with medications and see what works. Try all of the different stimulant types, starting with the oldest (because it's the best-understood). If none of them work for you, then you'll have to find other means to work on your focus issues; talk therapy is not likely to make a difference. I'm sure Ask Metafilter can recommend someone in your area who fits this description.

Comment author: jsalvatier 16 November 2012 04:21:24PM 0 points [-]

Huh, why Ask Metafilter?

Comment author: novalis 17 November 2012 05:08:36AM 1 point [-]

Because they found someone good for a friend of mine. And the prevailing community standards there mean that you simply don't get snarky or useless answers; you get useful answers or nothing at all. Which is rather nice.

Comment author: [deleted] 16 November 2012 01:17:14AM *  0 points [-]

Be wary of self-diagnosis. As you probably already know, it's really easy to introduce bias into self-analysis.

Is there a way respondents can code their answers so that jsalvatier can perform an analysis while blinded? For example, don't just say which behaviors are associated with ADHD. Instead, ask a question about whether he exhibits certain behaviors which may be correlated (or negatively correlated, or not at all correlated) with ADHD. But only include which it is in a rot13'd paragraph.

He can first answer that question and then decode the rot13 "answer." This would give him much clearer, unbiased evidence.

EDIT: An (obviously untrue) example for clarity...

Do you like popcorn?

Fhpu naq fhpu n fghql sbhaq gung n yvxvat bs cbcpbea jnf fgebatyl cerqvpgvir bs fbzrbar univat NQUQ.

Comment author: jsalvatier 16 November 2012 06:39:31AM 0 points [-]

Yes, that's clearly a concern. I wasn't planning on self diagnosing, but going to a psychiatrist to be evaluated. That's one thing I wondered about questionnaires used for evaluation, do they include questions which are not related to ADHD?

Comment author: [deleted] 16 November 2012 02:44:31PM -1 points [-]

I think so, but I don't want to generalize from anecdotal evidence.

Comment author: ewang 16 November 2012 01:55:55AM 0 points [-]

Just wait until "fgebatyl cerqvpgvir" starts working its way into the back of the subject's brain.

Comment author: zntneo 19 November 2012 03:48:22PM 0 points [-]

Here is a study that says it predicts criminal recidivism. This study says its predicts substance abuse.

Comment author: DanielLC 17 November 2012 07:31:29AM 0 points [-]

I'm given to understand that people with ADHD react differently to caffeine and Ritalin than other people do. They calm down people with ADHD, and have the opposite effect on people who don't.

Comment author: DanArmak 17 November 2012 12:20:31PM *  6 points [-]

If that is true, then coffee should be an excellent (cheap, safe, quick) test of ADHD. Has anyone done double-blind caffeine vs. decaf trials and correlated the results with other measures and diagnoses?

Comment author: jsalvatier 27 November 2012 12:27:07AM 1 point [-]

This would have been convincing if true, but is apparently false. Looks like the key difference is dose, at low doses stimulants aid focus and at high doses inhibit it (or something like that).

Comment author: DanielLC 27 November 2012 07:43:37AM 0 points [-]

Interesting. I wonder if it would be possible to detect someone with ADHD by their preferred dose.

Come to think of it, the original test could still work. If we know that caffeine affects people with ADHD differently, the fact that it's because they're taking a smaller dose is irrelevant. It does mean that you're not allowed to control dosage, so it would be more prone to error.

Comment author: jsalvatier 18 November 2012 10:22:59AM 0 points [-]

I've heard that too, which would definitely count as strong evidence. Would be cool to see studies comparing ritalin or caffeine on ADHD vs non ADHD people.