8 ms·

> much of it seems very difficult to falsify It's quite straightforward, albeit involved (as in technically easy, but takes time) to falsify. You have to work

by kortex 4y ago

> much of it seems very difficult to falsify It's quite straightforward, albeit involved (as in technically easy, but takes time) to falsify. You have to work with a licensed medical professional who will evaluate traits, strengths, and difficulties, and to what extent they impact functioning as a person in society. Basically, are they "well-adjusted"? If they make it through school, college and adulthood without a ton of struggling, therapy, possibly meds, you can almost certainly rule out neurodivergence (at the very least, it won't be clinically significant )

jnovek 4y ago
> Basically, are they "well-adjusted"? This is a radically behaviorist interpretation. A common criticism of the diagnostics for ADHD (and Autism, for that matter) is that it ignores the person’s internal experience. I was formally diagnosed with ADHD in 2017. I’d been visibly quite successful in that time, but at the expense of my own mental health because I was fighting a constant uphill battle. ADHD was a set of shackles I didn’t even know I had.
- Ensorceled 4y ago
  Agreed. I was finally diagnosed with ADHD a few years ago. I had been self mediating with coffee and adrenaline for several decades. But I was, by all accounts, successful. Just not happy or healthy or as successful as I could have been.
  - kortex 4y ago
    > Just not happy or healthy or as successful as I could have been. That is precisely what I mean. You were not naturally "well-adjusted", you just learned to adjust and adapt over time. It wasn't the best choice of words but I can't edit.
    - Ensorceled 4y ago
      There are clinicians who believe that if you are not "below average" or "experiencing extreme distress" then, by definition, you don't have a disorder. Because I have a well paying job, some clinicians would not categorize me has having ADHD because I'm operating at an "above average" capacity. We're just reacting to what appears to be agreement with that approach, even if unintentional.
      - kortex 4y ago
        > We're just reacting to what appears to be agreement with that approach, even if unintentional. Agreed. I'm addressing precisely the point in GP comment "neurodiversity is not a falsifiable diagnosis", which is something I feel quite strongly about. Other issues in this complex space that I think also are worth being discussed but I am not trying to get into in this thread: - overdiagnosis of ADHD/ASD - underdiagnosis of ADHD/ASD in certain subgroups (especially women/NB, minority, and underprivileged groups) - ADHD/ASD are/are not on the same spectrum - drug-seeking behavior for access to stimulant meds - overmedication, undermedication, and incorrect diagnosis leading to iatrogenic harm (eg giving antipsychotics to a "bipolar" individual whose "bipolar" is realdy emotional lability due to ADHD/ASD Each one of those topics I could talk about at length. They are related, but distinct.
      - jnovek 4y ago
        Yes, this is what I though kortex meant. Thank you for clarifying.
- kortex 4y ago
  I think we are on the same page. Not being confrontational, but please re-read my comment, specifically: > If they make it through school, college and adulthood without a ton of struggling You wrote: > but at the expense of my own mental health because I was fighting a constant uphill battle. Gp wrote: > "By what process can someone reasonably determine that they are NOT neurodivergent?" I'm using "well-adjusted" here to mean like, naturally well-adjusted - you are able to complete life activities without constantly having to learn strategies and fight the good fight just to do what comes much more freely to neurotypicals. I.e. being able to socialize well doesn't disqualify you from ASD, because masking is a thing. A proper licensed professional will ask the right kind of questions to ascertain this. If you are successful but feel like if you stop struggling for a moment, that's a strong indicator.
  - jnovek 4y ago
    I reread and I think I pulled the trigger a bit early on that one. I advocate for myself and I recognize that I can premature to the defense at times. :-) I’m sorry!
JulianChastain 4y ago
I think the whole point of the term neordivergent is imply that many mental disorders aren't impairments in the sense of stop you from living life, but are different ways of perceiving. For example, I know an eye surgeon who was diagnosed with ADHD in his forties. He is incredibly successful and by all external measures well adjusted. This was because he had developed a set of very successful coping strategies to make up for his lack of executive function. I agree that it's pretty easy to falsify, I just think you have to actually ask the patient about how they experience life to do so.
- uoaei 4y ago
  This opens an interesting line of inquiry. Is ADHD simply the lack of adequate coping mechanisms? Is ADHD somehow the "default" state of a human mind, and the effect of maturing into a particular psychosocial niche that some level of coping mechanisms are required to "function" "correctly" per socially constructed standards?
  - kortex 4y ago
    > Is ADHD somehow the "default" state of a human mind, and the effect of maturing into a particular psychosocial niche that some level of coping mechanisms are required to "function" "correctly" per socially constructed standards? IMHO, yes, but actually, no? ADHD is marked by executive dysregulation. An immature brain (they say the brain does not mature until the 20s) also shows poor executive control. However, ADHD is detectable as certain processing difficulties within an age cohort. Similarly, I don't think it's a lack of coping mechanisms. It's very heritable, even controlling for upbringing/habits (I'm adopted by very obviously non-ADHD and disciplined parents - I did not pick up basically any of their coping skills naturally and had to develop my own). I think it's almost entirely congenital - between genes and gestation, your neurodivergency die is cast at birth (unless acquired via brain injury). > This was because he had developed a set of very successful coping strategies to make up for his lack of executive function. I think this takes a special set of conditions, and/or a mild case of it. Some people do learn to cope. I would contend even these folks have indicators of stress/mental health problems, even if non-obvious. Or they just drew the best possible ADHD hand in terms of life events.
MichaelCollins 4y ago
> Basically, are they "well-adjusted"? This is so easy to game. People read the diagnostic criteria online and echo it back to their doctor for a prescription. Their proof of needing adjustment can be little more than pointing to their grades and attributing their less than stellar academic performance to the list of ADHD symptoms they memorized online. EZ way to get yourself a stimulant subscription. This was particularly common during the pandemic when you could do it entirely online without actually meeting a doctor in person. I saw a lot of people explicitly advocating this sort of deception to get stimulant prescriptions; all described it as very easily done. I tend to think those drugs should be legal OTC, so part of me thinks "so what?" But the problem is that right now it isn't legal OTC, so the system is giving a leg up to anybody willing to lie to a doctor, while honest people have to make do with lesser PEDs like caffeine.
- falcolas 4y ago
  Someone being able to fake an illness does not signify that the illness does not exist. You can fake chronic back pain, migraines, suicidal tendencies, and so on. That doesn't make any of them any less real.
  - MichaelCollins 4y ago
    I'm responding to the claim that it's easy for doctors to falsify a false claim of ADHD from somebody who's drug seeking and has been coached online to say the right things to the doctor. This doesn't seem to be the case. ADHD may be real, but doctors seem to have a hard time distinguishing people who actually have it from people who just want the drugs and know what to tell the doctor because they watched a bunch of instructional videos about this sort of deception on tiktok. The 'test' for ADHD boils down to "evaluat[ing] traits, strengths, and difficulties, and to what extent they impact functioning as a person in society. Basically, are they "well-adjusted"?" It's not as though the evaluation is some chemical analysis in a lab, anybody so inclined can be coached to pass this evaluation by telling their doctor the right things.
    - falcolas 4y ago
kortex 4y ago
> Basically, are they "well-adjusted"? was a terrible choice of words on my part, but I can't edit now. What I mean here by "well-adjusted" has nothing to do with "appears functional from the outside". I mean "they appear functional and actually are and didn't have to contort themselves to do so". Does the patient self-medicate with nonmedical stimulants/stimulation? (caffeine, nicotine, other drugs, adrenaline junkie)? Did they have to struggle and claw to overcome executive issues and get some semblance of normalcy? Did they find a particular niche/trade where they can be successful? Do they succeed on the outside but feel burned out constantly inside? Those are not the folks I'm talking about. I'm saying folks who didn't need to go way out of their way to adapt in order to achieve an outward sense of normalcy. My father is one of the least-ADHD people I know. His life wasn't easy by any means (grew up very poor, had to work his way through high school and college), but also he didn't have any of the kind of turmoil growing up that I see in myself and each and every neurodivergent person I know.

by kortex 4y ago

jnovek 4y ago

> Basically, are they "well-adjusted"? This is a radically behaviorist interpretation. A common criticism of the diagnostics for ADHD (and Autism, for that matter) is that it ignores the person’s internal experience. I was formally diagnosed with ADHD in 2017. I’d been visibly quite successful in that time, but at the expense of my own mental health because I was fighting a constant uphill battle. ADHD was a set of shackles I didn’t even know I had.

Ensorceled 4y ago
Agreed. I was finally diagnosed with ADHD a few years ago. I had been self mediating with coffee and adrenaline for several decades. But I was, by all accounts, successful. Just not happy or healthy or as successful as I could have been.
- kortex 4y ago
  > Just not happy or healthy or as successful as I could have been. That is precisely what I mean. You were not naturally "well-adjusted", you just learned to adjust and adapt over time. It wasn't the best choice of words but I can't edit.
  - Ensorceled 4y ago
    There are clinicians who believe that if you are not "below average" or "experiencing extreme distress" then, by definition, you don't have a disorder. Because I have a well paying job, some clinicians would not categorize me has having ADHD because I'm operating at an "above average" capacity. We're just reacting to what appears to be agreement with that approach, even if unintentional.
    - kortex 4y ago
      > We're just reacting to what appears to be agreement with that approach, even if unintentional. Agreed. I'm addressing precisely the point in GP comment "neurodiversity is not a falsifiable diagnosis", which is something I feel quite strongly about. Other issues in this complex space that I think also are worth being discussed but I am not trying to get into in this thread: - overdiagnosis of ADHD/ASD - underdiagnosis of ADHD/ASD in certain subgroups (especially women/NB, minority, and underprivileged groups) - ADHD/ASD are/are not on the same spectrum - drug-seeking behavior for access to stimulant meds - overmedication, undermedication, and incorrect diagnosis leading to iatrogenic harm (eg giving antipsychotics to a "bipolar" individual whose "bipolar" is realdy emotional lability due to ADHD/ASD Each one of those topics I could talk about at length. They are related, but distinct.
    - jnovek 4y ago
      Yes, this is what I though kortex meant. Thank you for clarifying.
kortex 4y ago
I think we are on the same page. Not being confrontational, but please re-read my comment, specifically: > If they make it through school, college and adulthood without a ton of struggling You wrote: > but at the expense of my own mental health because I was fighting a constant uphill battle. Gp wrote: > "By what process can someone reasonably determine that they are NOT neurodivergent?" I'm using "well-adjusted" here to mean like, naturally well-adjusted - you are able to complete life activities without constantly having to learn strategies and fight the good fight just to do what comes much more freely to neurotypicals. I.e. being able to socialize well doesn't disqualify you from ASD, because masking is a thing. A proper licensed professional will ask the right kind of questions to ascertain this. If you are successful but feel like if you stop struggling for a moment, that's a strong indicator.
- jnovek 4y ago
  I reread and I think I pulled the trigger a bit early on that one. I advocate for myself and I recognize that I can premature to the defense at times. :-) I’m sorry!

JulianChastain 4y ago

I think the whole point of the term neordivergent is imply that many mental disorders aren't impairments in the sense of stop you from living life, but are different ways of perceiving. For example, I know an eye surgeon who was diagnosed with ADHD in his forties. He is incredibly successful and by all external measures well adjusted. This was because he had developed a set of very successful coping strategies to make up for his lack of executive function. I agree that it's pretty easy to falsify, I just think you have to actually ask the patient about how they experience life to do so.

uoaei 4y ago
This opens an interesting line of inquiry. Is ADHD simply the lack of adequate coping mechanisms? Is ADHD somehow the "default" state of a human mind, and the effect of maturing into a particular psychosocial niche that some level of coping mechanisms are required to "function" "correctly" per socially constructed standards?
- kortex 4y ago
  > Is ADHD somehow the "default" state of a human mind, and the effect of maturing into a particular psychosocial niche that some level of coping mechanisms are required to "function" "correctly" per socially constructed standards? IMHO, yes, but actually, no? ADHD is marked by executive dysregulation. An immature brain (they say the brain does not mature until the 20s) also shows poor executive control. However, ADHD is detectable as certain processing difficulties within an age cohort. Similarly, I don't think it's a lack of coping mechanisms. It's very heritable, even controlling for upbringing/habits (I'm adopted by very obviously non-ADHD and disciplined parents - I did not pick up basically any of their coping skills naturally and had to develop my own). I think it's almost entirely congenital - between genes and gestation, your neurodivergency die is cast at birth (unless acquired via brain injury). > This was because he had developed a set of very successful coping strategies to make up for his lack of executive function. I think this takes a special set of conditions, and/or a mild case of it. Some people do learn to cope. I would contend even these folks have indicators of stress/mental health problems, even if non-obvious. Or they just drew the best possible ADHD hand in terms of life events.

MichaelCollins 4y ago

> Basically, are they "well-adjusted"? This is so easy to game. People read the diagnostic criteria online and echo it back to their doctor for a prescription. Their proof of needing adjustment can be little more than pointing to their grades and attributing their less than stellar academic performance to the list of ADHD symptoms they memorized online. EZ way to get yourself a stimulant subscription. This was particularly common during the pandemic when you could do it entirely online without actually meeting a doctor in person. I saw a lot of people explicitly advocating this sort of deception to get stimulant prescriptions; all described it as very easily done. I tend to think those drugs should be legal OTC, so part of me thinks "so what?" But the problem is that right now it isn't legal OTC, so the system is giving a leg up to anybody willing to lie to a doctor, while honest people have to make do with lesser PEDs like caffeine.

falcolas 4y ago
Someone being able to fake an illness does not signify that the illness does not exist. You can fake chronic back pain, migraines, suicidal tendencies, and so on. That doesn't make any of them any less real.
- MichaelCollins 4y ago
  I'm responding to the claim that it's easy for doctors to falsify a false claim of ADHD from somebody who's drug seeking and has been coached online to say the right things to the doctor. This doesn't seem to be the case. ADHD may be real, but doctors seem to have a hard time distinguishing people who actually have it from people who just want the drugs and know what to tell the doctor because they watched a bunch of instructional videos about this sort of deception on tiktok. The 'test' for ADHD boils down to "evaluat[ing] traits, strengths, and difficulties, and to what extent they impact functioning as a person in society. Basically, are they "well-adjusted"?" It's not as though the evaluation is some chemical analysis in a lab, anybody so inclined can be coached to pass this evaluation by telling their doctor the right things.
  - falcolas 4y ago

kortex 4y ago

> Basically, are they "well-adjusted"? was a terrible choice of words on my part, but I can't edit now. What I mean here by "well-adjusted" has nothing to do with "appears functional from the outside". I mean "they appear functional and actually are and didn't have to contort themselves to do so". Does the patient self-medicate with nonmedical stimulants/stimulation? (caffeine, nicotine, other drugs, adrenaline junkie)? Did they have to struggle and claw to overcome executive issues and get some semblance of normalcy? Did they find a particular niche/trade where they can be successful? Do they succeed on the outside but feel burned out constantly inside? Those are not the folks I'm talking about. I'm saying folks who didn't need to go way out of their way to adapt in order to achieve an outward sense of normalcy. My father is one of the least-ADHD people I know. His life wasn't easy by any means (grew up very poor, had to work his way through high school and college), but also he didn't have any of the kind of turmoil growing up that I see in myself and each and every neurodivergent person I know.