10 ms·

I'm a psychiatrist, so I obviously have a bias, but I have been pretty alarmed by the caviler attitude to the diagnosis and treatment of ADHD and Autism-spectru

I'm a psychiatrist, so I obviously have a bias, but I have been pretty alarmed by the caviler attitude to the diagnosis and treatment of ADHD and Autism-spectrum disorders. This is not specifically directed at this product launch, rather a general observation, but we have evidence based instruments to aid in diagnosis (that still requires a contextual clinical interpretation!) and evidence about what works and what doesn't. Most of the stuff I see is pretty squarely an evidence-free affair. Wether it's a cash grab or a well-intentioned effort, both can be harmful. Marketing interventions to a specific diagnosis with known treatments should not be taken lightly. Non-medical interventions can be effective, and therefore they can be harmful.

Apocryphon 1y ago
What are your thoughts on the QbTest? Is it rigorous or is it incomplete for diagnosing ADHD?
- phren0logy 1y ago
  I was not familiar with it until now. At a quick glance, it looks like it has some overlap with the CPT. But generally speaking, this is going to give a snapshot in time in one setting, which is helpful, but just one part of the picture. As the makers of the test note, it still requires a clinical interview and rating scales to arrive at a diagnosis: > Should QbTest be used with other measures? > It is not meant to be a standalone tool for diagnosing ADHD. Instead, it has been designed to be added to the assessment process along with a clinical interview and rating scales.
cameronbedard 1y ago
What do you think of what the app is trying to accomplish? I see it as a attempt at self intervention or helping someone get started. You mentioned evidence about what works and what doesn't. As someone who struggled with ADHD, I am curious about your thoughts on the app intentions or goals.
jamestimmins 1y ago
Curious about your thoughts on homebuilt AI tools for dealing with ADHD side effects. I've identified a handful of habits I struggle with but want to do, and thought processes that can be challenging. I've planned to plug these into an LLM to have it do midday checkins about how I'm feeling and then respond in line with what I want to focus on. Never occurred to me that something focused on symptoms instead of treatment could be harmful, but I suppose it's worth considering.
- phren0logy 1y ago
  I don't know your tools, but if you aren't recommending them to others for money, then we're already in a different category. But succinctly, if something can help you form habits, it can probably help you form bad habits.
- lawlessone 1y ago
  bear with me for the tangent. And don't take what i say here as a reason you shouldn't try tools or try to build your own tools. I used to try the Pomodoro technique it worked fantastic ...briefly. Once the novelty wore off I stopped using it. It turned into an extra task I needed to do in order to do other tasks. AI would probably follow the same trajectory for me unless you make it impossible to turn off.
pjfin123 1y ago
How is $5/mo a cash grab? Psychiatrists charge more
- rimunroe 1y ago
  Something can be a cash grab even if it’s cheap if it doesn’t do something effectively or is just trying to take advantage of people in need
- lawlessone 1y ago
  scaling.
- lawlessone 1y ago
  scaling. Psychiatrist charges one person more. But if you can charge a million people $5 dollars you'll make a lot more.
vaindil 1y ago
I both agree and disagree with you. I think neurodivergence has become a bit "trendy" lately, and some people have latched onto these labels when they may not be clinically appropriate. However, these evidence-based diagnostic tools aren't perfect. My sister was properly diagnosed with ADHD several years ago, and she encouraged me to get tested. My tester, a PhD psychologist who specialized in neuropsych testing, said the evidence was borderline, but ultimately refused to give a diagnosis because I did well in high school and that's unheard of in "true" ADHD. I promise I'm not exaggerating--I have the report to prove it. He completely ignored that I never had to pay attention in school because it was so easy for me, and I only started to run into problems in college when the material got more difficult. Thankfully my psychiatrist disagreed with that and started me on medication anyway, and since then I've actually been able to understand why I am the way I am and work through my issues. (I found out a year later that my parents actually had me tested in first grade and I was diagnosed then, but they intentionally kept it from me my whole life.) I know this is just one anecdote, but it's a common discussion point online that mental healthcare like this isn't always the most accessible. I think well-intentioned research and self-diagnosis can certainly have their place, depending on one's circumstances, and as long as care is taken to avoid unscientific information.
- keeganpoppen 1y ago
  i had a very similar experience as well... who knew that you can't have ADHD if you do well in school, even if school (even college) was easy enough to not ever need to dig deep in the way that you have to do every day in real life (if you're ambitious, anyway).
  - hirvi74 1y ago
    I constantly read people that have experiences like this, then on the other hand, I know countless people that lied about having ADHD and received treatment with virtually no issues at all. I do not advocate for drug-seeking behaviors, but I find it wild how there are such contrasting diagnostic experiences. I wonder if professionals would be less adverse to treatment administration if patients were more willing to trial non-stimulants first?
ndndndnd 1y ago
In my (anecdotal but decades long) experience, psych folks tend to be overconfident in their methods and tools and evidence. As if studies provide ironclad proof that your way is the best and only way to go. That hasn't been my experience at all and it's pretty easy to find a crapton of neurodivergent folks that would agree. I am biased too but I have endured a lot of anguish putting my faith in psych professionals. The vast majority of progress I've made over the years has come via discussions with other folks like me. But you claim it's unsafe? It's been more effective (and safer) to find my own way.
lawlessone 1y ago
I don't know what to think about it anymore myself. it does seem like a trend. But at the same time as someone diagnosed in my 30's that meds really helped. i'd feel like i'm pulling up the ladder on others. The neurodiversity at work trend does irk me a little, especially when people start talking about so called "superpowers" and their benefits to the company.
- hirvi74 1y ago
  > start talking about so called "superpowers" I cannot stand people like that. I am not trying to be all 'woe is me', but ADHD has had non-stop negative impacts on my life from childhood through present time. I am in my 30s too (diagnosed in early 20s and treated since), and I've basically just given up on life.
- nopassrecover 1y ago
  What would the world be like if an identity-associated (and seemingly ego-threatening to others) label was not a requirement to get access to a consumable good that made a material impact not only on an individual’s wellbeing, and life-time outcomes, but even for those who value this more, value to the economic and capital and social system. Like imagine saying you need to spend thousands in proving to people that coffee is something that would help you get a pep in your step at 3pm on Wednesday to be able to get your morning latte. Or to reframe this, why does everyone care so much, especially in an era when we’ve given up so many other values and multi-generational investments at times in a baby and bathwater sense.
thisislife2 1y ago
Thank you for sharing this. I have often been very cynical here, and elsewhere online, about ADHD, especially amongst adults. Most of the cynicism stems from the capitalistic nature of modern pharmaceutical companies - it literally seems like they are trying to create a market for their "ADHD" drugs through online social marketing - "You can't concentrate on a task? Must be ADHD.", "You don't feel like doing something productive? Oh, that's ADHD for sure", "Do you frequently procrastinate and feel guilty about? Yup, that's ADHD" and so on ... The issue I have with "ADHD" in general is that there are so many other well-recognized and researched causes that more satisfactorily explain many of these behavioural issues - like depression and / or anxiety - than "ADHD". There are even personality disorders that can cause such long-term behavioural issues - for e.g., Avoidant Personality Disorder or even Obsessive Compulsive Personality Disorder (both stemming from anxiety issues), and they can be more correctly and confidently diagnosed than the cluster** that is "ADHD" (whose diagnostic criteria has been already revised multiple times in the Diagnostic and Statistical Manual). Alan Schwarz, the author of the book ADHD Nation has investigated the ties between pharmaceutical companies and doctors: > "The six-question screening instrument that was endorsed by the World Health Organization was devised by doctors with a very long history in ADHD research," he says. "These are, generally, men who have been enriched by the pharmaceutical industry in order to churn out research and churn out things like this that merely expand the ADHD market. "What we've seen over the past 10 [to] 20 years is a constant enthusiasm on the part of the ADHD lobby to get more and more adults to consider the possibility that they, too, have ADHD," Schwarz says. (Source: Adult ADHD Can't Be Diagnosed With A Simple Screening Test, Doctors Warn - https://www.npr.org/sections/health-shots/2017/05/29/527654633/adult-adhd-cant-be-diagnosed-with-a-simple-screening-test-doctors-warn https://www.npr.org/sections/health-shots/2017/05/29/5276546... ). I am not against self-help or personal research. But please note that it is very easy to be mislead by such things and very easy to misdiagnose your symptoms. Even the professionals have a tough time with this!
- ndndndnd 1y ago
  I'm neurodivergent and honestly this comment causes me pain.
- lawlessone 1y ago
hirvi74 1y ago
What are your clinical observations and opinions on actual research backed treatments? I am mainly concerned about the efficacy of stimulants as a treatment as opposed to non-stimulants and psychotherapeutic interventions. Also, is there are evidence based instruments to aid in diagnosis, then why do those same instruments tend to magically be removed from care during the treatment phase? For the sake of analogy, if a patient were to be diagnosed with hypertension and an anti-hypertensive medication regiment is started. I imagine upon returning for a follow up visit, the patient's blood pressure will be remeasured in order to verify the efficacy of the treatment. For ADHD, I had to go through quite a significant diagnostic process before being given the green light for treatment. Upon returning for a follow up, the only methodology used to gauge treatment efficacy is being asked, "How is <insert medication> work for you?" I always try to answer the question honestly, but after almost 12 years of treatment, I still am not sure what to expect in terms of treatment. Are such questions truly the only evaluation of treatment? How can one tell if medication is working better than they realize or not at all? Perhaps my expectations are too high? Also, wouldn't some metric help determine if tolerance is occurring?
- lazystar 1y ago
  > How can one tell if medication is working better than they realize or not at all? in my case, if i still have a job, then its working lol
  - hirvi74 1y ago
    Ha! Not a bad test at all. I wish I could use the same test. However my employer is not a good test for dysfunction is often rewarded. I can't say any specifics about the domain I work in, but just know the name starts with the letter 'g' and ends with 'overnment'.
rendx 1y ago
The biggest quarrel I have with it is that even if you get clinically tested, at least in the cases where I asked friends who got tested, they did not even try to rule out other causes, like repressed childhood trauma/cPTSD. People might end up on potentially lifelong medication, where other treatment options and recovery may be available. see e.g. https://www.nature.com/articles/d41586-020-00922-8 https://www.nature.com/articles/d41586-020-00922-8 , https://www.healthline.com/health/adhd/adhd-linked-to-trauma https://www.healthline.com/health/adhd/adhd-linked-to-trauma
- doright 1y ago
  What is even more insidious is if your own abusers adopt the clinical methodology and label you with a condition (ADHD in my case) such that you as a young person are incentivized to forget about the abuse they themselves perpetrated. I have lost decades of treatment to this exact phenomenon and it was completely iatrogenic. I no longer think any label suits my lived experience anymore other than "traumatized", which is something that happened to me (as opposed to "ADHD", which is something I am).
  - rendx 1y ago
    It did not "happen to you". It was done to you.
checker659 1y ago
As a late diagnosed ADHD person, I’d rather there be over diagnosis than under diagnosis. We don’t understand the brain. There are a lot of us that suffer in silence.
laserbeam 1y ago
At some points in life I spent several weeks with my therapist and one session with a psychiatrist exploring whether I have ADHD. Turns out I don’t. It was an important journey in my past, not because it determined that brain is “normal”, but because I learned a lot about myself. Every single self diagnostic tool I have looked at in that period would have screwed me over. I would have misdiagnosed myself. I second everything in this comment. If you think you have ADHD, explore the topic with professionals. Your own biases can trap you with internet apps.
nopassrecover 1y ago
If I were to say to you for the sake of argument that contextual clinical interpretation was no longer required, let’s say that we had a perfect test some other way, does part of you feel threatened or attached or defensive or argumentative? The reason I ask is that your response leans very heavily into the importance of expertise and a specific form of knowledge, without showing the kind of subjective empathy for the experience of the people dealing with these challenges that I’m confident you have in spades given your profession. And given your personal draw to scientific expertise (given your profession), and investment in building that expertise in yourself, and continued personal material and ego investment in that expertise being valued (and the school of thought that legitimises and makes that expertise worthy), as well as your clear intelligence and exploration and insights in this space, it seems an interesting question to ask whether in your deepest reflection there is any sense of conflict or tendency to bias, and how you consider if that shapes your views.
deleted 1y ago
[deleted]

Apocryphon 1y ago

What are your thoughts on the QbTest? Is it rigorous or is it incomplete for diagnosing ADHD?

phren0logy 1y ago
I was not familiar with it until now. At a quick glance, it looks like it has some overlap with the CPT. But generally speaking, this is going to give a snapshot in time in one setting, which is helpful, but just one part of the picture. As the makers of the test note, it still requires a clinical interview and rating scales to arrive at a diagnosis: > Should QbTest be used with other measures? > It is not meant to be a standalone tool for diagnosing ADHD. Instead, it has been designed to be added to the assessment process along with a clinical interview and rating scales.

cameronbedard 1y ago

What do you think of what the app is trying to accomplish? I see it as a attempt at self intervention or helping someone get started. You mentioned evidence about what works and what doesn't. As someone who struggled with ADHD, I am curious about your thoughts on the app intentions or goals.

jamestimmins 1y ago

Curious about your thoughts on homebuilt AI tools for dealing with ADHD side effects. I've identified a handful of habits I struggle with but want to do, and thought processes that can be challenging. I've planned to plug these into an LLM to have it do midday checkins about how I'm feeling and then respond in line with what I want to focus on. Never occurred to me that something focused on symptoms instead of treatment could be harmful, but I suppose it's worth considering.

phren0logy 1y ago
I don't know your tools, but if you aren't recommending them to others for money, then we're already in a different category. But succinctly, if something can help you form habits, it can probably help you form bad habits.
lawlessone 1y ago
bear with me for the tangent. And don't take what i say here as a reason you shouldn't try tools or try to build your own tools. I used to try the Pomodoro technique it worked fantastic ...briefly. Once the novelty wore off I stopped using it. It turned into an extra task I needed to do in order to do other tasks. AI would probably follow the same trajectory for me unless you make it impossible to turn off.

pjfin123 1y ago

How is $5/mo a cash grab? Psychiatrists charge more

rimunroe 1y ago
Something can be a cash grab even if it’s cheap if it doesn’t do something effectively or is just trying to take advantage of people in need
lawlessone 1y ago
scaling.
lawlessone 1y ago
scaling. Psychiatrist charges one person more. But if you can charge a million people $5 dollars you'll make a lot more.

vaindil 1y ago

I both agree and disagree with you. I think neurodivergence has become a bit "trendy" lately, and some people have latched onto these labels when they may not be clinically appropriate. However, these evidence-based diagnostic tools aren't perfect. My sister was properly diagnosed with ADHD several years ago, and she encouraged me to get tested. My tester, a PhD psychologist who specialized in neuropsych testing, said the evidence was borderline, but ultimately refused to give a diagnosis because I did well in high school and that's unheard of in "true" ADHD. I promise I'm not exaggerating--I have the report to prove it. He completely ignored that I never had to pay attention in school because it was so easy for me, and I only started to run into problems in college when the material got more difficult. Thankfully my psychiatrist disagreed with that and started me on medication anyway, and since then I've actually been able to understand why I am the way I am and work through my issues. (I found out a year later that my parents actually had me tested in first grade and I was diagnosed then, but they intentionally kept it from me my whole life.) I know this is just one anecdote, but it's a common discussion point online that mental healthcare like this isn't always the most accessible. I think well-intentioned research and self-diagnosis can certainly have their place, depending on one's circumstances, and as long as care is taken to avoid unscientific information.

keeganpoppen 1y ago
i had a very similar experience as well... who knew that you can't have ADHD if you do well in school, even if school (even college) was easy enough to not ever need to dig deep in the way that you have to do every day in real life (if you're ambitious, anyway).
- hirvi74 1y ago
  I constantly read people that have experiences like this, then on the other hand, I know countless people that lied about having ADHD and received treatment with virtually no issues at all. I do not advocate for drug-seeking behaviors, but I find it wild how there are such contrasting diagnostic experiences. I wonder if professionals would be less adverse to treatment administration if patients were more willing to trial non-stimulants first?

ndndndnd 1y ago

In my (anecdotal but decades long) experience, psych folks tend to be overconfident in their methods and tools and evidence. As if studies provide ironclad proof that your way is the best and only way to go. That hasn't been my experience at all and it's pretty easy to find a crapton of neurodivergent folks that would agree. I am biased too but I have endured a lot of anguish putting my faith in psych professionals. The vast majority of progress I've made over the years has come via discussions with other folks like me. But you claim it's unsafe? It's been more effective (and safer) to find my own way.

lawlessone 1y ago

I don't know what to think about it anymore myself. it does seem like a trend. But at the same time as someone diagnosed in my 30's that meds really helped. i'd feel like i'm pulling up the ladder on others. The neurodiversity at work trend does irk me a little, especially when people start talking about so called "superpowers" and their benefits to the company.

hirvi74 1y ago
> start talking about so called "superpowers" I cannot stand people like that. I am not trying to be all 'woe is me', but ADHD has had non-stop negative impacts on my life from childhood through present time. I am in my 30s too (diagnosed in early 20s and treated since), and I've basically just given up on life.
nopassrecover 1y ago
What would the world be like if an identity-associated (and seemingly ego-threatening to others) label was not a requirement to get access to a consumable good that made a material impact not only on an individual’s wellbeing, and life-time outcomes, but even for those who value this more, value to the economic and capital and social system. Like imagine saying you need to spend thousands in proving to people that coffee is something that would help you get a pep in your step at 3pm on Wednesday to be able to get your morning latte. Or to reframe this, why does everyone care so much, especially in an era when we’ve given up so many other values and multi-generational investments at times in a baby and bathwater sense.

thisislife2 1y ago

Thank you for sharing this. I have often been very cynical here, and elsewhere online, about ADHD, especially amongst adults. Most of the cynicism stems from the capitalistic nature of modern pharmaceutical companies - it literally seems like they are trying to create a market for their "ADHD" drugs through online social marketing - "You can't concentrate on a task? Must be ADHD.", "You don't feel like doing something productive? Oh, that's ADHD for sure", "Do you frequently procrastinate and feel guilty about? Yup, that's ADHD" and so on ... The issue I have with "ADHD" in general is that there are so many other well-recognized and researched causes that more satisfactorily explain many of these behavioural issues - like depression and / or anxiety - than "ADHD". There are even personality disorders that can cause such long-term behavioural issues - for e.g., Avoidant Personality Disorder or even Obsessive Compulsive Personality Disorder (both stemming from anxiety issues), and they can be more correctly and confidently diagnosed than the cluster** that is "ADHD" (whose diagnostic criteria has been already revised multiple times in the Diagnostic and Statistical Manual). Alan Schwarz, the author of the book ADHD Nation has investigated the ties between pharmaceutical companies and doctors: > "The six-question screening instrument that was endorsed by the World Health Organization was devised by doctors with a very long history in ADHD research," he says. "These are, generally, men who have been enriched by the pharmaceutical industry in order to churn out research and churn out things like this that merely expand the ADHD market. "What we've seen over the past 10 [to] 20 years is a constant enthusiasm on the part of the ADHD lobby to get more and more adults to consider the possibility that they, too, have ADHD," Schwarz says. (Source: Adult ADHD Can't Be Diagnosed With A Simple Screening Test, Doctors Warn - https://www.npr.org/sections/health-shots/2017/05/29/527654633/adult-adhd-cant-be-diagnosed-with-a-simple-screening-test-doctors-warn https://www.npr.org/sections/health-shots/2017/05/29/5276546... ). I am not against self-help or personal research. But please note that it is very easy to be mislead by such things and very easy to misdiagnose your symptoms. Even the professionals have a tough time with this!

ndndndnd 1y ago
I'm neurodivergent and honestly this comment causes me pain.
lawlessone 1y ago

hirvi74 1y ago

What are your clinical observations and opinions on actual research backed treatments? I am mainly concerned about the efficacy of stimulants as a treatment as opposed to non-stimulants and psychotherapeutic interventions. Also, is there are evidence based instruments to aid in diagnosis, then why do those same instruments tend to magically be removed from care during the treatment phase? For the sake of analogy, if a patient were to be diagnosed with hypertension and an anti-hypertensive medication regiment is started. I imagine upon returning for a follow up visit, the patient's blood pressure will be remeasured in order to verify the efficacy of the treatment. For ADHD, I had to go through quite a significant diagnostic process before being given the green light for treatment. Upon returning for a follow up, the only methodology used to gauge treatment efficacy is being asked, "How is <insert medication> work for you?" I always try to answer the question honestly, but after almost 12 years of treatment, I still am not sure what to expect in terms of treatment. Are such questions truly the only evaluation of treatment? How can one tell if medication is working better than they realize or not at all? Perhaps my expectations are too high? Also, wouldn't some metric help determine if tolerance is occurring?

lazystar 1y ago
> How can one tell if medication is working better than they realize or not at all? in my case, if i still have a job, then its working lol
- hirvi74 1y ago
  Ha! Not a bad test at all. I wish I could use the same test. However my employer is not a good test for dysfunction is often rewarded. I can't say any specifics about the domain I work in, but just know the name starts with the letter 'g' and ends with 'overnment'.

rendx 1y ago

The biggest quarrel I have with it is that even if you get clinically tested, at least in the cases where I asked friends who got tested, they did not even try to rule out other causes, like repressed childhood trauma/cPTSD. People might end up on potentially lifelong medication, where other treatment options and recovery may be available. see e.g. https://www.nature.com/articles/d41586-020-00922-8 https://www.nature.com/articles/d41586-020-00922-8 , https://www.healthline.com/health/adhd/adhd-linked-to-trauma https://www.healthline.com/health/adhd/adhd-linked-to-trauma

doright 1y ago
What is even more insidious is if your own abusers adopt the clinical methodology and label you with a condition (ADHD in my case) such that you as a young person are incentivized to forget about the abuse they themselves perpetrated. I have lost decades of treatment to this exact phenomenon and it was completely iatrogenic. I no longer think any label suits my lived experience anymore other than "traumatized", which is something that happened to me (as opposed to "ADHD", which is something I am).
- rendx 1y ago
  It did not "happen to you". It was done to you.

checker659 1y ago

As a late diagnosed ADHD person, I’d rather there be over diagnosis than under diagnosis. We don’t understand the brain. There are a lot of us that suffer in silence.

laserbeam 1y ago

At some points in life I spent several weeks with my therapist and one session with a psychiatrist exploring whether I have ADHD. Turns out I don’t. It was an important journey in my past, not because it determined that brain is “normal”, but because I learned a lot about myself. Every single self diagnostic tool I have looked at in that period would have screwed me over. I would have misdiagnosed myself. I second everything in this comment. If you think you have ADHD, explore the topic with professionals. Your own biases can trap you with internet apps.

nopassrecover 1y ago

If I were to say to you for the sake of argument that contextual clinical interpretation was no longer required, let’s say that we had a perfect test some other way, does part of you feel threatened or attached or defensive or argumentative? The reason I ask is that your response leans very heavily into the importance of expertise and a specific form of knowledge, without showing the kind of subjective empathy for the experience of the people dealing with these challenges that I’m confident you have in spades given your profession. And given your personal draw to scientific expertise (given your profession), and investment in building that expertise in yourself, and continued personal material and ego investment in that expertise being valued (and the school of thought that legitimises and makes that expertise worthy), as well as your clear intelligence and exploration and insights in this space, it seems an interesting question to ask whether in your deepest reflection there is any sense of conflict or tendency to bias, and how you consider if that shapes your views.

deleted 1y ago

[deleted]