Does anyone have experience with the emotional dysregulatiom bit and what that looks like as an adult?
I have friends with adhd tell me that I have it, but my parents have suggested there was nothing present to indicate I had it as a child, which seems to be a binary input for diagnosis.
But I do seem to way overreact to the silliest things. For example, if my toddler trips and falls, my mind immediately races to "they definitely knocked all their teeth out and will be in pain and will have dentures forever and will never enjoy life again", and that seems to short circuit my reaction into a total panic/meltdown before I've even looked at the kid's face (which never hit the ground). And the advice of the internet such as deep breathing, stepping away, etc. is totally unhelpful as it seems my reaction is instantaneous. Then there's the crash and shame that follows it once the initial surge passes, which feels like my brain is lurching forward in my skull when I can feel it happening or stop it. And then I vow to never do it again, but then it happens.
I seem to mostly exist as a normal human otherwise. I can hyperfocus on coding, but that could just be normal focus because that's what I do all day.
My suspicion is that I have depression since the symptoms are overlapped, and I've never scored below a 20 on the phq-9.
Recently when I've crashed, I've started considering seeing a psychiatrist, but my motivation seems to run out quickly after I start considering it or looking them up. I also don't want to be involuntarily detained and lose my tsa precheck.
Edit: Not sure this is relevant, but I do tend to hit/slap my face when I get in these overwhelmed states, which my wife has pointed out is not normal nor okay.
It reminds me that ADHD is really not that useful of a name, executive function disorder would be a more accurate name from when I was looking into ADHD in the past. It's not about attention deficit per se, as that's downstream of struggling with executive functioning. At least it's the definition that lines up with my experience best (I have ADHD). I'll make lists in order to keep track of important tasks (which in theory would help with attention deficit) but then I'll sit down to do the things on the list and... can't. It's such a hard thing to explain, but no amount of attention hacks can get me over the hump of doing the tasks I'm dreading. That seems much more related to executive functioning.
For me it’s that as soon as I intend to begin a task, I start thinking about every step, and everything that might go wrong at every step, and planning contingencies for every hypothetical problem, and on and on.
So suddenly the task seems totally overwhelming, when I could just… not do it. So I find a time later I can attempt it and after a few times it is no longer novel and I forget about it.
If anything is hyper-active, it’s the executive function part of my brain that is driven to plan out every tiny, hypothetical detail before I can start.
What’s missing is the reward and internal incentives for doing things when there are other things that do feel good to do (that aren’t what I need to do).
I'm the same way and I've found there's no real way around it. I've found it's actually a really useful way of thinking for complex projects and planning and prioritization, but bad for getting things done. The only things that work for me to manage this:
1. Relentlessly make distractions high friction. Block websites, go to the office if you get distracted at home, etc.
2. Use time-based daily planning instead of goal-based (stuff like pomodoro helps). If I put "create work plan for project Z" on my to-do list, it is ambiguous and I will put it off forever. If I just say "Spend 25 minutes on work plan for project Z, no pressure on outcome/output", I make tons of progress (and often can continue the task for a while)
This is a great insight, I wonder if that's a sign of Innatentive type ADHD. But I would say that the process of thinking of other things that also need to be done, is not done by the executive function part of the brain. The executive disfunction is the decision not to begin the task.
I experience the same thing very frequently. I likened it to activation energy in a reaction, that no matter what I did I couldn't create the required electrochemical bias in my brain needed to put ideas into action. It's like being stranded in your own mind, you know what you need to do, but the 'go' just never arrives.
I eventually discovered that the adrenaline response from extreme stress ('if I don't get this fucking thing done by 7:30am I'm fired' kind of thing) allows me to lock in and do the thing.
>I eventually discovered that the adrenaline response from extreme stress ('if I don't get this fucking thing done by 7:30am I'm fired' kind of thing) allows me to lock in and do the thing.
I went the other way. I knew from the start that this "trick" helped me work. It took until my 30s to learn that that's ADHD and that I can skip the stress with medication. God knows how many years of life I've robbed myself of with the stress spikes.
For me, the side effects of the medication are intolerable. I wish there was a way to get that starting impulse without stimulants or SNRIs which kill my libido
If it helps, another trick I used to use was external help. As in, calling a colleague and starting in pair programming or simply discussing or whatever. Having eyes on me had the same effect as the looming deadline without the stress.
You have to learn to be super trigger happy with it, otherwise you fall in the trap of 'I've been inactive for too long, I can't call and reveal that I haven't started'.
Yes, I agree, I'm lucky that legality was never a concern.
I'm covered by public healthcare so access to medication is stable and costs literal cents. My only complain is that ADHD is not at all known here so it took time and luck to get a diagnosis, because the possibility wasn't in my radar.
It was a surprise to visit London recently and see the amount of ADHD-related ads everywhere (books,clinics, etc).
I use the same analogy explaining to people what my meds do. They’re a catalyst in that they lower the activation energy of doing anything other than doomscrolling
That wouldn't work (for me, at least). As soon as I figured out the pattern, I'd know I had a week after the 'deadline' and then the pressure is off until that week is passed/nearly up
That's been my experience with tricks. I'll think of some clever trick to work around my ADHD, and it'll work great for about two weeks. Then after that I'll start anticipating it and working around it. The self-defeating nature of ADHD might be one of the most frustrating things.
Everything is due NOW, seems to work best for me. Just a list to make empty, so I can sleep. Give me deadlines, or ask for estimates, and the task is doomed.
I've always considered it Too Much Attention Disorder.
The way I like to think about it is that neurotypical people have a beam of light shining out in front of them, wherever they turn their head the light shines and that's where their attention is. Nothing else distracts them from where the light is shining.
With ADHD (for me at least) it's like 50 beams of light scanning the entire room constantly for 'something'. This is too much attention to things that I'm not really interested in, but can distract me from anything I'm trying to do or wan't to do.
For things that I am really interested in (like writing code) the 50 beams of light all manage to synchronise and focus in the same place and that's hyperfocus.
Attention means an ability to ignore unimportant things. This is why the disorder is attention deficit - your ability to ignore distractions is diminished.
Yea, ADHD attention is a like targeting system that has only one setting - it's constantly seeking the most stimulating activity nearby and never stops - sometimes the most engaging feeling activity even changes from minute to minute.
But the hyper-focus can be magical when it targets the task you need to do!
I find similar behaviour in myself, particularly that dreading a task makes it significantly more difficult to start. I find that if I can manage to do just a little bit, even just open the application and maybe look around a bit at what I need to do, it really gets the momentum going for me.
Do you think there's anything that differentiates what we might call "general task dread" that perhaps anyone experiences to a certain degree from a more broad executive function disorder? Or is it that dreading leading to task paralysis is one of many symptoms of an executive function disorder?
How are you for task completion? For me, transferring a load of laundry from the washer to dryer is not an atomic operation. There is ample room to get derailed and wander off during the twenty seconds it should take. It can be interrupted by almost anything. Oh, I forgot to send that message. Oh, I forgot to check for the parcel. Oh, I need to go to the store today still. And I will walk away and forget to come back and finish.
I think the frequency and level of impairment is what differentiates normal executive dysfunction from an executive functioning disorder.
Perhaps a bit rhetorical, but how often does this task dread occur? Does it also ever occur for things you want to do, not just obligated to do?
For me, I experience this issue for many tasks everyday. Then again, I have never had a normal executive functioning, so I cannot claim to know what it is like for normies.
I’ll also add that ADHD is more than just executive dysfunction too.
Someone else who describes it like I do. You sit down to do a task, and there's an "invisible wall" between you and the objective. You physically CAN'T type on the keyboard if it pertains to the task at hand. You get up to go on a walk, and all of a sudden CANNOT WAIT to get back home to start the task. It sounds like the most enjoyable thing ever! Until... you get home and are greeted by the "invisible wall" again...
When I was a teenager, this would sometimes get so extremely bad that I could only describe the feeling of forcing yourself to push through this wall as almost painful.
My body would tense up to the point of shaking and I could feel my brain absolutely SCREAMING "NO. NO. NO."
In my mental model of ADHD, executive functioning is at the center of an hourglass-shaped graph. The bottom half consists of multiple "internal" layers/systems (neurological, psychological), in which some deficiency or deficiencies cause a lack of executive functioning (arrows point up from layers down below upwards to the central element of "executive functioning" to visualize the direction of causation). The upper half shows the outward facing layers/system behavior, social relationships, skills; the arrows point only upwards. I don't have any scientific source for this graph, but I never experienced any "ADHD"-related problem that I couldn't understand through this lens. Happy to share my sketch if anyone is interested.
It’s that I try and then can’t. When stuck in bed I can feel this momentum building in my head to push for movement and the a surge of will and then nothing. I didn’t reach the threshold of exerting my will and now I’m waiting for the next wave.
Yeah, it’s a common topic of discussion in the various adhd discussion groups across the internet. Unfortunately changing the name would have some unintended effects because a bunch of regulations and other things are using the current denomination
Ah man I feel you. What helped a bit for me is relentlessly trying to get your career focused on only fun things. It's a long term strategy, but I am now a not-so-successful-yet entrepreneur but I do love about 95% of what I do and that makes me do things fast and without it feeling like effort.
Executive function problems are symptoms of ADHD, therefore renaming it as executive function disorder would omit the root cause. Dr. Edward Hallowell proposes Variable Attention Stimulus Trait (VAST) as a better name.
It was even called "minimal brain damage" at one point early on!
I'm also reminded that "Obsessive-Compulsive Disorder" and "Obsessive-Compulsive Personality Disorder" are different in kind but necessarily in magnitude.
The former comcerns more localized obsessions and the latter is more of a global "default state of perfectionism".
to me it is definitely "attention deficit", and it is a deficit in attention in two distinct ways:
1) it's a deficit in that i can't put my attention where i want to put it when i want to put it there. this is definitely "attention deficit" to me.
2) when my attention wants to focus on something on its own somehow, i can't prevent it from putting its attention on that; that thing becomes my main focus for some amount of time that I can't really control. that's also definitely "attention deficit" to me, but in another way than the first way.
I always picture it like trying to force and hold a strong magnet flush against the like pole of another. It seems like it will be easy at first, but the closer they get, the harder it becomes and just as you are about to manage it, they fly apart and the magnet gets stuck to an even stronger one nearby.
You manage to pry them apart, but it goes flying through the air and only to get stuck on an even stronger magnet still. And on it goes, over and over, until the magnet is stuck on the biggest, strongest magnet.
Your attention is constantly being repelled from less engaging activities to more highly engaging activities, and eventually you land on whatever the most engaging activity is nearby. Sometimes without even realizing it
Your comment's parent might know very little about ADHD, but your critique shows an antiquated view as well. It's not only the ADHD person that needs to change by any means available so that they fit the expectation of the system. The system, too, is in need of change, so that we accommodate more diverse people. Improving the environment that you operate in goes a very long way and might enable exactly the kind of change that makes children and adults with ADHD thrive. Medication is just one option. CBT and more flexible environments are as important, probably even more so.
It's not an either/or thing. At least for my kid, it's been a combination of the 3 that have helped, but if you dropped a component (including the medication), she wouldn't be doing nearly as well.
I agree with the label being a huge problem. It's basically compressing a multitude of individual characters with huge differences on multiple dimensions of behavior into a binary label, which people confronted with someone bearing that label then decompress based on their personal view on the topic, which is like an algorithm trained on caricatures of what society portraits as ADHD. Your comment sounds like you're doing the same mistake: you take your favorite solution for a complex problem, which (I agree here!) might actually be sufficient for some, a relief for many, any at least good or not harmful for everyone else, but you try to market it as the only necessary solution while invalidating everyone's needs that go beyond this solution. It creates the reactions that you can see in already a handful comments that basically call for the individual to accommodate to the system at all cost...
Hmm, I do this this is a point worth considering, but it needs nuance. ADHD is overdiagnosed in young boys, by about 3% iirc. But the thing is overdiagnosis doesn't mean that it doesn't exist at all. It's certainly underdiagnosed in middle-aged women for example, and tends to be underdiagnosed in women in general. There's also a point to be made that some ADHD meds are not without side effects, and kids aren't always listened to when they complain about them (I have a friend who was on Concerta as a kid and had a lot of side effects that really bothered her). But also, ADHD meds are a complete lifeline when they work, and they do work in most cases.
> It's certainly underdiagnosed in middle-aged women for example, and tends to be underdiagnosed in women in general.
What I'd like to see studied more is whether that root cause is underdiagnosis of inattentive type ADHD. My daughter was diagnosed because my wife is aware of this and had her evaluated, which led to me getting evaluated and eventually on medication. The common thread I've observed is that if you're reasonably intelligent such that it's not causing you to fail classes/get fired, people will just call you lazy and not entertain the idea that there's actually something else wrong. Couple that with girls/women having inattentive type w/o hyperactivity, and I think you do end up with a pretty solid bias.
> But also, ADHD meds are a complete lifeline when they work, and they do work in most cases.
For some there's a lot of trial and error, too. I wonder how many give up or insurance stops paying before they get to the right medication.
Ok, but what about when those children grow into adults that can’t sit still for 8 hours either? I am in my mid-thirties and I am still waiting for the hyperactivity to die down.
> Do you think most people are made to sit still for 8 hours?
No, I was just reiterating the value in the GP comment. I do think the ability to set still has some sort of distribution like all other human attributes. I think it's more important to focus on how little someone sits still compared to how long someone sits still. I'd be lucky to make it a few minutes.
> Do you think someone who can't do that is defective?
No, I do not think of myself nor others that way. I would identify as misaligned. Honestly, ADHD does not cause me as much harm as it does for everyone else in my life. And brother, let me tell you, after all the punishment you receive for being misaligned, you really start to believe you are defective.
Getting the best out of yourself and your environment isn't a matter of waiting to fit in to the sit-down-and-focus shaped life. You have to learn about yourself and learn about how to shape your environment to live your best life, and a major step is not thinking about having that temperament as a disease to be overcome.
Ironically, I know myself very well. I had no choice early on life. I was not officially diagnosed until I was a young adult, FWIW.
Most of my difficulties in life are due to the intersections of my 'temperament' with others. If there was a way I could make life work for me, I would have done so by now. I did not choose to have this 'temperament', and I do not want to have this 'temperament.'
If you have been able to make your life fit for you, consider me jealous. But you need to understand that because you or others are capable of doing so does not mean everyone else is capable of the same.
It’s amazing to see a disproven and frankly ancient viewpoint espoused with a straight face here. When I was a kid in the eighties your way of thinking was already defunct.
This isn't defunct in any way. To the contrary. I've been diagnosed with ADHD myself and creating an environment that is accommodating to my individual needs has absolutely been in line with what experts recommended to be, and it's been a corner stone of my success.
CBT teaches you to evaluate how to shape the environments your living in so that you can benefit the most from your resources and weaknesses and suffer the least from your weaknesses. For some people, this can include taking stimulants, and this is where I do not condone your parent comment's undertone. Nevertheless, it's been proven over and over again that the rigid system that we call schools does not welcome neuro-atypical students and that we could do a lot more to help those who do not react well to stimulants, who do not want to use them (for whatever individual reason), or simply haven't been diagnosed yet! Allowing for movement instead of forcing to suppress it is a very good example for what could be done. One shouldn't make the mistake to think that this alone would be enough for every single child with ADHD, though. But for some, it could be enough.
Exactly. It also ignores recent genetic testing that's showing how different mental illnesses and developmental disorders cluster around the same dysfunctional gene cohorts. To very little surprise ADHD and Autism appear to be closely related for example.
> Some physicians and researchers have argued for years that emotional dysregulation is not peripheral to ADHD but a central, overlooked part of the condition. Yet this symptom does not appear in the formal diagnostic criteria for ADHD in the manual that doctors use to classify mental disorders. That gap has left clinicians without a clear way to categorize what they’re seeing: Are these children best understood as having severe anxiety, as being on the autism spectrum, or as something else entirely? Or does ADHD itself need to be more broadly defined?
Again and again and again. Psychiatry is an epistemic mess.
Psychiatrists are touristic guides of the Paris catacombs that orient themselves with a map of the subway.
"With DSM-V, psychiatry firmly regressed to early 19th-century medical practice. Despite the fact that we know the origins of many of the problems it identifies, its diagnoses describe surface phenomena but completely ignore the underlying causes. Even before DSM-V was released, the American Journal of Psychiatry published the results of validity tests of various new diagnoses which indicated that the DSM largely lacks what, in the world of science is known as, 'reliability', that is, the ability to produce consistent, replicable results. In other words, it lacks scientific validity." ― Bessel Van Der Kolk, M.D.
That "something else entirely" for me was trauma. which has no search hits in this comment thread so far.
I was given an ADHD diagnosis as a child before it was in vogue. From my (admittedly) biased perspective I was given this as a result of hyperactivity which might have stabilized on its own given enough time, but my caretakers reacting poorly to my early behavior caused long-lasting traumatic symptoms which happen to line up with many symptoms of ADHD. So I just assumed that ADHD was the case the whole time. I started to suspect something was off when stimulants did not help my problems, but unfortunately it was not enough to escape the sphere of trying to solve my issues with ineffective ADHD-centric solutions until long into my adulthood.
Childhood trauma on top of misdiagnosis on top of continuing familial issues was an awful combination for me and I can't say that I've made that much progress from therapy, only that at this point I can survive with full awareness of the reality of how I was treated. It felt like I had been living in an alternate reality for decades and now I can't stop thinking about what I've found out.
I’m sorry you went through all that; it sounds really difficult. I can relate, having come from a similar background and situation. However, I wasn’t actually diagnosed with adhd until well into adulthood. The meds have helped, but I also have been given other emotional deregulation diagnoses, and I’ve been wondering if it’s all one thing. This article and your experiences add to that perception, for me.
Regarding progress in therapy, it’s a lot of work for sure. I would recommend looking into brainspotting (1) - it’s been hugely helpful for processing trauma, for me. YMMV
Not having enough sex is hard to formalize as a diagnostic criterium.
Joke aside (which is on me), I have doubts that it's about psychiatry being an epistemic mess. And when I say "that it's (not) about", I mean that it's not (or is) relevant to the framing of the problem.
a) it's only been almost 200 hundred years, most of which were spend building crowd control rather than exploring minds, so it's not an issue of semantics and 'mental' x 'neural' topologies defined in as unambiguous terms as possible. psychology drew lines for the wrong reasons but men, who build and still run the field, are, ... well ... not very manly, are they? nobody is, these days. Some mafia says jump & people jump, you read it in studies and subtext all the time, and in real life, just look at the the amounts of highly functioning autistic people just rolling with the rules of conformity in 'realms' with 'grander'--meaning, in context, requiring high education (not the half baked kind)--purpose. It's weird.
b) "regulation" implies continuity, which requires literally no more than 2 things:
1. learning a few rules, which is an active thing, much easier for ADHD and other people than the thing they have no control over whatsoever, which is
2. brain circuits that don't (or do) constantly break continuity of ... all the things that return thoughts and emotions even though the "main" function isn't done, or any (or only some) of the concurrent, async functions called by the "main" function are or are not done, (yet), all while all the 'context and reality and "presence" sustaining functions' are just stable enough ... (minus that cool part of the CNS that does it's thing no matter what)
All that said, I have to check the study in detail.
We should never forget that the personalities of parents (and other involved parties) play a 1337% more important role than the subtype of ADHD or whatever symptoms a person "shows".
I'm a little confused. ADD & ADHD started as children's issues, if I understand it. Adults had already developed beyond it (was where I thought it started). Then later it got combined into only "ADHD" and adults where recognized (not sure which was first). This article only speaks of children. Has it reverted back to children only? I got diagnosed, only a few years ago.
It does look like they are going the right direction. I year or more ago, I looked up my symptoms on the WHO list of diagnosis and most were on both the ADHD and the spectrum list. I don't believe I've ever had a thorough diagnosis, so I was trying to understand better where I might fit. All I ended up with is that there were a lot of symptoms that border lined.
It felt like it was a bit under defined, like IBS (which I was falsely diagnosed with once) because they just didn't know another one that fit. Anyway, I would love more understanding. The "beyond" is common in people I've spoken with, so is the emotional dysregulation...
I think this is me. I was diagnosed with “regular” ADHD a few years ago, but I’ve had issues with rejection sensitive dysphoria my whole life. As a kid I would have a lot of meltdowns when I couldn’t get something right on the first try or made any kind of mistake.
The meltdowns stopped, but I still have issues spiralling into thoughts of failure and being a horrible person when I feel like I’ve disappointed family or friends.
Guanfacine has helped though. Tried a bunch of medications and this is the only one that seems to have made an impact.
Hey, you've basically described me to a tee as a boy. I had the exact same temperament: meltdowns when I thought I disappointed people, putting myself down all the time for failures and mistakes. My parents weren't even particularly strict.
Might be worth giving Qelbree a shot as well. I switched to it last year and...yeah, it' was a complete game changer. Hard to get insurance to cover, but it's been well worth it.
I recall someone posting that the human brain is essentially "overclocked". I don't recall if that was the phrasing but the gist was that our level of intelligence can only exist by skirting the fringes of sanity. Like some set of dynamic differential equations where, if you bump a coefficient, it spins off into chaos.
Perhaps this Brave New World, as opposed to the more agrarian one our species had been accustomed to, pushes many of us over that threshold.
No science to back this but my first diagnosis was explained similarly. The claim was that the brain consumed all the neurotransmitter chemicals quickly and runs out. Amphetamines speed up production, so you have any instead of none. Idk how correct that is but it seems to work.
Given that this includes rat and mouse studies, it seems like this theory is more around the idea that criticality is a characteristic of how brains work in general, not that human brains hit criticality as a peculiarity of our particularly high intelligence
So that article does not support the "overclocked" thesis, rather that this critical state is needed for optimal performance.
I do agree with the original sentiment, that we are not exactly well adapted to our environment. Or our environment to us, cause this is the main point I think that is missing from this discourse about adhd or other modern frequent mental conditions: too high expectations. Cause of our inherent human narcissism we think we are more attentive and logical than we actually are, so naturally those with lower attention become noticeable first. Or whatever other metric we are measuring leading to whatever condition (depression, autism, ...). At least that mechanism seems underreported in the public. Anyone familiar with how this is viewed on in academia?
Melissa DelBello, a professor of psychiatry and pediatrics at the University of Cincinnati, said that while brain imaging holds promise, it is still impractical to conduct such scans broadly in clinical settings because they are too expensive and not yet precise enough at the level of the individual.
As if questionnaires and slot-machine prescription medicine treatments are accurate. I don't want to generalize for lack of statistical data, but reports of psychiatrists 'just phoning it in' while providing little actual patient engagement are widespread.
I was surprised by how cleanly our results came together,” said Pan, a neuroimaging expert with the West China Hospital of Sichuan University and the Turner Institute for Brain and Mental Health at Monash University in Australia. “We used no clinical information whatsoever in the clustering, and yet the three biotypes that emerged mapped well onto clinically recognized ADHD presentations.
Really cool that this worked out. Now I want to get my brain scanned...
same. any way to do this without being part of some clinical trial? my shit is busted it'd be nice to understand how feel like that would be meaningful in awareness
One thing that I can’t seem to parse from the article is why the researchers assume that this is an unresearched part of ADHD and not a different disorder entirely. I’m sure they have their reasons, but I don’t think it’s written in the article.
To me it seems that if it’s not „treatable“ the same way ADHD is, I’m not sure if it’s useful to categorize it as such. On the other hand, I’m happy if kids with this disorder can get a diagnosis and treatment that actually helps them sometime in the future due to this research.
You have a set of diagnosis criteria, and matching those criteria gets you the ADHD diagnosis. This study takes people who fit the diagnosis, and says there's a test you can do to split those people into three groups.
But yes, once they have a better understanding of what that difference means, the next step might well be to split the ADHD diagnosis into two separate disorders, or even that, like cancer, ADHD is actually a whole range of separate but related conditions.
> why the researchers assume that this is an unresearched part of ADHD and not a different disorder entirely
Whether or not the extreme dysregulation is a different disorder in its own right or not, is not relevant here. They are grouping ADHD matches; clinically recognized ADHD presentations plus MRI recognized ADHD which have a distinct brain sub-pattern occurring in people that have the same distinct behavioral traits. ADHD frequently has co-occurring conditions.
"Identifying “specific subtypes” of ADHD will make it easier to treat these children effectively". Having a more objective way to diagnosis for things like that seems to be the focus of the approach. They expect it to keep evolving, so I wouldn't say they are assuming anything about absolute labels -- just grouping what they now know to be true, that certain external traits match certain distinct brain patterns that are within the larger adhd brain structure.
Also, I think it's not that it is "not treatable" as ADHD, it's that ADHD can be treated in many different ways and currently the wide variety of responses to such is still a black box. Adderall instant release could briefly make me tired, I would sometimes break off a small piece and use it as a sleep aid. Some other `treatments` (I prefer societal alignment coping aid) resulted in what seemed like an expensive joke. Subtypes may eventually be able to show which options work best for which types and to start there first, instead of the current default iteration.
It is a good point and I also struggled with that bit somewhat. It is different in so many ways, have different symptoms, does not respond (as well) to the same medication, and affect different parts of the brain. The jump from there to "subtype" was not too logical for me ...
I've described the field of Psychiatry as trying to describe a building, using only its shadow (projection from high dimensional space to 2d space), with only a handful of choices for the building type. Ultimately only the building (the patient) really knows the full scope of complexity, but a doctor has to be careful in how they get info out.
I don't have a solution, as its an inherently hard problem with a lot of risks (like giving medicine to the wrong person). But I also think this desire to have nice categories for things can be counterproductive in a lot of cases.
I personally think rebranding aspergers + Autism to the autism spectrum was a mistake, as there's a huge difference between someone who's really good at their job but weird and despises certain workplace nonsense - and someone who can't take care of themselves.
ADHD is another great example of a bucket that makes non sense. We were evolved to be hunter gatherers that get many hours of walking or running, and other physical activity every day. Then we act surprised when 11 year olds don't want to sit still 6 hours a day, or getting people like me to write a JIRA ticket is like pulling teeth.
I think separating out these large categories into smaller ones is a good step, but ultimately I think the categories are a counterproductive solution to our human urge to find a logical explanation to things.
I’ve always found the evolutionary biology lens very compelling for ADHD — consider hunters and gatherers. Hunters benefit greatly from the ability to quickly and sharply shift attention in an instant. They thrive at night and can hyper-focus on the thrill of the hunt. As civilization progressed, society was optimized for the majority (gatherers), and the hunters are marked as “disordered” for systemic incompatibilities.
I'm always sceptical of studies which look at a single diagnosis rather than pooling multiple related diagnoses, because the boundaries between them are so fuzzy
They've basically "reinvented" DSM-IV ADHD-PH, -PI, and -C more or less, but at least someone's examined the organ responsible rather than treat it like a magical black box.
ADHD is interesting. I think ADHD is mainly an executive dysfunction and reward centre dysfunction, from my own experience.
And a bit of nature, a bit of nurture.
It’s a real double edged sword for me.
On one hand relationships and “boring” tasks feel insurmountable. When I say boring I don’t even mean boring in the traditional sense, I just mean “not novel” - so even something like playing my favourite ever video game gets extremely difficult once the novelty is gone.
On the other hand, as a software developer, working on novel concepts or exploring novel concepts or ideas is basically like crack-cocaine, I literally can’t stop or put them down.
Double edged sword is struggling with most basic tasks, but excelling at the peripheries.
When you put it that way this might be one of the greatest disabilities ever. Humans that don’t complete things they begin and chase novelty are hard to respect because it’s common and trite. Persevering through failure and the hard bits is essentially the crux of achievement, productivity and success.
Well, I’ve been persevering through the hard bits for 42 years, and still struggle with it. It’s not about chasing novelty, it’s about novelty being many many times more attractive than it is for others.
I don’t agree as greatest disability ever as in “most-disabling” I’d say it’s the greatest potential modifier disability there is.
Some scenarios I loathe having it, but when I’m in the flow state I love it.
It’s made my life-path very non-standard (huge swings up and down), but it’s also created insane opportunities (when paired with high-drive and completing things/discipline)
I personally don’t consider it a disability in my case, but I’m definitely at a disadvantage in a typical work environment compared to my peers. So I understand completely why it’s generally classed as a disability in today’s society and societal expectations.
Like autism, it can produce insane outcomes (think savants etc), and if you can find the right environment for you, you can outperform more neurotypical peers.
I for instance finish all my software projects, because I force myself through discipline. My work output is probably the same or slightly less-good than my peers. But my personal projects where I have full creative control of the outcomes I’d say far exceeds my peers.
I mean in my own case, I’ve achieved far more than my friends and peers - whether that be in business success or other creative areas, but at massive cost - they have much more stability than me, whereas my path is a very non-linear path. I either do exceptionally well or exceptionally shit, no in-between, very black and white
How do you manage to finish things? After a while, for me, the novelty high wears out, and instead it becomes a wall.
Some project require something silly, like sending 1 email to be completed, and it becomes an impossible task
Haha, this made me chuckle so much. That's basically how it goes for me also. Even asking myself, why don't you just do it, then doing something else, feeling guilty about not sending the mail first.
The thing is most people get into a flow state and then persevere through when it’s not enjoyable anymore. If you’re just capable of the first part what’s the point.
It’s great that you can get through the entirety of something because I think that deserves a high form of respect.
> “They are simmering volcanoes basically,” Rosen said. “When things go wrong, they explode. These are kids who will have hour-long meltdowns, throw things and hit and break things.”
...
> For children with this extreme form of ADHD, standard behavioral strategies may fall short. DelBello said that widely used approaches such as positive reinforcement — like giving prizes or other trinkets, or extra recess for good behavior — do not always have the intended effect.
I'm a former foster parent who adopted kids from foster care. Two of them were diagnosed with RAD[1]. This "extreme form" of ADHD aligns with both my personal experience of RAD and a subset of the symptoms described by clinicians. Attachment issues in general are either commonly comorbid with, or misdiagnosed as ADHD and ODD[2] (the latter of which also somewhat matches the symptoms from TFA).
I don't really have a point here, just an observation I wanted to make.
Does anyone have experience with the emotional dysregulatiom bit and what that looks like as an adult?
I have friends with adhd tell me that I have it, but my parents have suggested there was nothing present to indicate I had it as a child, which seems to be a binary input for diagnosis.
But I do seem to way overreact to the silliest things. For example, if my toddler trips and falls, my mind immediately races to "they definitely knocked all their teeth out and will be in pain and will have dentures forever and will never enjoy life again", and that seems to short circuit my reaction into a total panic/meltdown before I've even looked at the kid's face (which never hit the ground). And the advice of the internet such as deep breathing, stepping away, etc. is totally unhelpful as it seems my reaction is instantaneous. Then there's the crash and shame that follows it once the initial surge passes, which feels like my brain is lurching forward in my skull when I can feel it happening or stop it. And then I vow to never do it again, but then it happens.
I seem to mostly exist as a normal human otherwise. I can hyperfocus on coding, but that could just be normal focus because that's what I do all day.
My suspicion is that I have depression since the symptoms are overlapped, and I've never scored below a 20 on the phq-9.
Recently when I've crashed, I've started considering seeing a psychiatrist, but my motivation seems to run out quickly after I start considering it or looking them up. I also don't want to be involuntarily detained and lose my tsa precheck.
Edit: Not sure this is relevant, but I do tend to hit/slap my face when I get in these overwhelmed states, which my wife has pointed out is not normal nor okay.
It reminds me that ADHD is really not that useful of a name, executive function disorder would be a more accurate name from when I was looking into ADHD in the past. It's not about attention deficit per se, as that's downstream of struggling with executive functioning. At least it's the definition that lines up with my experience best (I have ADHD). I'll make lists in order to keep track of important tasks (which in theory would help with attention deficit) but then I'll sit down to do the things on the list and... can't. It's such a hard thing to explain, but no amount of attention hacks can get me over the hump of doing the tasks I'm dreading. That seems much more related to executive functioning.
For me it’s that as soon as I intend to begin a task, I start thinking about every step, and everything that might go wrong at every step, and planning contingencies for every hypothetical problem, and on and on.
So suddenly the task seems totally overwhelming, when I could just… not do it. So I find a time later I can attempt it and after a few times it is no longer novel and I forget about it.
If anything is hyper-active, it’s the executive function part of my brain that is driven to plan out every tiny, hypothetical detail before I can start.
What’s missing is the reward and internal incentives for doing things when there are other things that do feel good to do (that aren’t what I need to do).
I'm the same way and I've found there's no real way around it. I've found it's actually a really useful way of thinking for complex projects and planning and prioritization, but bad for getting things done. The only things that work for me to manage this:
1. Relentlessly make distractions high friction. Block websites, go to the office if you get distracted at home, etc.
2. Use time-based daily planning instead of goal-based (stuff like pomodoro helps). If I put "create work plan for project Z" on my to-do list, it is ambiguous and I will put it off forever. If I just say "Spend 25 minutes on work plan for project Z, no pressure on outcome/output", I make tons of progress (and often can continue the task for a while)
3. music
4. the obvious diet/sleep/meds advice
This is a great insight, I wonder if that's a sign of Innatentive type ADHD. But I would say that the process of thinking of other things that also need to be done, is not done by the executive function part of the brain. The executive disfunction is the decision not to begin the task.
I experience the same thing very frequently. I likened it to activation energy in a reaction, that no matter what I did I couldn't create the required electrochemical bias in my brain needed to put ideas into action. It's like being stranded in your own mind, you know what you need to do, but the 'go' just never arrives.
I eventually discovered that the adrenaline response from extreme stress ('if I don't get this fucking thing done by 7:30am I'm fired' kind of thing) allows me to lock in and do the thing.
>I eventually discovered that the adrenaline response from extreme stress ('if I don't get this fucking thing done by 7:30am I'm fired' kind of thing) allows me to lock in and do the thing.
I went the other way. I knew from the start that this "trick" helped me work. It took until my 30s to learn that that's ADHD and that I can skip the stress with medication. God knows how many years of life I've robbed myself of with the stress spikes.
For me, the side effects of the medication are intolerable. I wish there was a way to get that starting impulse without stimulants or SNRIs which kill my libido
If it helps, another trick I used to use was external help. As in, calling a colleague and starting in pair programming or simply discussing or whatever. Having eyes on me had the same effect as the looming deadline without the stress.
You have to learn to be super trigger happy with it, otherwise you fall in the trap of 'I've been inactive for too long, I can't call and reveal that I haven't started'.
Yep, same, except I was like 40. Couldn't believe it took me that long.
interesting. the meds help me in many ways, but often I still need that activation energy to kick things off
Yes, I agree, I'm lucky that legality was never a concern.
I'm covered by public healthcare so access to medication is stable and costs literal cents. My only complain is that ADHD is not at all known here so it took time and luck to get a diagnosis, because the possibility wasn't in my radar.
It was a surprise to visit London recently and see the amount of ADHD-related ads everywhere (books,clinics, etc).
I use the same analogy explaining to people what my meds do. They’re a catalyst in that they lower the activation energy of doing anything other than doomscrolling
We need two kinds of managers. Normal managers that manages normal people and ADHD managers that manage the ADHD folk.
The ADHD manager has one extra responsibility. Make the thing due 1 week earlier.
That wouldn't work (for me, at least). As soon as I figured out the pattern, I'd know I had a week after the 'deadline' and then the pressure is off until that week is passed/nearly up
That's been my experience with tricks. I'll think of some clever trick to work around my ADHD, and it'll work great for about two weeks. Then after that I'll start anticipating it and working around it. The self-defeating nature of ADHD might be one of the most frustrating things.
Everything is due NOW, seems to work best for me. Just a list to make empty, so I can sleep. Give me deadlines, or ask for estimates, and the task is doomed.
> It's not about attention deficit per se
I've always considered it Too Much Attention Disorder.
The way I like to think about it is that neurotypical people have a beam of light shining out in front of them, wherever they turn their head the light shines and that's where their attention is. Nothing else distracts them from where the light is shining.
With ADHD (for me at least) it's like 50 beams of light scanning the entire room constantly for 'something'. This is too much attention to things that I'm not really interested in, but can distract me from anything I'm trying to do or wan't to do.
For things that I am really interested in (like writing code) the 50 beams of light all manage to synchronise and focus in the same place and that's hyperfocus.
Attention means an ability to ignore unimportant things. This is why the disorder is attention deficit - your ability to ignore distractions is diminished.
That’s such a beautiful way of putting it
Yea, ADHD attention is a like targeting system that has only one setting - it's constantly seeking the most stimulating activity nearby and never stops - sometimes the most engaging feeling activity even changes from minute to minute.
But the hyper-focus can be magical when it targets the task you need to do!
I find similar behaviour in myself, particularly that dreading a task makes it significantly more difficult to start. I find that if I can manage to do just a little bit, even just open the application and maybe look around a bit at what I need to do, it really gets the momentum going for me.
Do you think there's anything that differentiates what we might call "general task dread" that perhaps anyone experiences to a certain degree from a more broad executive function disorder? Or is it that dreading leading to task paralysis is one of many symptoms of an executive function disorder?
How are you for task completion? For me, transferring a load of laundry from the washer to dryer is not an atomic operation. There is ample room to get derailed and wander off during the twenty seconds it should take. It can be interrupted by almost anything. Oh, I forgot to send that message. Oh, I forgot to check for the parcel. Oh, I need to go to the store today still. And I will walk away and forget to come back and finish.
I love moving all my laundry to the dryer and forgetting to start the dryer. Probably happens once or twice a month.
I think the frequency and level of impairment is what differentiates normal executive dysfunction from an executive functioning disorder.
Perhaps a bit rhetorical, but how often does this task dread occur? Does it also ever occur for things you want to do, not just obligated to do?
For me, I experience this issue for many tasks everyday. Then again, I have never had a normal executive functioning, so I cannot claim to know what it is like for normies.
I’ll also add that ADHD is more than just executive dysfunction too.
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Someone else who describes it like I do. You sit down to do a task, and there's an "invisible wall" between you and the objective. You physically CAN'T type on the keyboard if it pertains to the task at hand. You get up to go on a walk, and all of a sudden CANNOT WAIT to get back home to start the task. It sounds like the most enjoyable thing ever! Until... you get home and are greeted by the "invisible wall" again...
When I was a teenager, this would sometimes get so extremely bad that I could only describe the feeling of forcing yourself to push through this wall as almost painful.
My body would tense up to the point of shaking and I could feel my brain absolutely SCREAMING "NO. NO. NO."
In my mental model of ADHD, executive functioning is at the center of an hourglass-shaped graph. The bottom half consists of multiple "internal" layers/systems (neurological, psychological), in which some deficiency or deficiencies cause a lack of executive functioning (arrows point up from layers down below upwards to the central element of "executive functioning" to visualize the direction of causation). The upper half shows the outward facing layers/system behavior, social relationships, skills; the arrows point only upwards. I don't have any scientific source for this graph, but I never experienced any "ADHD"-related problem that I couldn't understand through this lens. Happy to share my sketch if anyone is interested.
Please do! This is very original and maybe most interesting conceptualisation in this thread.
It’s that I try and then can’t. When stuck in bed I can feel this momentum building in my head to push for movement and the a surge of will and then nothing. I didn’t reach the threshold of exerting my will and now I’m waiting for the next wave.
Guess we’ll see how my diagnosis goes.
As they often say, ADHD is about having _too much_ attention and not being able to control it.
Yeah, it’s a common topic of discussion in the various adhd discussion groups across the internet. Unfortunately changing the name would have some unintended effects because a bunch of regulations and other things are using the current denomination
Ah man I feel you. What helped a bit for me is relentlessly trying to get your career focused on only fun things. It's a long term strategy, but I am now a not-so-successful-yet entrepreneur but I do love about 95% of what I do and that makes me do things fast and without it feeling like effort.
>What helped a bit for me is relentlessly trying to get your career focused on only fun things.
That's what I did.
But now AI is threatening to ruin that.
Executive function problems are symptoms of ADHD, therefore renaming it as executive function disorder would omit the root cause. Dr. Edward Hallowell proposes Variable Attention Stimulus Trait (VAST) as a better name.
It was even called "minimal brain damage" at one point early on!
I'm also reminded that "Obsessive-Compulsive Disorder" and "Obsessive-Compulsive Personality Disorder" are different in kind but necessarily in magnitude.
The former comcerns more localized obsessions and the latter is more of a global "default state of perfectionism".
How are you dealing with that executive dysfunction in the end?
to me it is definitely "attention deficit", and it is a deficit in attention in two distinct ways:
1) it's a deficit in that i can't put my attention where i want to put it when i want to put it there. this is definitely "attention deficit" to me.
2) when my attention wants to focus on something on its own somehow, i can't prevent it from putting its attention on that; that thing becomes my main focus for some amount of time that I can't really control. that's also definitely "attention deficit" to me, but in another way than the first way.
I always picture it like trying to force and hold a strong magnet flush against the like pole of another. It seems like it will be easy at first, but the closer they get, the harder it becomes and just as you are about to manage it, they fly apart and the magnet gets stuck to an even stronger one nearby.
You manage to pry them apart, but it goes flying through the air and only to get stuck on an even stronger magnet still. And on it goes, over and over, until the magnet is stuck on the biggest, strongest magnet.
Your attention is constantly being repelled from less engaging activities to more highly engaging activities, and eventually you land on whatever the most engaging activity is nearby. Sometimes without even realizing it
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That's not what ADHD is, that's what someone who knows very little about ADHD and has never experienced it themselves thinks it is.
Your comment's parent might know very little about ADHD, but your critique shows an antiquated view as well. It's not only the ADHD person that needs to change by any means available so that they fit the expectation of the system. The system, too, is in need of change, so that we accommodate more diverse people. Improving the environment that you operate in goes a very long way and might enable exactly the kind of change that makes children and adults with ADHD thrive. Medication is just one option. CBT and more flexible environments are as important, probably even more so.
It's not an either/or thing. At least for my kid, it's been a combination of the 3 that have helped, but if you dropped a component (including the medication), she wouldn't be doing nearly as well.
>Your comment's parent might know very little about ADHD
I know plenty about myself and that label.
I agree with the label being a huge problem. It's basically compressing a multitude of individual characters with huge differences on multiple dimensions of behavior into a binary label, which people confronted with someone bearing that label then decompress based on their personal view on the topic, which is like an algorithm trained on caricatures of what society portraits as ADHD. Your comment sounds like you're doing the same mistake: you take your favorite solution for a complex problem, which (I agree here!) might actually be sufficient for some, a relief for many, any at least good or not harmful for everyone else, but you try to market it as the only necessary solution while invalidating everyone's needs that go beyond this solution. It creates the reactions that you can see in already a handful comments that basically call for the individual to accommodate to the system at all cost...
There are many people who have the diagnosis and don’t agree with the mainstream perspective on medication etc. Don’t claim to speak everyone.
Hmm, I do this this is a point worth considering, but it needs nuance. ADHD is overdiagnosed in young boys, by about 3% iirc. But the thing is overdiagnosis doesn't mean that it doesn't exist at all. It's certainly underdiagnosed in middle-aged women for example, and tends to be underdiagnosed in women in general. There's also a point to be made that some ADHD meds are not without side effects, and kids aren't always listened to when they complain about them (I have a friend who was on Concerta as a kid and had a lot of side effects that really bothered her). But also, ADHD meds are a complete lifeline when they work, and they do work in most cases.
> It's certainly underdiagnosed in middle-aged women for example, and tends to be underdiagnosed in women in general.
What I'd like to see studied more is whether that root cause is underdiagnosis of inattentive type ADHD. My daughter was diagnosed because my wife is aware of this and had her evaluated, which led to me getting evaluated and eventually on medication. The common thread I've observed is that if you're reasonably intelligent such that it's not causing you to fail classes/get fired, people will just call you lazy and not entertain the idea that there's actually something else wrong. Couple that with girls/women having inattentive type w/o hyperactivity, and I think you do end up with a pretty solid bias.
> But also, ADHD meds are a complete lifeline when they work, and they do work in most cases.
For some there's a lot of trial and error, too. I wonder how many give up or insurance stops paying before they get to the right medication.
Ok, but what about when those children grow into adults that can’t sit still for 8 hours either? I am in my mid-thirties and I am still waiting for the hyperactivity to die down.
>Ok, but what about when those children grow into adults that can’t sit still for 8 hours either?
Frankly, my ability to do exactly that when I do something I'm interested in is part of the problem.
I'd snap out of my hyperfocus at 11pm, realizing I haven't eaten or drank anything since lunchtime.
Do you think most people are made to sit still for 8 hours? Do you think someone who can't do that is defective?
> Do you think most people are made to sit still for 8 hours?
No, I was just reiterating the value in the GP comment. I do think the ability to set still has some sort of distribution like all other human attributes. I think it's more important to focus on how little someone sits still compared to how long someone sits still. I'd be lucky to make it a few minutes.
> Do you think someone who can't do that is defective?
No, I do not think of myself nor others that way. I would identify as misaligned. Honestly, ADHD does not cause me as much harm as it does for everyone else in my life. And brother, let me tell you, after all the punishment you receive for being misaligned, you really start to believe you are defective.
Getting the best out of yourself and your environment isn't a matter of waiting to fit in to the sit-down-and-focus shaped life. You have to learn about yourself and learn about how to shape your environment to live your best life, and a major step is not thinking about having that temperament as a disease to be overcome.
Ironically, I know myself very well. I had no choice early on life. I was not officially diagnosed until I was a young adult, FWIW.
Most of my difficulties in life are due to the intersections of my 'temperament' with others. If there was a way I could make life work for me, I would have done so by now. I did not choose to have this 'temperament', and I do not want to have this 'temperament.'
If you have been able to make your life fit for you, consider me jealous. But you need to understand that because you or others are capable of doing so does not mean everyone else is capable of the same.
I understand, very personally, the struggle and frustration.
It’s amazing to see a disproven and frankly ancient viewpoint espoused with a straight face here. When I was a kid in the eighties your way of thinking was already defunct.
This isn't defunct in any way. To the contrary. I've been diagnosed with ADHD myself and creating an environment that is accommodating to my individual needs has absolutely been in line with what experts recommended to be, and it's been a corner stone of my success.
CBT teaches you to evaluate how to shape the environments your living in so that you can benefit the most from your resources and weaknesses and suffer the least from your weaknesses. For some people, this can include taking stimulants, and this is where I do not condone your parent comment's undertone. Nevertheless, it's been proven over and over again that the rigid system that we call schools does not welcome neuro-atypical students and that we could do a lot more to help those who do not react well to stimulants, who do not want to use them (for whatever individual reason), or simply haven't been diagnosed yet! Allowing for movement instead of forcing to suppress it is a very good example for what could be done. One shouldn't make the mistake to think that this alone would be enough for every single child with ADHD, though. But for some, it could be enough.
And that viewpoint doesnt even account for adult ADHD/executive dysfunction.
Exactly. It also ignores recent genetic testing that's showing how different mental illnesses and developmental disorders cluster around the same dysfunctional gene cohorts. To very little surprise ADHD and Autism appear to be closely related for example.
> Some physicians and researchers have argued for years that emotional dysregulation is not peripheral to ADHD but a central, overlooked part of the condition. Yet this symptom does not appear in the formal diagnostic criteria for ADHD in the manual that doctors use to classify mental disorders. That gap has left clinicians without a clear way to categorize what they’re seeing: Are these children best understood as having severe anxiety, as being on the autism spectrum, or as something else entirely? Or does ADHD itself need to be more broadly defined?
Again and again and again. Psychiatry is an epistemic mess.
Psychiatrists are touristic guides of the Paris catacombs that orient themselves with a map of the subway.
"With DSM-V, psychiatry firmly regressed to early 19th-century medical practice. Despite the fact that we know the origins of many of the problems it identifies, its diagnoses describe surface phenomena but completely ignore the underlying causes. Even before DSM-V was released, the American Journal of Psychiatry published the results of validity tests of various new diagnoses which indicated that the DSM largely lacks what, in the world of science is known as, 'reliability', that is, the ability to produce consistent, replicable results. In other words, it lacks scientific validity." ― Bessel Van Der Kolk, M.D.
That’s because psychiatry is intended to revert people to the cultural average so that they fit in and don’t have a bad time
Literally the key defining feature of whether something is a disorder is whether it “impedes” your life, and that could be literally anything
That "something else entirely" for me was trauma. which has no search hits in this comment thread so far.
I was given an ADHD diagnosis as a child before it was in vogue. From my (admittedly) biased perspective I was given this as a result of hyperactivity which might have stabilized on its own given enough time, but my caretakers reacting poorly to my early behavior caused long-lasting traumatic symptoms which happen to line up with many symptoms of ADHD. So I just assumed that ADHD was the case the whole time. I started to suspect something was off when stimulants did not help my problems, but unfortunately it was not enough to escape the sphere of trying to solve my issues with ineffective ADHD-centric solutions until long into my adulthood.
Childhood trauma on top of misdiagnosis on top of continuing familial issues was an awful combination for me and I can't say that I've made that much progress from therapy, only that at this point I can survive with full awareness of the reality of how I was treated. It felt like I had been living in an alternate reality for decades and now I can't stop thinking about what I've found out.
I’m sorry you went through all that; it sounds really difficult. I can relate, having come from a similar background and situation. However, I wasn’t actually diagnosed with adhd until well into adulthood. The meds have helped, but I also have been given other emotional deregulation diagnoses, and I’ve been wondering if it’s all one thing. This article and your experiences add to that perception, for me.
Regarding progress in therapy, it’s a lot of work for sure. I would recommend looking into brainspotting (1) - it’s been hugely helpful for processing trauma, for me. YMMV
Thank you for sharing!
(1) brainspotting.com
> emotional dysregulation
Not having enough sex is hard to formalize as a diagnostic criterium.
Joke aside (which is on me), I have doubts that it's about psychiatry being an epistemic mess. And when I say "that it's (not) about", I mean that it's not (or is) relevant to the framing of the problem.
a) it's only been almost 200 hundred years, most of which were spend building crowd control rather than exploring minds, so it's not an issue of semantics and 'mental' x 'neural' topologies defined in as unambiguous terms as possible. psychology drew lines for the wrong reasons but men, who build and still run the field, are, ... well ... not very manly, are they? nobody is, these days. Some mafia says jump & people jump, you read it in studies and subtext all the time, and in real life, just look at the the amounts of highly functioning autistic people just rolling with the rules of conformity in 'realms' with 'grander'--meaning, in context, requiring high education (not the half baked kind)--purpose. It's weird.
b) "regulation" implies continuity, which requires literally no more than 2 things:
1. learning a few rules, which is an active thing, much easier for ADHD and other people than the thing they have no control over whatsoever, which is
2. brain circuits that don't (or do) constantly break continuity of ... all the things that return thoughts and emotions even though the "main" function isn't done, or any (or only some) of the concurrent, async functions called by the "main" function are or are not done, (yet), all while all the 'context and reality and "presence" sustaining functions' are just stable enough ... (minus that cool part of the CNS that does it's thing no matter what)
All that said, I have to check the study in detail. We should never forget that the personalities of parents (and other involved parties) play a 1337% more important role than the subtype of ADHD or whatever symptoms a person "shows".
I'm a little confused. ADD & ADHD started as children's issues, if I understand it. Adults had already developed beyond it (was where I thought it started). Then later it got combined into only "ADHD" and adults where recognized (not sure which was first). This article only speaks of children. Has it reverted back to children only? I got diagnosed, only a few years ago.
It does look like they are going the right direction. I year or more ago, I looked up my symptoms on the WHO list of diagnosis and most were on both the ADHD and the spectrum list. I don't believe I've ever had a thorough diagnosis, so I was trying to understand better where I might fit. All I ended up with is that there were a lot of symptoms that border lined.
It felt like it was a bit under defined, like IBS (which I was falsely diagnosed with once) because they just didn't know another one that fit. Anyway, I would love more understanding. The "beyond" is common in people I've spoken with, so is the emotional dysregulation...
I think this is me. I was diagnosed with “regular” ADHD a few years ago, but I’ve had issues with rejection sensitive dysphoria my whole life. As a kid I would have a lot of meltdowns when I couldn’t get something right on the first try or made any kind of mistake.
The meltdowns stopped, but I still have issues spiralling into thoughts of failure and being a horrible person when I feel like I’ve disappointed family or friends.
Guanfacine has helped though. Tried a bunch of medications and this is the only one that seems to have made an impact.
Hey, you've basically described me to a tee as a boy. I had the exact same temperament: meltdowns when I thought I disappointed people, putting myself down all the time for failures and mistakes. My parents weren't even particularly strict.
Glad I wasn't just a weird, overly sensitive kid.
"Glad I wasn't just a weird, overly sensitive kid."
Oh we are, just we have neurological reasons for it :D
Might be worth giving Qelbree a shot as well. I switched to it last year and...yeah, it' was a complete game changer. Hard to get insurance to cover, but it's been well worth it.
Do you have to take it everyday?
I recall someone posting that the human brain is essentially "overclocked". I don't recall if that was the phrasing but the gist was that our level of intelligence can only exist by skirting the fringes of sanity. Like some set of dynamic differential equations where, if you bump a coefficient, it spins off into chaos.
Perhaps this Brave New World, as opposed to the more agrarian one our species had been accustomed to, pushes many of us over that threshold.
No science to back this but my first diagnosis was explained similarly. The claim was that the brain consumed all the neurotransmitter chemicals quickly and runs out. Amphetamines speed up production, so you have any instead of none. Idk how correct that is but it seems to work.
https://en.wikipedia.org/wiki/Critical_brain_hypothesis
Given that this includes rat and mouse studies, it seems like this theory is more around the idea that criticality is a characteristic of how brains work in general, not that human brains hit criticality as a peculiarity of our particularly high intelligence
So that article does not support the "overclocked" thesis, rather that this critical state is needed for optimal performance. I do agree with the original sentiment, that we are not exactly well adapted to our environment. Or our environment to us, cause this is the main point I think that is missing from this discourse about adhd or other modern frequent mental conditions: too high expectations. Cause of our inherent human narcissism we think we are more attentive and logical than we actually are, so naturally those with lower attention become noticeable first. Or whatever other metric we are measuring leading to whatever condition (depression, autism, ...). At least that mechanism seems underreported in the public. Anyone familiar with how this is viewed on in academia?
> I don't recall if that was the phrasing but the gist was that our level of intelligence can only exist by skirting the fringes of sanity.
https://www.sciencedirect.com/science/article/pii/S014976342...
Melissa DelBello, a professor of psychiatry and pediatrics at the University of Cincinnati, said that while brain imaging holds promise, it is still impractical to conduct such scans broadly in clinical settings because they are too expensive and not yet precise enough at the level of the individual.
As if questionnaires and slot-machine prescription medicine treatments are accurate. I don't want to generalize for lack of statistical data, but reports of psychiatrists 'just phoning it in' while providing little actual patient engagement are widespread.
It's not really usable for assessing individuals. The "biotype" explains roughly 1% of variation in symptoms.
same. any way to do this without being part of some clinical trial? my shit is busted it'd be nice to understand how feel like that would be meaningful in awareness
One thing that I can’t seem to parse from the article is why the researchers assume that this is an unresearched part of ADHD and not a different disorder entirely. I’m sure they have their reasons, but I don’t think it’s written in the article.
To me it seems that if it’s not „treatable“ the same way ADHD is, I’m not sure if it’s useful to categorize it as such. On the other hand, I’m happy if kids with this disorder can get a diagnosis and treatment that actually helps them sometime in the future due to this research.
You have a set of diagnosis criteria, and matching those criteria gets you the ADHD diagnosis. This study takes people who fit the diagnosis, and says there's a test you can do to split those people into three groups.
But yes, once they have a better understanding of what that difference means, the next step might well be to split the ADHD diagnosis into two separate disorders, or even that, like cancer, ADHD is actually a whole range of separate but related conditions.
> why the researchers assume that this is an unresearched part of ADHD and not a different disorder entirely
Whether or not the extreme dysregulation is a different disorder in its own right or not, is not relevant here. They are grouping ADHD matches; clinically recognized ADHD presentations plus MRI recognized ADHD which have a distinct brain sub-pattern occurring in people that have the same distinct behavioral traits. ADHD frequently has co-occurring conditions.
"Identifying “specific subtypes” of ADHD will make it easier to treat these children effectively". Having a more objective way to diagnosis for things like that seems to be the focus of the approach. They expect it to keep evolving, so I wouldn't say they are assuming anything about absolute labels -- just grouping what they now know to be true, that certain external traits match certain distinct brain patterns that are within the larger adhd brain structure.
Also, I think it's not that it is "not treatable" as ADHD, it's that ADHD can be treated in many different ways and currently the wide variety of responses to such is still a black box. Adderall instant release could briefly make me tired, I would sometimes break off a small piece and use it as a sleep aid. Some other `treatments` (I prefer societal alignment coping aid) resulted in what seemed like an expensive joke. Subtypes may eventually be able to show which options work best for which types and to start there first, instead of the current default iteration.
This link adds more about their research. https://medicalxpress.com/news/2026-03-distinct-adhd-biotype...
It is a good point and I also struggled with that bit somewhat. It is different in so many ways, have different symptoms, does not respond (as well) to the same medication, and affect different parts of the brain. The jump from there to "subtype" was not too logical for me ...
Diabetes has a similar issue, with type 1 and type 2 having very different causes and pathologies.
I've described the field of Psychiatry as trying to describe a building, using only its shadow (projection from high dimensional space to 2d space), with only a handful of choices for the building type. Ultimately only the building (the patient) really knows the full scope of complexity, but a doctor has to be careful in how they get info out.
I don't have a solution, as its an inherently hard problem with a lot of risks (like giving medicine to the wrong person). But I also think this desire to have nice categories for things can be counterproductive in a lot of cases.
I personally think rebranding aspergers + Autism to the autism spectrum was a mistake, as there's a huge difference between someone who's really good at their job but weird and despises certain workplace nonsense - and someone who can't take care of themselves.
ADHD is another great example of a bucket that makes non sense. We were evolved to be hunter gatherers that get many hours of walking or running, and other physical activity every day. Then we act surprised when 11 year olds don't want to sit still 6 hours a day, or getting people like me to write a JIRA ticket is like pulling teeth.
I think separating out these large categories into smaller ones is a good step, but ultimately I think the categories are a counterproductive solution to our human urge to find a logical explanation to things.
Merging autism and aspergers was not a mistake. There wasn't at the time enough science to separate them.
There are separations to be made within autism, absolutely 100%, but the separations they hade made were also definitely 100% wrong.
Anyone know to what paper this article refers? I don't have WaPo
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...
I’ve always found the evolutionary biology lens very compelling for ADHD — consider hunters and gatherers. Hunters benefit greatly from the ability to quickly and sharply shift attention in an instant. They thrive at night and can hyper-focus on the thrill of the hunt. As civilization progressed, society was optimized for the majority (gatherers), and the hunters are marked as “disordered” for systemic incompatibilities.
I'm always sceptical of studies which look at a single diagnosis rather than pooling multiple related diagnoses, because the boundaries between them are so fuzzy
Here's a similar study from some years back which doesn't have that flaw: https://pmc.ncbi.nlm.nih.gov/articles/PMC6880188/
They've basically "reinvented" DSM-IV ADHD-PH, -PI, and -C more or less, but at least someone's examined the organ responsible rather than treat it like a magical black box.
I think the article was honing in on emotional dysregulation which iirc isn't a big component of the DSM-IV definition.
The DSM seems pretty far behind the research by now, but I'd be surprised if emotional dysregulation was not mentioned in the next one.
Another interesting thing that's not in the DSM - very high likelihood of balance / motor control problems (clumsiness, falling).
ADHD is interesting. I think ADHD is mainly an executive dysfunction and reward centre dysfunction, from my own experience.
And a bit of nature, a bit of nurture.
It’s a real double edged sword for me.
On one hand relationships and “boring” tasks feel insurmountable. When I say boring I don’t even mean boring in the traditional sense, I just mean “not novel” - so even something like playing my favourite ever video game gets extremely difficult once the novelty is gone.
On the other hand, as a software developer, working on novel concepts or exploring novel concepts or ideas is basically like crack-cocaine, I literally can’t stop or put them down.
Double edged sword is struggling with most basic tasks, but excelling at the peripheries.
How are you dealing with the executive dysfunction part?
When you put it that way this might be one of the greatest disabilities ever. Humans that don’t complete things they begin and chase novelty are hard to respect because it’s common and trite. Persevering through failure and the hard bits is essentially the crux of achievement, productivity and success.
Well, I’ve been persevering through the hard bits for 42 years, and still struggle with it. It’s not about chasing novelty, it’s about novelty being many many times more attractive than it is for others.
I don’t agree as greatest disability ever as in “most-disabling” I’d say it’s the greatest potential modifier disability there is.
Some scenarios I loathe having it, but when I’m in the flow state I love it.
It’s made my life-path very non-standard (huge swings up and down), but it’s also created insane opportunities (when paired with high-drive and completing things/discipline)
I personally don’t consider it a disability in my case, but I’m definitely at a disadvantage in a typical work environment compared to my peers. So I understand completely why it’s generally classed as a disability in today’s society and societal expectations.
Like autism, it can produce insane outcomes (think savants etc), and if you can find the right environment for you, you can outperform more neurotypical peers.
I for instance finish all my software projects, because I force myself through discipline. My work output is probably the same or slightly less-good than my peers. But my personal projects where I have full creative control of the outcomes I’d say far exceeds my peers.
I mean in my own case, I’ve achieved far more than my friends and peers - whether that be in business success or other creative areas, but at massive cost - they have much more stability than me, whereas my path is a very non-linear path. I either do exceptionally well or exceptionally shit, no in-between, very black and white
How do you manage to finish things? After a while, for me, the novelty high wears out, and instead it becomes a wall. Some project require something silly, like sending 1 email to be completed, and it becomes an impossible task
I force myself to do one project at a time, and don’t let myself pick up a new project until I’ve finished the current one.
I actually have realised I can’t juggle more than 1 major thing in life at a time.
So I just do work, gym, and 1 project at a time . My life is simple. If I’m doing a oroject, I don’t read books or play games for instance
Haha, this made me chuckle so much. That's basically how it goes for me also. Even asking myself, why don't you just do it, then doing something else, feeling guilty about not sending the mail first.
> I’d say it’s the greatest potential modifier disability there is
What a great way to describe it.
The thing is most people get into a flow state and then persevere through when it’s not enjoyable anymore. If you’re just capable of the first part what’s the point.
It’s great that you can get through the entirety of something because I think that deserves a high form of respect.
> “They are simmering volcanoes basically,” Rosen said. “When things go wrong, they explode. These are kids who will have hour-long meltdowns, throw things and hit and break things.”
...
> For children with this extreme form of ADHD, standard behavioral strategies may fall short. DelBello said that widely used approaches such as positive reinforcement — like giving prizes or other trinkets, or extra recess for good behavior — do not always have the intended effect.
I'm a former foster parent who adopted kids from foster care. Two of them were diagnosed with RAD[1]. This "extreme form" of ADHD aligns with both my personal experience of RAD and a subset of the symptoms described by clinicians. Attachment issues in general are either commonly comorbid with, or misdiagnosed as ADHD and ODD[2] (the latter of which also somewhat matches the symptoms from TFA).
I don't really have a point here, just an observation I wanted to make.
1: https://en.wikipedia.org/wiki/Reactive_attachment_disorder
2: https://en.wikipedia.org/wiki/Oppositional_defiant_disorder
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