14 ms·

The link between August birthdays and ADHD (2018)

141 points by dymk 4y ago

deleted 4y ago
[deleted]
abracadaniel 4y ago
Non-paywall link https://web.archive.org/web/20221020023129/https://www.nytimes.com/2018/11/28/opinion/august-birthdays-adhd.html https://web.archive.org/web/20221020023129/https://www.nytim...
klempner 4y ago
The flip side of this is that people who legitimately have ADHD are surely more likely to have it diagnosed if they're having to deal with the added academic difficulty of going through school almost a year earlier than their September born peers. That is, even in a world with no overdiagnosis of ADHD, we would 100% expect an effect of the sort this article raises.
- colechristensen 4y ago
  I think I had the opposite effect whereby ADHD symptoms were created because i was so far ahead of my peers (September birthday) that some cognitive skills never developed properly for lack of challenge. (I have test results that point to very selective cognitive skill gaps which might be attributable to that)
  - phnofive 4y ago
    I'm in the same boat - what tests are you referring to? Might be something I can learn about myself there...
    - colechristensen 4y ago
      I had a full 4 hour neuropsych test done as the result of a concussion. The test I was bad at was where they read you a list of random words and test your ability to retain immediately and after spaced repetitions. The first time I heard it I retained very little but on subsequent repetitions what I did learn I retained. So like a very specific sort of being bad at something. The rest of the tests were all in decently high percentiles.
      - Hnrobert42 4y ago
        Could that “gap” have been attributable to the concussion, though?
        colechristensen 4y ago
        No the concussion was recent, the problem demonstrated by the tests made a lot of lifelong things make sense.
      - dylan604 4y ago
        >where they read you a list of random words and test your ability to retain immediately Person, woman, man, camera, TV type words? Sounds like other neuro tests. I've screwed up these tests as I focus on repeating each word in the gap between the next word being said then repeat with the new word being added to the point I've missed the next word. I've never "liked" this test, as I don't think it's always indicative of what they are trying to make it. This sounds more like interviewing a potential server that isn't allowed to write down the order.
        wincy 4y ago
        This is called the working memory index score, for what it’s worth.
      - wincy 4y ago
        Sounds like the WAIS-III intelligence test. The state tested me using this as an admission criteria for a summer camp full of gifted children. They accepted two kids from our school which was generally pretty rare, especially considering our school’s socioeconomic level. If I recall correctly you’re talking about the working memory index. I scored 50th percentile on that portion of the test but top 0.4% overall, which I’ve always felt like reveals something about my “ADHD brain”. It’s definitely not the norm. The administering psychologist seemed super interested in my testing and I asked a lot of questions about the process. She brought me back in for a second day of tests as some of the tests I exceeded the space available. I recall they had a band writing symbol recognition and copying test, and I filled up a page front and back, so she had to come back the next day with more pages to accurately measure me since you aren’t supposed to “ace” a part of an intelligence test. I often think about it because I often think “well, being 1 in 250 is pretty good, but that also means there’s literally millions of people smarter than me”. Hard work and building good habits like going to bed on time has been key to actually making use of the “raw power” of my brain, and Adderall as an adult has helped a ton with this despite side effects that I try to keep under control (irritability and seeming more ‘robotic’. Every time I try to stop using it I feel like my career slips and I become depressed. The me on Adderall is capable of being a competent software engineering team lead juggling multiple balls in the air. The me without Adderall struggles as a senior software engineer writing code for one project. I’m excited to take a 2 week break from the meds on vacation later this year though. I constantly feel like I’m “grinding my gears” too hard, so to speak, like the Adderall is adding jet fuel to my engine of a brain and it’s gonna burn me out. It hasn’t happened yet but I really want to avoid tolerance.
- montanalow 4y ago
  The converse is also true. We may be missing diagnosis for people born in September, who may struggle but not quite meet the definitions which often include academic performance.
  - thomastjeffery 4y ago
    Even "academic performance" isn't a clear enough predictor. It isn't even a single axis! I was a perfect student all through grade school; except I had terrible grades in almost every class. Why? Because I almost never did homework. I usually aced tests without even trying, though. And I could always provide meaningful input into class discussions. But that isn't enough for the strict traditional structure of academia. Teachers would make me stay after school to try to catch up on homework, and I would just wait patiently until it was late enough in the evening that they would give up and let me go home. This was a recurring pattern from 4rth grade all through 12th. I only graduated high school because I finished hundreds of pages of make-up work over the last couple weeks. The reality is I couldn't do homework. I could focus and sit still, which must have meant I don't have any attention or hyperactivity disorder... ...but that's not what ADHD is. It's an executive functioning disorder. ADHD is being diagnosed more today because it has been incredibly under-diagnosed in the past. It's still significantly underdiagnosed in adults today.
    - jasonladuke0311 4y ago
      This largely mirrors my experience. You know how people talk about addiction, and how they are "drawn" to their poison, like by some force? The polar opposite of that is what I felt with homework. Like trying to push two identical magnetic poles together.
      - thomastjeffery 4y ago
        > Like trying to push two magnetic poles together ...with atrophied hands. I knew I could, I knew I should, but I could never do. I could only watch myself, never participate. It's really validating to have words like "executive dysfunction" to describe this pattern, as opposed to "lazy", "tired", and "unmotivated" - which are all I had growing up.
- jay_kyburz 4y ago
  I wonder if it was a less of an issue in the past, because we would make kids with difficulties repeat a year. They would go from youngest to oldest. I'm sure repeating brings with it all kids of other problems.
- notacoward 4y ago
  Good point, and also I wonder how many of these diagnoses are deliberately sought by parents aware of the "relative age within school year" phenomenon. Holding kids back a year because of this has become so common that it has a name: redshirting. Having them diagnosed as ADHD and either medicating or holding back seems like a natural extension. I don't mean to suggest that anyone's faking it BTW. As the authors point out, the real problem here might be underdiagnosis of September children. But parents of August kids might be more than a little predisposed to schedule that doctor visit, listen to that diagnosis, etc. in a way that parents of September kids would not be.
phnofive 4y ago
Submitted a few times in the past but never discussed. --- An unexplored link here is No Child Left Behind and its successors; in 2001, K-12 became standardized test prep schools as grades earned funding. Bubbling certainly drove me a little batty.
fnordpiglet 4y ago
As a June baby in a state with a July cut off, I was always nearly a year younger than the majority of the class. It caused me no end of difficulty in school, to the point I loathed school, barely graduated high school with a 2.0 GPA and more than the legal limit of skipped days, diagnosed with ADD, and went straight to career in the valley. It was only when I was close to 30 that I sort of realized I actually was smart and could do well in school, and quit my lucrative career to get highest honors at UIUC CS- a very difficult program where graduating with C’s was an achievement - but I pulled off a 4.0 (A+ at UIUC adds nothing to the GPA). When I had my daughter, born in late May, I held her back a year in preschool and put her in a private school that mixes multiple years in the same differentiated class. She is so happy in school, and I just hope that she doesn’t have to experience the years of misery and failure I experienced that led to an adult life filled with anxiety that I’ve only recently conquered. Public school in the US is not structured in a way that is adaptable to the various states of human maturation you see in kids that all mature in different ways at different rates. It’s factory education, and if you’re not a widget of the right shape it cuts you up.
- travbrack 4y ago
  Really inspiring story. Why did you pursue school so late in your career? Just to prove to yourself that you could do it?
- owlninja 4y ago
  What changed at 30?
- brendank310 4y ago
  Nice work, that program is no joke.
- rconti 4y ago
  Do you think there's something about the precise age (to within a few months) that a child begins school that drives this bias in diagnosis? Or would we have the same problem with a hard cutoff date, even if all kids started school an entire year later? Or is it largely a matter of how much development a child undergoes even in 1 month at such an age (eg, a combination of factors)? I guess I ask because there will always have to be a cutoff, even if it's a soft cutoff. As a non-parent, the best solution I can see is to give the parents the knowledge and freedom to make the choice, and to add this data to perhaps mitigate over-diagnosis (and any attached stigma). Of course, as I write this out, it occurs to me how much of a burden on parents an extra year without school could be
urthor 4y ago
Psychiatry & neuroscience today are some of the closest equivalents to physicians applying leeches in the 16th century. Through no fault of their own. We, simply, have legitimately very little knowledge of those fields of science. Our understanding of the human brain is just not there. So much of Psychiatry is throwing pills at symptoms after talking about your life. That's often the state of the art in the field. Genetic sequencing, and the ability to use genetic markers to diagnose illness, hopefully will change things. A cheap and effective diagnostic tool that isn't based on guesswork and "tell me your life story."
- 29athrowaway 4y ago
  If a neuroscientist can explain a truly brain, they would be able to explain a much simpler thing such as a CPU or GPU. But, can they? No, they can't. Psychology is in great part pseudoscience. Lots of studies that are neither falsifiable or reproducible. Psychiatrists are the modern equivalent of barber surgeons, or trying to make fine jewelry with a chisel and a hammer.
  - throwaway0asd 4y ago
    Diamonds are still cut with chisel and hammer. Most of your comment sounds like a bunch of logical fallacies.
- 111111101101 4y ago
  Leeches actually work though and we still use them today.
  - WhyCause 4y ago
    Cupping is probably a better analogy. Also, there was a long stretch of time there where we didn't use leeches, at least in part due to the stigma associated with the older practice.
- Hnrobert42 4y ago
  I agree. I have thought that in 200 years, people will look back at mental health care at this time with a mixture of horror and pity.
KineticTroi 4y ago
Nothing about solar cycles, or sun position, and other seasonal factors relating to fetal development. An old topic, covered in better detail in a plethora of past research articles. Might be more revealing to read about seasonal differences between children born in south vs north hemispheres.
- joemi 4y ago
  I'm not sure if what you're talking about has anything to do with the article. It sounds like you're just making a flippant comment based on the title of the article (please correct me if I'm wrong). From the article: > Most states have arbitrary cutoffs for kindergarten entry, with children who do not reach a given age by a certain date required to wait a year. In 18 states, children who will turn 5 before Sept. 1 can enter kindergarten in the year that they turn 5; children who will turn 5 after Sept. 1 must wait until the next year. So in states with Sept. 1 cutoffs, in any given class, August-born children will usually be the youngest and September-born children the oldest. These arbitrary cutoffs have important implications for the diagnosis of A.D.H.D.
  - caddemon 4y ago
    There are also other reasons birth month could be related to psychiatric disease that sound more pseudoscience-y at first. There's good reason to believe that infection at the wrong time of pregnancy can increase risk of Schizophrenia for example, meaning that the alignment of cold and flu season could affect disease rates by birth month. I agree the comment was probably just being sarcastic, but I think it's worth noting that there could be a more biological component to an effect like this, doesn't need to be a societal environment/diagnosis rate thing to be plausible. It's interesting reading about a lot of pseudoscience as you go through scientific training, because obviously you have an immediate negative reaction to it. But I've started to notice that more often than not there is some underlying grain of truth that is taken to an extreme and/or given a ridiculous explanation. This in turn dampens real research on the potentially interesting line of questioning.
riwsky 4y ago
Classic Gemini excuse-making. Clearly these kids' problems are caused by $CELESTIAL_BODY being at $PLACE during $TIME; idk why they keep whining like this! But also: focus isn't distributed bimodally; ADHD is in some respects a matter of degree, not kind. Accordingly, many ADHD treatments also improve the abilities of people without ADHD—to ends both benign (the "secular literature" of productivity porn, which overlaps with behavioral ADHD management) and less-so (widespread stimulant abuse on college campuses). That leaves us with evaluating impairment to a student's quality of life. Is doing that by comparison to their classmates subjective? No—you can still make objective statements about comparative ability—but the ethical question of "do Gemini deserve a 12-month cognitive disadvantage compared to their grade-level peers?" is harder to answer than the medical "would this kid still be diagnosed if they were relatively older?". The article's argument is weaker for eliding it.
- NoToP 4y ago
  What's the difference between stimulant use with a prescription and stimulant use without? A priori why demonize one as abuse and accept the other as legitimate.
  - riwsky 4y ago
    Honestly, I took it as an axiom so as to steel-man the article's argument; if there were no difference between prescribed and unprescribed use, any dismissal of concerns about overprescription would be trivial. But if I had to argue for it: I'd wager that unprescribed usage on college campuses is more likely to fall outside of medical guidelines (e.g. at late hours to pull all nighters, or in higher doses for recreational and euphoriant purposes). Whether or not one demonizes this as unethical, it should be uncontroversial to describe the concomitant increases in e.g. seizure risk, addiction, and other side effects as not-benign. It also advantages 1) lawbreakers who 2) can afford secondhand stimulants. Yes, this is also evidence towards "ok so don't legally require an rx to purchase these"—but such are the rules of the game students are playing, and the argument from personal freedom is strained when made in a competitive context.
  - hinkley 4y ago
deleted 4y ago
[deleted]
bound008 4y ago
I would highly recommend any readers on here who have ADHD to read "Scattered: How Attention Deficit Disorder Originates" by Dr. Gabor Maté[1] It provides a compelling argument as to the root cause of ADHD. [1] https://drgabormate.com/book/scattered-minds/ https://drgabormate.com/book/scattered-minds/
- astrange 4y ago
  Nice nominative determinism, maté is quite the most caffeinated thing I've had in my life.
- elcritch 4y ago
  I would recommend taking this book or similar ones with a grain of salt. Just going off the summary it claims to "prove" that ADHD isn't inheritable, which goes against lots of well established research showing strong inheritability of ADHD. Any books that claim to undercover the "root cause" of something as varied and complex likely haven't. Now it might have great insights, but presenting the book this way gives a bit of undertone as "cure ADHD with this one simple trick!". Guessing about the content of the book, it likely seems to discuss healing emotional regulation by some means. If so I'd agree it's a valuable aspect of treating ADHD, as most ADHD'ers also suffer significant emotional damage. That damage and accompanying maladaptive coping often is far impactful than ADHD itself.
  - deleted 4y ago
    [deleted]
  - mbrock 4y ago
    Maté says the inheritable trait is a kind of nervous sensitivity that develops into ADHD in certain early childhood environments especially when the caretakers are stressed, depressed, or otherwise unable to provide the infant with the stable, responsive gaze that they need. I don’t know how true that is, but that’s the idea in “Scattered Minds.”
- cja 4y ago
  He literally starts the book by saying that he didn't know much about ADHD until four or five years before writing and then he and his three(?) sons were all diagnosed with it and then (or so I gather because I stopped reading then) he comes up with some novel theories contradicting the experts in the field. There's so much evidence-based material to read from people who have spent decades studying ADHD that it's a shame instead to waste time on Mate. He may be an expert in some things, just not this
brador 4y ago
At age 10 that's a 10% advantage in life experience, growth, and social skills. Huge.
kova12 4y ago
Can we ban submissions which are under paywall.. it's kinda bait and switch'y, every time I click on these I can't help feeling I've been rickrolled
- bell-cot 4y ago
  For most HN submissions from paywalled sites, disabling javascript in your browser is a good-enough solution.
- taoufix 4y ago
  https://web.archive.org/web/20221020095951/https://www.nytimes.com/2018/11/28/opinion/august-birthdays-adhd.html https://web.archive.org/web/20221020095951/https://www.nytim...
chrsig 4y ago
Sometimes I wish HN had a rule against posting things about mental health (perhaps with the exception of Ask HN threads). At the very least, I'm curious what the statistics on references are compared to technical topics. There's always so much misinformation in ADHD threads. It's really exhausting.
- bachmeier 4y ago
  > Sometimes I wish HN had a rule against posting things about mental health Don't stop at mental health; basically any discussion outside of programming is a disaster AFAICT. It doesn't get cleaned up because the participants don't realize how bad it is. I avoid anything close to economics. I only checked the comments here to see if there was a non-paywalled version.
  - technoooooost 4y ago
- user_7832 4y ago
  Perhaps, but is it really detrimental to discuss it? HN is decently moderately enough to avoid flame wars, and sure there's a lot of anecdotal talk going about by folks who aren't doctors, but that doesn't mean that patients/the public shouldn't discuss health. Perhaps a sticky/banner for health topics may be a good idea? Like "This is a health topic, please don't make unverifiable claims and mark your opinions as your own"?
  - user_7832 4y ago
    Come to think of it, starting paragraphs/comments with syntax would be a decent solution. Like: OPINION: I think.... ANECDOTE: When I experienced this...
BigglesB 4y ago
As a counter-anecdote, I have an early September birthday, but the 1st Sept cut-off was advisory rather than strictly enforced. So I was a “year ahead” of where I should have been for my exact age up until I was 13. At which point I repeated a year, going from the youngest of my classmates to the oldest. Exactly the sort of child the article implies would at risk of being over-diagnosed with ADHD as a pre-teen. Except I wasn’t diagnosed until almost 25 years later. Of course I’m just one data-point, but I’d be curious whether the developmental age differences might potentially _cause_ ADHD development among younger classmates rather than just indicate misdiagnosis.
drogus 4y ago
I’m wondering if the opposite might be true as well - underdiagnosing people from different months. I was born in March and in Poland where I grew up school was assigned by birth year. So the oldest kids in a given class were from January, the youngest from December. I have had little problems in primary school and gymnasium without putting much work into it. Then in high school it got harder, but I still passed, again, without almost any work, skipping classes, being late all the time. I started really struggling at an university and later in life and I eventually got diagnosed. Granted, ADHD disgnosis was rather uncommon in Poland in the 90s, but I can see how a kid doing good early in school could have been not diagnosed.
corobo 4y ago
> All this raises the question of whether the disease is being overdiagnosed. No chance of it not actually being a disease? Maybe different brain types are as common as blood types. We'll never know while we label anything that doesn't play nicely with commercialism as diseased haha
- nrabulinski 4y ago
  This idea has been proposed multiple times before but, from what I remember (and I’m paraphrasing here) we’re identifying it as a disorder not because it’s a disease per se but because it affects the lives of those people and in general has been deteriorating ever since humans changed their lifestyles from hunters to farmers. I think this video talked about this concept in more depth https://youtu.be/QUjYy4Ksy1E https://youtu.be/QUjYy4Ksy1E
- dt2m 4y ago
  Not a disease? That's down to semantics and personal opinion. What isn't opinion is the fact that the symptoms of ADHD have been objectively identified on a global scale, in people from very different cultures and social classes. I agree that it isn't beneficial to label a very livable condition with the same word that we use for much harsher illnesses, and it doesn't help that it's not a visible condition. But as somebody with ADHD, it really hurts me to keep seeing this argument repeated ad nausea. Maybe the issue isn't that it is being overdiagnosed, but rather the fact that the only treatment we consider worthwhile is prescribing amphetamines to children.
  - corobo 4y ago
    > But as somebody with ADHD, it really hurts me to keep seeing this argument repeated ad nausea. I've not seen or made this argument before, where does it usually go and/or what is the end result? I too have ADHD, I'm sorry if my curiosity and thoughts have caused you harm. I'm new to it and want to know what's what. Do you have any wikis or articles or twitter threads that can get me up to speed on the basics without traumatising people?
- oldgradstudent 4y ago
lqet 4y ago
I am endlessly fascinated by the effect your birth month may have on you. It begins with trivial things: if you are born in summer, then by the time you are 6 months old and have developed a vague awareness of your world, "going out" means adding uncomfortably many layers of clothing and being tossed into a cold and harsh environment. Whereas if you are born in winter, your first real playtime outside is a warm and wonderful experience, with flowers and butterflies and soft grass. But the effect on your personality may go beyond this [0]: > The season in which babies are born can have a dramatic effect on their future risk relating to the development of conditions such as neurological disorders, including seasonal affective disorder, bipolar depression, schizophrenia and type I diabetes. Research has shown that the season a baby is born in can have a major effect on whether or not they will become a heavy smoker. > The risk of suicide increases by 17% for people born in the spring–early summer compared with those born in the autumn–early winter Our daughter sleeps better and longer in winter, because it gets dark early - so her birth month correlates with the amount of sleep she got in certain stages of development during the last years. In past ages, the birth month also directly influenced how much (and what kind of) food was available in certain stages of development. This may sound esoteric, but I really think there is some deep truth in attributing personality traits to astrological signs. [0] https://en.wikipedia.org/wiki/Influence_of_seasonal_birth_in_humans https://en.wikipedia.org/wiki/Influence_of_seasonal_birth_in...
- Defitio 4y ago
  Personality traits are not mentioned in your references wiki article. There are plenty of counter examples of other people who are born in the same month than me who are totally different. There is also a huge difference how people handle sickness like the ones mentioned in the wik article. The origin of those signs are also totally different and are pure fiction
  - bmitc 4y ago
    There are statistics for these things. Counter examples just means they’re somewhere else in the distribution.
mFixman 4y ago
I honestly think that the best way to fix everything wrong in the world is to reduce class sizes in schools, and age categorisation seems like a good place to start. If there is such a difference between the academic results of a kid born in July and another one born in August, wouldn't it make sense to double the amount of classes and group the children in age groups of 6 months of length rather than a year of length?
- cmrdporcupine 4y ago
  The Montessori approach actually does the opposite re: age categorization. Small classes, yes, very. But classes with multiple age groups together. 3 year age spans is my recollection. Basically "junior elementary" and "senior elementary" and "adolescent" is how I've seen it grouped. Many ideas going on here, but partially it's younger kids learning from older kids or being able to access "older" material if they can handle it, encouraging mentoring relationships, not living under the illusion that just because two kids are the same age that they are measurable against each other on some skill sets, encouraging individualized learning paths, etc.
runlaszlorun 4y ago
lotophage 4y ago
There is some overlap here with a recent article in The Atlantic article that makes the case for delaying the start of school for boys: https://www.theatlantic.com/magazine/archive/2022/10/boys-delayed-entry-school-start-redshirting/671238/ https://www.theatlantic.com/magazine/archive/2022/10/boys-de...
taoufix 4y ago
https://web.archive.org/web/20221020095951/https://www.nytimes.com/2018/11/28/opinion/august-birthdays-adhd.html https://web.archive.org/web/20221020095951/https://www.nytim...
bayesian_horse 4y ago
ADHD is actually underdiagnosed in most countries... A proper diagnosis is highly correlated both with the probability of certain consequences (violence, drug addiction, low academic performance...) and the likelihood of treatment lessening those consequences.
deleted 4y ago
[deleted]
mklarmann 4y ago
Usually there is more than one class that starts at the same location. They already would do a great job by just grouping them all by age...
thomastjeffery 4y ago
The problem here is not ADHD being over diagnosed. The problem is using academic performance in place of actual diagnosis in the first place. It's a good predictor, but we are entirely capable of more. ADHD is the best studied disorder there is. ADHD has been very significantly plaugued by misinformation and stygma. Misinformation is still baked into the name itself! But things are getting better. People are learning that ADHD is actually an executive functioning disorder, that you aren't likely to grow out of it as an adult, and that stimulant medication isn't the Boogeyman that the war on drugs has made it out to be. So it's no wonder that we are seeing increased diagnosis rates! We're seeing an increase of LGBTQ+ identification rates, too. It's pretty obvious why. This whole article is just fear mongering backed by circular reasoning. Do better, NYT.
hirvi74 4y ago
I was born towards the middle of the year, but I started school at age 5 instead of 6. I really wish my parents started me later. I think I would have had a lot less issues adapting to such a system. I have ADHD too, and I wasn't diagnosed until my classical guitar professor basically told me to get treated or don't come back, but in a slightly more tactful manner. The most disappointing part of the process was when I told people outside my family about my diagnosis. I was met with plenty of resounding comments like, "Wait, how did you not know?" or a "Yea, everyone knows you do. I knew within seconds of meeting you." It wasn't the... response I was hoping for, but oh well. =/ I figured once treated life would hop back on track, and I'd be able to apply myself, become who I was destined to be, etc.. But over the years, I have learned that ADHD, while impairing, wasn't what held me back, and still isn't what is holding me back. There is something else, I am still searching for it. (I don't mean something like a clinical disease, but perhaps my personality, past trauma, thought patterns, etc..)
onetokeoverthe 4y ago
[dead]

141 points by dymk 4y ago

deleted 4y ago

[deleted]

Non-paywall link https://web.archive.org/web/20221020023129/https://www.nytimes.com/2018/11/28/opinion/august-birthdays-adhd.html https://web.archive.org/web/20221020023129/https://www.nytim...

klempner 4y ago

The flip side of this is that people who legitimately have ADHD are surely more likely to have it diagnosed if they're having to deal with the added academic difficulty of going through school almost a year earlier than their September born peers. That is, even in a world with no overdiagnosis of ADHD, we would 100% expect an effect of the sort this article raises.

colechristensen 4y ago
I think I had the opposite effect whereby ADHD symptoms were created because i was so far ahead of my peers (September birthday) that some cognitive skills never developed properly for lack of challenge. (I have test results that point to very selective cognitive skill gaps which might be attributable to that)
- phnofive 4y ago
  I'm in the same boat - what tests are you referring to? Might be something I can learn about myself there...
  - colechristensen 4y ago
    I had a full 4 hour neuropsych test done as the result of a concussion. The test I was bad at was where they read you a list of random words and test your ability to retain immediately and after spaced repetitions. The first time I heard it I retained very little but on subsequent repetitions what I did learn I retained. So like a very specific sort of being bad at something. The rest of the tests were all in decently high percentiles.
    - Hnrobert42 4y ago
      Could that “gap” have been attributable to the concussion, though?
      - colechristensen 4y ago
        No the concussion was recent, the problem demonstrated by the tests made a lot of lifelong things make sense.
    - dylan604 4y ago
      >where they read you a list of random words and test your ability to retain immediately Person, woman, man, camera, TV type words? Sounds like other neuro tests. I've screwed up these tests as I focus on repeating each word in the gap between the next word being said then repeat with the new word being added to the point I've missed the next word. I've never "liked" this test, as I don't think it's always indicative of what they are trying to make it. This sounds more like interviewing a potential server that isn't allowed to write down the order.
      - wincy 4y ago
        This is called the working memory index score, for what it’s worth.
    - wincy 4y ago
      Sounds like the WAIS-III intelligence test. The state tested me using this as an admission criteria for a summer camp full of gifted children. They accepted two kids from our school which was generally pretty rare, especially considering our school’s socioeconomic level. If I recall correctly you’re talking about the working memory index. I scored 50th percentile on that portion of the test but top 0.4% overall, which I’ve always felt like reveals something about my “ADHD brain”. It’s definitely not the norm. The administering psychologist seemed super interested in my testing and I asked a lot of questions about the process. She brought me back in for a second day of tests as some of the tests I exceeded the space available. I recall they had a band writing symbol recognition and copying test, and I filled up a page front and back, so she had to come back the next day with more pages to accurately measure me since you aren’t supposed to “ace” a part of an intelligence test. I often think about it because I often think “well, being 1 in 250 is pretty good, but that also means there’s literally millions of people smarter than me”. Hard work and building good habits like going to bed on time has been key to actually making use of the “raw power” of my brain, and Adderall as an adult has helped a ton with this despite side effects that I try to keep under control (irritability and seeming more ‘robotic’. Every time I try to stop using it I feel like my career slips and I become depressed. The me on Adderall is capable of being a competent software engineering team lead juggling multiple balls in the air. The me without Adderall struggles as a senior software engineer writing code for one project. I’m excited to take a 2 week break from the meds on vacation later this year though. I constantly feel like I’m “grinding my gears” too hard, so to speak, like the Adderall is adding jet fuel to my engine of a brain and it’s gonna burn me out. It hasn’t happened yet but I really want to avoid tolerance.
montanalow 4y ago
The converse is also true. We may be missing diagnosis for people born in September, who may struggle but not quite meet the definitions which often include academic performance.
- thomastjeffery 4y ago
  Even "academic performance" isn't a clear enough predictor. It isn't even a single axis! I was a perfect student all through grade school; except I had terrible grades in almost every class. Why? Because I almost never did homework. I usually aced tests without even trying, though. And I could always provide meaningful input into class discussions. But that isn't enough for the strict traditional structure of academia. Teachers would make me stay after school to try to catch up on homework, and I would just wait patiently until it was late enough in the evening that they would give up and let me go home. This was a recurring pattern from 4rth grade all through 12th. I only graduated high school because I finished hundreds of pages of make-up work over the last couple weeks. The reality is I couldn't do homework. I could focus and sit still, which must have meant I don't have any attention or hyperactivity disorder... ...but that's not what ADHD is. It's an executive functioning disorder. ADHD is being diagnosed more today because it has been incredibly under-diagnosed in the past. It's still significantly underdiagnosed in adults today.
  - jasonladuke0311 4y ago
    This largely mirrors my experience. You know how people talk about addiction, and how they are "drawn" to their poison, like by some force? The polar opposite of that is what I felt with homework. Like trying to push two identical magnetic poles together.
    - thomastjeffery 4y ago
      > Like trying to push two magnetic poles together ...with atrophied hands. I knew I could, I knew I should, but I could never do. I could only watch myself, never participate. It's really validating to have words like "executive dysfunction" to describe this pattern, as opposed to "lazy", "tired", and "unmotivated" - which are all I had growing up.
jay_kyburz 4y ago
I wonder if it was a less of an issue in the past, because we would make kids with difficulties repeat a year. They would go from youngest to oldest. I'm sure repeating brings with it all kids of other problems.
notacoward 4y ago
Good point, and also I wonder how many of these diagnoses are deliberately sought by parents aware of the "relative age within school year" phenomenon. Holding kids back a year because of this has become so common that it has a name: redshirting. Having them diagnosed as ADHD and either medicating or holding back seems like a natural extension. I don't mean to suggest that anyone's faking it BTW. As the authors point out, the real problem here might be underdiagnosis of September children. But parents of August kids might be more than a little predisposed to schedule that doctor visit, listen to that diagnosis, etc. in a way that parents of September kids would not be.

phnofive 4y ago

Submitted a few times in the past but never discussed. --- An unexplored link here is No Child Left Behind and its successors; in 2001, K-12 became standardized test prep schools as grades earned funding. Bubbling certainly drove me a little batty.

fnordpiglet 4y ago

As a June baby in a state with a July cut off, I was always nearly a year younger than the majority of the class. It caused me no end of difficulty in school, to the point I loathed school, barely graduated high school with a 2.0 GPA and more than the legal limit of skipped days, diagnosed with ADD, and went straight to career in the valley. It was only when I was close to 30 that I sort of realized I actually was smart and could do well in school, and quit my lucrative career to get highest honors at UIUC CS- a very difficult program where graduating with C’s was an achievement - but I pulled off a 4.0 (A+ at UIUC adds nothing to the GPA). When I had my daughter, born in late May, I held her back a year in preschool and put her in a private school that mixes multiple years in the same differentiated class. She is so happy in school, and I just hope that she doesn’t have to experience the years of misery and failure I experienced that led to an adult life filled with anxiety that I’ve only recently conquered. Public school in the US is not structured in a way that is adaptable to the various states of human maturation you see in kids that all mature in different ways at different rates. It’s factory education, and if you’re not a widget of the right shape it cuts you up.

travbrack 4y ago
Really inspiring story. Why did you pursue school so late in your career? Just to prove to yourself that you could do it?
owlninja 4y ago
What changed at 30?
brendank310 4y ago
Nice work, that program is no joke.
rconti 4y ago
Do you think there's something about the precise age (to within a few months) that a child begins school that drives this bias in diagnosis? Or would we have the same problem with a hard cutoff date, even if all kids started school an entire year later? Or is it largely a matter of how much development a child undergoes even in 1 month at such an age (eg, a combination of factors)? I guess I ask because there will always have to be a cutoff, even if it's a soft cutoff. As a non-parent, the best solution I can see is to give the parents the knowledge and freedom to make the choice, and to add this data to perhaps mitigate over-diagnosis (and any attached stigma). Of course, as I write this out, it occurs to me how much of a burden on parents an extra year without school could be

urthor 4y ago

Psychiatry & neuroscience today are some of the closest equivalents to physicians applying leeches in the 16th century. Through no fault of their own. We, simply, have legitimately very little knowledge of those fields of science. Our understanding of the human brain is just not there. So much of Psychiatry is throwing pills at symptoms after talking about your life. That's often the state of the art in the field. Genetic sequencing, and the ability to use genetic markers to diagnose illness, hopefully will change things. A cheap and effective diagnostic tool that isn't based on guesswork and "tell me your life story."

29athrowaway 4y ago
If a neuroscientist can explain a truly brain, they would be able to explain a much simpler thing such as a CPU or GPU. But, can they? No, they can't. Psychology is in great part pseudoscience. Lots of studies that are neither falsifiable or reproducible. Psychiatrists are the modern equivalent of barber surgeons, or trying to make fine jewelry with a chisel and a hammer.
- throwaway0asd 4y ago
  Diamonds are still cut with chisel and hammer. Most of your comment sounds like a bunch of logical fallacies.
111111101101 4y ago
Leeches actually work though and we still use them today.
- WhyCause 4y ago
  Cupping is probably a better analogy. Also, there was a long stretch of time there where we didn't use leeches, at least in part due to the stigma associated with the older practice.
Hnrobert42 4y ago
I agree. I have thought that in 200 years, people will look back at mental health care at this time with a mixture of horror and pity.

KineticTroi 4y ago

Nothing about solar cycles, or sun position, and other seasonal factors relating to fetal development. An old topic, covered in better detail in a plethora of past research articles. Might be more revealing to read about seasonal differences between children born in south vs north hemispheres.

joemi 4y ago
I'm not sure if what you're talking about has anything to do with the article. It sounds like you're just making a flippant comment based on the title of the article (please correct me if I'm wrong). From the article: > Most states have arbitrary cutoffs for kindergarten entry, with children who do not reach a given age by a certain date required to wait a year. In 18 states, children who will turn 5 before Sept. 1 can enter kindergarten in the year that they turn 5; children who will turn 5 after Sept. 1 must wait until the next year. So in states with Sept. 1 cutoffs, in any given class, August-born children will usually be the youngest and September-born children the oldest. These arbitrary cutoffs have important implications for the diagnosis of A.D.H.D.
- caddemon 4y ago
  There are also other reasons birth month could be related to psychiatric disease that sound more pseudoscience-y at first. There's good reason to believe that infection at the wrong time of pregnancy can increase risk of Schizophrenia for example, meaning that the alignment of cold and flu season could affect disease rates by birth month. I agree the comment was probably just being sarcastic, but I think it's worth noting that there could be a more biological component to an effect like this, doesn't need to be a societal environment/diagnosis rate thing to be plausible. It's interesting reading about a lot of pseudoscience as you go through scientific training, because obviously you have an immediate negative reaction to it. But I've started to notice that more often than not there is some underlying grain of truth that is taken to an extreme and/or given a ridiculous explanation. This in turn dampens real research on the potentially interesting line of questioning.

riwsky 4y ago

Classic Gemini excuse-making. Clearly these kids' problems are caused by $CELESTIAL_BODY being at $PLACE during $TIME; idk why they keep whining like this! But also: focus isn't distributed bimodally; ADHD is in some respects a matter of degree, not kind. Accordingly, many ADHD treatments also improve the abilities of people without ADHD—to ends both benign (the "secular literature" of productivity porn, which overlaps with behavioral ADHD management) and less-so (widespread stimulant abuse on college campuses). That leaves us with evaluating impairment to a student's quality of life. Is doing that by comparison to their classmates subjective? No—you can still make objective statements about comparative ability—but the ethical question of "do Gemini deserve a 12-month cognitive disadvantage compared to their grade-level peers?" is harder to answer than the medical "would this kid still be diagnosed if they were relatively older?". The article's argument is weaker for eliding it.

NoToP 4y ago
What's the difference between stimulant use with a prescription and stimulant use without? A priori why demonize one as abuse and accept the other as legitimate.
- riwsky 4y ago
  Honestly, I took it as an axiom so as to steel-man the article's argument; if there were no difference between prescribed and unprescribed use, any dismissal of concerns about overprescription would be trivial. But if I had to argue for it: I'd wager that unprescribed usage on college campuses is more likely to fall outside of medical guidelines (e.g. at late hours to pull all nighters, or in higher doses for recreational and euphoriant purposes). Whether or not one demonizes this as unethical, it should be uncontroversial to describe the concomitant increases in e.g. seizure risk, addiction, and other side effects as not-benign. It also advantages 1) lawbreakers who 2) can afford secondhand stimulants. Yes, this is also evidence towards "ok so don't legally require an rx to purchase these"—but such are the rules of the game students are playing, and the argument from personal freedom is strained when made in a competitive context.
- hinkley 4y ago

deleted 4y ago

[deleted]

bound008 4y ago

I would highly recommend any readers on here who have ADHD to read "Scattered: How Attention Deficit Disorder Originates" by Dr. Gabor Maté[1] It provides a compelling argument as to the root cause of ADHD. [1] https://drgabormate.com/book/scattered-minds/ https://drgabormate.com/book/scattered-minds/

astrange 4y ago
Nice nominative determinism, maté is quite the most caffeinated thing I've had in my life.
elcritch 4y ago
I would recommend taking this book or similar ones with a grain of salt. Just going off the summary it claims to "prove" that ADHD isn't inheritable, which goes against lots of well established research showing strong inheritability of ADHD. Any books that claim to undercover the "root cause" of something as varied and complex likely haven't. Now it might have great insights, but presenting the book this way gives a bit of undertone as "cure ADHD with this one simple trick!". Guessing about the content of the book, it likely seems to discuss healing emotional regulation by some means. If so I'd agree it's a valuable aspect of treating ADHD, as most ADHD'ers also suffer significant emotional damage. That damage and accompanying maladaptive coping often is far impactful than ADHD itself.
- deleted 4y ago
  [deleted]
- mbrock 4y ago
  Maté says the inheritable trait is a kind of nervous sensitivity that develops into ADHD in certain early childhood environments especially when the caretakers are stressed, depressed, or otherwise unable to provide the infant with the stable, responsive gaze that they need. I don’t know how true that is, but that’s the idea in “Scattered Minds.”
cja 4y ago
He literally starts the book by saying that he didn't know much about ADHD until four or five years before writing and then he and his three(?) sons were all diagnosed with it and then (or so I gather because I stopped reading then) he comes up with some novel theories contradicting the experts in the field. There's so much evidence-based material to read from people who have spent decades studying ADHD that it's a shame instead to waste time on Mate. He may be an expert in some things, just not this

brador 4y ago

At age 10 that's a 10% advantage in life experience, growth, and social skills. Huge.

kova12 4y ago

Can we ban submissions which are under paywall.. it's kinda bait and switch'y, every time I click on these I can't help feeling I've been rickrolled

bell-cot 4y ago
For most HN submissions from paywalled sites, disabling javascript in your browser is a good-enough solution.
taoufix 4y ago
https://web.archive.org/web/20221020095951/https://www.nytimes.com/2018/11/28/opinion/august-birthdays-adhd.html https://web.archive.org/web/20221020095951/https://www.nytim...

chrsig 4y ago

Sometimes I wish HN had a rule against posting things about mental health (perhaps with the exception of Ask HN threads). At the very least, I'm curious what the statistics on references are compared to technical topics. There's always so much misinformation in ADHD threads. It's really exhausting.

bachmeier 4y ago
> Sometimes I wish HN had a rule against posting things about mental health Don't stop at mental health; basically any discussion outside of programming is a disaster AFAICT. It doesn't get cleaned up because the participants don't realize how bad it is. I avoid anything close to economics. I only checked the comments here to see if there was a non-paywalled version.
- technoooooost 4y ago
user_7832 4y ago
Perhaps, but is it really detrimental to discuss it? HN is decently moderately enough to avoid flame wars, and sure there's a lot of anecdotal talk going about by folks who aren't doctors, but that doesn't mean that patients/the public shouldn't discuss health. Perhaps a sticky/banner for health topics may be a good idea? Like "This is a health topic, please don't make unverifiable claims and mark your opinions as your own"?
- user_7832 4y ago
  Come to think of it, starting paragraphs/comments with syntax would be a decent solution. Like: OPINION: I think.... ANECDOTE: When I experienced this...

BigglesB 4y ago

As a counter-anecdote, I have an early September birthday, but the 1st Sept cut-off was advisory rather than strictly enforced. So I was a “year ahead” of where I should have been for my exact age up until I was 13. At which point I repeated a year, going from the youngest of my classmates to the oldest. Exactly the sort of child the article implies would at risk of being over-diagnosed with ADHD as a pre-teen. Except I wasn’t diagnosed until almost 25 years later. Of course I’m just one data-point, but I’d be curious whether the developmental age differences might potentially _cause_ ADHD development among younger classmates rather than just indicate misdiagnosis.

drogus 4y ago

I’m wondering if the opposite might be true as well - underdiagnosing people from different months. I was born in March and in Poland where I grew up school was assigned by birth year. So the oldest kids in a given class were from January, the youngest from December. I have had little problems in primary school and gymnasium without putting much work into it. Then in high school it got harder, but I still passed, again, without almost any work, skipping classes, being late all the time. I started really struggling at an university and later in life and I eventually got diagnosed. Granted, ADHD disgnosis was rather uncommon in Poland in the 90s, but I can see how a kid doing good early in school could have been not diagnosed.

corobo 4y ago

> All this raises the question of whether the disease is being overdiagnosed. No chance of it not actually being a disease? Maybe different brain types are as common as blood types. We'll never know while we label anything that doesn't play nicely with commercialism as diseased haha

nrabulinski 4y ago
This idea has been proposed multiple times before but, from what I remember (and I’m paraphrasing here) we’re identifying it as a disorder not because it’s a disease per se but because it affects the lives of those people and in general has been deteriorating ever since humans changed their lifestyles from hunters to farmers. I think this video talked about this concept in more depth https://youtu.be/QUjYy4Ksy1E https://youtu.be/QUjYy4Ksy1E
dt2m 4y ago
Not a disease? That's down to semantics and personal opinion. What isn't opinion is the fact that the symptoms of ADHD have been objectively identified on a global scale, in people from very different cultures and social classes. I agree that it isn't beneficial to label a very livable condition with the same word that we use for much harsher illnesses, and it doesn't help that it's not a visible condition. But as somebody with ADHD, it really hurts me to keep seeing this argument repeated ad nausea. Maybe the issue isn't that it is being overdiagnosed, but rather the fact that the only treatment we consider worthwhile is prescribing amphetamines to children.
- corobo 4y ago
  > But as somebody with ADHD, it really hurts me to keep seeing this argument repeated ad nausea. I've not seen or made this argument before, where does it usually go and/or what is the end result? I too have ADHD, I'm sorry if my curiosity and thoughts have caused you harm. I'm new to it and want to know what's what. Do you have any wikis or articles or twitter threads that can get me up to speed on the basics without traumatising people?
oldgradstudent 4y ago

lqet 4y ago

I am endlessly fascinated by the effect your birth month may have on you. It begins with trivial things: if you are born in summer, then by the time you are 6 months old and have developed a vague awareness of your world, "going out" means adding uncomfortably many layers of clothing and being tossed into a cold and harsh environment. Whereas if you are born in winter, your first real playtime outside is a warm and wonderful experience, with flowers and butterflies and soft grass. But the effect on your personality may go beyond this [0]: > The season in which babies are born can have a dramatic effect on their future risk relating to the development of conditions such as neurological disorders, including seasonal affective disorder, bipolar depression, schizophrenia and type I diabetes. Research has shown that the season a baby is born in can have a major effect on whether or not they will become a heavy smoker. > The risk of suicide increases by 17% for people born in the spring–early summer compared with those born in the autumn–early winter Our daughter sleeps better and longer in winter, because it gets dark early - so her birth month correlates with the amount of sleep she got in certain stages of development during the last years. In past ages, the birth month also directly influenced how much (and what kind of) food was available in certain stages of development. This may sound esoteric, but I really think there is some deep truth in attributing personality traits to astrological signs. [0] https://en.wikipedia.org/wiki/Influence_of_seasonal_birth_in_humans https://en.wikipedia.org/wiki/Influence_of_seasonal_birth_in...

Defitio 4y ago
Personality traits are not mentioned in your references wiki article. There are plenty of counter examples of other people who are born in the same month than me who are totally different. There is also a huge difference how people handle sickness like the ones mentioned in the wik article. The origin of those signs are also totally different and are pure fiction
- bmitc 4y ago
  There are statistics for these things. Counter examples just means they’re somewhere else in the distribution.

mFixman 4y ago

I honestly think that the best way to fix everything wrong in the world is to reduce class sizes in schools, and age categorisation seems like a good place to start. If there is such a difference between the academic results of a kid born in July and another one born in August, wouldn't it make sense to double the amount of classes and group the children in age groups of 6 months of length rather than a year of length?

cmrdporcupine 4y ago
The Montessori approach actually does the opposite re: age categorization. Small classes, yes, very. But classes with multiple age groups together. 3 year age spans is my recollection. Basically "junior elementary" and "senior elementary" and "adolescent" is how I've seen it grouped. Many ideas going on here, but partially it's younger kids learning from older kids or being able to access "older" material if they can handle it, encouraging mentoring relationships, not living under the illusion that just because two kids are the same age that they are measurable against each other on some skill sets, encouraging individualized learning paths, etc.

runlaszlorun 4y ago

lotophage 4y ago

There is some overlap here with a recent article in The Atlantic article that makes the case for delaying the start of school for boys: https://www.theatlantic.com/magazine/archive/2022/10/boys-delayed-entry-school-start-redshirting/671238/ https://www.theatlantic.com/magazine/archive/2022/10/boys-de...

taoufix 4y ago

https://web.archive.org/web/20221020095951/https://www.nytimes.com/2018/11/28/opinion/august-birthdays-adhd.html https://web.archive.org/web/20221020095951/https://www.nytim...

bayesian_horse 4y ago

ADHD is actually underdiagnosed in most countries... A proper diagnosis is highly correlated both with the probability of certain consequences (violence, drug addiction, low academic performance...) and the likelihood of treatment lessening those consequences.

deleted 4y ago

[deleted]

mklarmann 4y ago

Usually there is more than one class that starts at the same location. They already would do a great job by just grouping them all by age...

thomastjeffery 4y ago

The problem here is not ADHD being over diagnosed. The problem is using academic performance in place of actual diagnosis in the first place. It's a good predictor, but we are entirely capable of more. ADHD is the best studied disorder there is. ADHD has been very significantly plaugued by misinformation and stygma. Misinformation is still baked into the name itself! But things are getting better. People are learning that ADHD is actually an executive functioning disorder, that you aren't likely to grow out of it as an adult, and that stimulant medication isn't the Boogeyman that the war on drugs has made it out to be. So it's no wonder that we are seeing increased diagnosis rates! We're seeing an increase of LGBTQ+ identification rates, too. It's pretty obvious why. This whole article is just fear mongering backed by circular reasoning. Do better, NYT.

hirvi74 4y ago

I was born towards the middle of the year, but I started school at age 5 instead of 6. I really wish my parents started me later. I think I would have had a lot less issues adapting to such a system. I have ADHD too, and I wasn't diagnosed until my classical guitar professor basically told me to get treated or don't come back, but in a slightly more tactful manner. The most disappointing part of the process was when I told people outside my family about my diagnosis. I was met with plenty of resounding comments like, "Wait, how did you not know?" or a "Yea, everyone knows you do. I knew within seconds of meeting you." It wasn't the... response I was hoping for, but oh well. =/ I figured once treated life would hop back on track, and I'd be able to apply myself, become who I was destined to be, etc.. But over the years, I have learned that ADHD, while impairing, wasn't what held me back, and still isn't what is holding me back. There is something else, I am still searching for it. (I don't mean something like a clinical disease, but perhaps my personality, past trauma, thought patterns, etc..)

onetokeoverthe 4y ago

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