6 ms·

Ive been saying this forever. Even with single disorder like ADHD, per the DSM two individuals can be diagnosed whilst sharing only 3 of the 9 symptoms, whichs

Ive been saying this forever. Even with single disorder like ADHD, per the DSM two individuals can be diagnosed whilst sharing only 3 of the 9 symptoms, whichs admits that each of the symptoms can have a cause that is not from ADHD. So if someone has 6 symptoms how do you know theyre not all independently caused? Given a large enough population it's a guarantee

DANmode 1y ago
The shallowly buried truth here is that ADHD, CFS, and other common conditions are not standalone random diseases, but diagnostic names for groupings of common symptoms, caused by seemingly completely unrelated stuff ranging from childhood trauma, to a staph infection or mercury leak in a tooth root.
- thirdacc 1y ago
  I don't think ADHD in particular is caused by unrelated stuff. The heritability findings are pretty strong. > A study of 894 ADHD probands and 1135 of their siblings aged 5–17 years old found a ninefold increased risk of ADHD in siblings of ADHD probands compared with siblings of controls [2]. Adoption studies suggest that the familial factors of ADHD are attributable to genetic factors rather than shared environmental factors [3, 4] with the most recent one reporting rates of ADHD to be greater among biological relatives of non-adopted ADHD children than adoptive relatives of adopted ADHD children. The adoptive relatives had a risk for ADHD like the risk in relatives of control children [4]. > Twin studies rely on the difference between the within-pair similarities of monozygotic (MZ) twin pairs, who are genetically identical, and dizygotic (DZ) twin pairs, who share, on average, 50% of their segregating genes. The mean heritability across 37 twin studies of ADHD or measures of inattentiveness and hyperactivity is 74% (Fig. 1). A similar heritability estimate of around 80% was seen in a study of MZ and DZ twins, full siblings, and maternal and paternal half-siblings [5]. The heritability is similar in males and females and for the inattentive and hyperactive-impulsive components of ADHD [6,7,8]. https://www.nature.com/articles/s41380-018-0070-0 https://www.nature.com/articles/s41380-018-0070-0
  - andoando 1y ago
    Isnt this explained simply by families who are aware of, willing, capable of disgnosing their children are more likely to tske another child to a diagnosis vs a random child? Granted they did have a control for adopted siblings
    - taneq 1y ago
      Twin studies are explicitly about scrolling for this kind of family bias.
      - rendx 1y ago
        "twin studies fail to separate the effects of genes and the prenatal environment. This failure casts doubt on claims of the relative effects of genes and environment on intelligence, psychiatric disorders, personality and other psychological variables, and other conditions." https://www.psychologytoday.com/gb/blog/looking-in-the-cultural-mirror/201006/why-twin-studies-dont-separate-genes-and-environment https://www.psychologytoday.com/gb/blog/looking-in-the-cultu... "Although many twin studies have been conducted (which is quite an understatement; there are almost 9,000 hits for “twin study” on PubMed!), there have long been critics who argue that they are scientiﬁcally worthless." Smith, Jinkinson. (2020). The debate over twin studies: an overview. http://dx.doi.org/10.22541/au.159674847.78026661 http://dx.doi.org/10.22541/au.159674847.78026661 "Because heritability is defined by both genetic and environmental influences, it is not a fixed characteristic of a disease or trait, but a population-specific estimate, analogous to, for example, the mean height, cholesterol level or life expectancy in a population. It also cannot be interpretated at the family or individual level." Kaprio J. (2012). Twins and the mystery of missing heritability: the contribution of gene-environment interactions. Journal of internal medicine, 272(5), 440–448. https://doi.org/10.1111/j.1365-2796.2012.02587.x https://doi.org/10.1111/j.1365-2796.2012.02587.x
  - lynx97 1y ago
    (How) did they control for parental influence vs. genetic heritability? I grew up with a pathologically anxious mother. I still remember having to counteract her behaviour to avoid it leaking into my world, before I managed to move out. She is still a trigger for me, 30 years later. I can only stand having her around me for at max. 2 hours, then my vessel is full. IMO, I am not convinced that a sibling study rules out environmental influences.
derefr 1y ago
> per the DSM two individuals can be diagnosed whilst sharing only 3 of the 9 symptoms, whichs admits that each of the symptoms can have a cause that is not from ADHD. To be clear, ADHD, despite having "disorder" in the name, is actually a syndrome: a complex of symptoms that, when recognized together, indicate that a certain set of interventional treatments will likely be applicable. Diagnosing someone with a syndrome does not indicate any knowledge is available on the cause (etiology) of the symptoms. Many different things can cause the same set of symptoms. But if a certain treatment ameliorates anything qualifying as that syndrome, regardless of the upstream cause, then the diagnosis of the syndrome (and so the existence of the syndrome as a concept) is useful, even if it's not informative. The DSM actually covers two very different categories of what we might call "mental" illnesses: neurocognitive illnesses, and neuroendocrine (or neurohormonal) illnesses. Neurocognitive illnesses — structural problems with the brain or its cells (think Parkinson's Disease, or ALS, or Lewy Body dementia) — are usually traceable to specific etiologies, as each one usually has either a very unique presentation of signs and symptoms, or has unique markers that can be assayed/biopsied for. Neuroendocrine illnesses, on the other hand, are almost always syndromes. Many different upstream problems (genetic, toxic, nutritive, auto-immune, etc) can potentially cause the same small menagerie of messenger-chemicals to get out of whack, and due to this, many different upstream problems end up looking like the same few "templates" of symptoms. If you can put the particular out-of-whack messenger-chemicals back into whack with drugs that do that, then you've fixed the symptoms — which doesn't fix the upstream problem (if it even can be fixed), but does fully compensate downstream for the upstream problem.
- andoando 1y ago
  If we fully admit that the DSM is merely a tool for treatment, a stastical tool to say "this drug might help the issues youre feeling" fine, however this is not the view Ive commonly seen in phycitatric literature, which points at ADHD being a "real disorder", as something definite one "has". Patients also commonly believe they have a definite disorder, saying things like how they finally "discovered" they have ADHd or even that they might "have undiagnosed ADHD". If we agree that the diagnosis is not informative, thst it is merely putting a name to something one already knows about themselves, do we then agree that this kind of talk is invalid? If so, and if this view is really prevalent in psychiatry, somehow it's completely lost on the general public and media.
thesmtsolver 1y ago
> diagnosed whilst sharing only 3 of the 9 symptoms, whichs admits that each of the symptoms can have a cause that is not from ADHD It does not logically follow that different symptoms -> different causes. (Fire can cause smoke, heat, soot, etc. Depending on the wind and other conditions, only some of them may be observable.) One root cause can manifest in different ways depending on interactions with other factors. The genetic basis for ADHD is well studied and points to a single set of core causes.
- andoando 1y ago
  I have symptoms 1-6, you have symptoms 4-9. We only share 4,5,6. Or I have 1,3,5,6,7,8, you have 2,4,6,7,8,9. Surely then, each of the symptoms (precieved, subjective symptoms) at that, can exist without ADHD. So my question is, how do you know I simply dont have multiple completely independent things that together present the 6 symptoms? Even if we are to agree its a genetic condition, the diagnosis of sny particular individual isnt based on genes so theres room for criticism of the diagnostic process
  - siva7 1y ago
    That's where the math ends and clinical diagnosis starts because those number games take you only so far. Furthermore, ADHD is classified into different subtypes so it was never a question of meeting all 9 but only the subset relevant for your own subtype. It's also not diagnosed by ticking of the trait list from the DSM with your doctor but by using recognized clinical questionnaires.
    - andoando 1y ago
      The personal questionnaires, aside from the fact that they're ridiculously easy to game and hardly ever throughly verified, are pointed to answer the crtieria defined by the DSM. If the DSM isnt what defines ADHD, what is?
      - siva7 1y ago
        The DSM is an international expert collection of acknowledged diseases - it just answers briefly the "what is this?" question, nothing more while the medical societies in your respective country implement the actual guidelines on how to diagnose and treat the diseases by using the recent scientific conclusions. So a MD isn't using the DSM to diagnose and treat you - this is a common misconception.
cardanome 1y ago
That is why we do differential diagnosis. Any ADHD diagnosis includes checking for any other mental or physical issue that could explain the symptoms. Any when anything else is ruled out AND it can be established that the person always struggled with those symptoms (ideally that they were present in childhood) will you get a diagnosis. Furthermore we know that ADHD has a genetic link. You have a 40% chance to have it when your parent has it. While we don't know every detail about how ADHD develops, we know it is something you are born with. I am so sick that people pretend that ADHD is some vague concept. No, it is vague for you because you are ignorant about it. Yes, ADHD can show up very differently in people. Which is not surprising because people happen to be different. Covid-19 can have widely different symptoms between people, doesn't mean it is not real. As an ADHD person when I interact with other with ADHD people, yes there are huge differences but there is always a shared understanding. I never have the feeling the person has a completely different thing. There is always shared understanding.
siva7 1y ago
That's understood by physicians and is also the reason why they are doing many questionnaire's with you (if they follow diagnostic guidelines) which might seem first confusing to the patient like unrelated to your actual symptoms but it's to rule out many other common diseases.
- andoando 1y ago
  Unrelated? Theyre so in your face its ridicously easy to get the diagnosis you're looking for

DANmode 1y ago

The shallowly buried truth here is that ADHD, CFS, and other common conditions are not standalone random diseases, but diagnostic names for groupings of common symptoms, caused by seemingly completely unrelated stuff ranging from childhood trauma, to a staph infection or mercury leak in a tooth root.

thirdacc 1y ago
I don't think ADHD in particular is caused by unrelated stuff. The heritability findings are pretty strong. > A study of 894 ADHD probands and 1135 of their siblings aged 5–17 years old found a ninefold increased risk of ADHD in siblings of ADHD probands compared with siblings of controls [2]. Adoption studies suggest that the familial factors of ADHD are attributable to genetic factors rather than shared environmental factors [3, 4] with the most recent one reporting rates of ADHD to be greater among biological relatives of non-adopted ADHD children than adoptive relatives of adopted ADHD children. The adoptive relatives had a risk for ADHD like the risk in relatives of control children [4]. > Twin studies rely on the difference between the within-pair similarities of monozygotic (MZ) twin pairs, who are genetically identical, and dizygotic (DZ) twin pairs, who share, on average, 50% of their segregating genes. The mean heritability across 37 twin studies of ADHD or measures of inattentiveness and hyperactivity is 74% (Fig. 1). A similar heritability estimate of around 80% was seen in a study of MZ and DZ twins, full siblings, and maternal and paternal half-siblings [5]. The heritability is similar in males and females and for the inattentive and hyperactive-impulsive components of ADHD [6,7,8]. https://www.nature.com/articles/s41380-018-0070-0 https://www.nature.com/articles/s41380-018-0070-0
- andoando 1y ago
  Isnt this explained simply by families who are aware of, willing, capable of disgnosing their children are more likely to tske another child to a diagnosis vs a random child? Granted they did have a control for adopted siblings
  - taneq 1y ago
    Twin studies are explicitly about scrolling for this kind of family bias.
    - rendx 1y ago
      "twin studies fail to separate the effects of genes and the prenatal environment. This failure casts doubt on claims of the relative effects of genes and environment on intelligence, psychiatric disorders, personality and other psychological variables, and other conditions." https://www.psychologytoday.com/gb/blog/looking-in-the-cultural-mirror/201006/why-twin-studies-dont-separate-genes-and-environment https://www.psychologytoday.com/gb/blog/looking-in-the-cultu... "Although many twin studies have been conducted (which is quite an understatement; there are almost 9,000 hits for “twin study” on PubMed!), there have long been critics who argue that they are scientiﬁcally worthless." Smith, Jinkinson. (2020). The debate over twin studies: an overview. http://dx.doi.org/10.22541/au.159674847.78026661 http://dx.doi.org/10.22541/au.159674847.78026661 "Because heritability is defined by both genetic and environmental influences, it is not a fixed characteristic of a disease or trait, but a population-specific estimate, analogous to, for example, the mean height, cholesterol level or life expectancy in a population. It also cannot be interpretated at the family or individual level." Kaprio J. (2012). Twins and the mystery of missing heritability: the contribution of gene-environment interactions. Journal of internal medicine, 272(5), 440–448. https://doi.org/10.1111/j.1365-2796.2012.02587.x https://doi.org/10.1111/j.1365-2796.2012.02587.x
- lynx97 1y ago
  (How) did they control for parental influence vs. genetic heritability? I grew up with a pathologically anxious mother. I still remember having to counteract her behaviour to avoid it leaking into my world, before I managed to move out. She is still a trigger for me, 30 years later. I can only stand having her around me for at max. 2 hours, then my vessel is full. IMO, I am not convinced that a sibling study rules out environmental influences.

derefr 1y ago

> per the DSM two individuals can be diagnosed whilst sharing only 3 of the 9 symptoms, whichs admits that each of the symptoms can have a cause that is not from ADHD. To be clear, ADHD, despite having "disorder" in the name, is actually a syndrome: a complex of symptoms that, when recognized together, indicate that a certain set of interventional treatments will likely be applicable. Diagnosing someone with a syndrome does not indicate any knowledge is available on the cause (etiology) of the symptoms. Many different things can cause the same set of symptoms. But if a certain treatment ameliorates anything qualifying as that syndrome, regardless of the upstream cause, then the diagnosis of the syndrome (and so the existence of the syndrome as a concept) is useful, even if it's not informative. The DSM actually covers two very different categories of what we might call "mental" illnesses: neurocognitive illnesses, and neuroendocrine (or neurohormonal) illnesses. Neurocognitive illnesses — structural problems with the brain or its cells (think Parkinson's Disease, or ALS, or Lewy Body dementia) — are usually traceable to specific etiologies, as each one usually has either a very unique presentation of signs and symptoms, or has unique markers that can be assayed/biopsied for. Neuroendocrine illnesses, on the other hand, are almost always syndromes. Many different upstream problems (genetic, toxic, nutritive, auto-immune, etc) can potentially cause the same small menagerie of messenger-chemicals to get out of whack, and due to this, many different upstream problems end up looking like the same few "templates" of symptoms. If you can put the particular out-of-whack messenger-chemicals back into whack with drugs that do that, then you've fixed the symptoms — which doesn't fix the upstream problem (if it even can be fixed), but does fully compensate downstream for the upstream problem.

andoando 1y ago
If we fully admit that the DSM is merely a tool for treatment, a stastical tool to say "this drug might help the issues youre feeling" fine, however this is not the view Ive commonly seen in phycitatric literature, which points at ADHD being a "real disorder", as something definite one "has". Patients also commonly believe they have a definite disorder, saying things like how they finally "discovered" they have ADHd or even that they might "have undiagnosed ADHD". If we agree that the diagnosis is not informative, thst it is merely putting a name to something one already knows about themselves, do we then agree that this kind of talk is invalid? If so, and if this view is really prevalent in psychiatry, somehow it's completely lost on the general public and media.

thesmtsolver 1y ago

> diagnosed whilst sharing only 3 of the 9 symptoms, whichs admits that each of the symptoms can have a cause that is not from ADHD It does not logically follow that different symptoms -> different causes. (Fire can cause smoke, heat, soot, etc. Depending on the wind and other conditions, only some of them may be observable.) One root cause can manifest in different ways depending on interactions with other factors. The genetic basis for ADHD is well studied and points to a single set of core causes.

andoando 1y ago
I have symptoms 1-6, you have symptoms 4-9. We only share 4,5,6. Or I have 1,3,5,6,7,8, you have 2,4,6,7,8,9. Surely then, each of the symptoms (precieved, subjective symptoms) at that, can exist without ADHD. So my question is, how do you know I simply dont have multiple completely independent things that together present the 6 symptoms? Even if we are to agree its a genetic condition, the diagnosis of sny particular individual isnt based on genes so theres room for criticism of the diagnostic process
- siva7 1y ago
  That's where the math ends and clinical diagnosis starts because those number games take you only so far. Furthermore, ADHD is classified into different subtypes so it was never a question of meeting all 9 but only the subset relevant for your own subtype. It's also not diagnosed by ticking of the trait list from the DSM with your doctor but by using recognized clinical questionnaires.
  - andoando 1y ago
    The personal questionnaires, aside from the fact that they're ridiculously easy to game and hardly ever throughly verified, are pointed to answer the crtieria defined by the DSM. If the DSM isnt what defines ADHD, what is?
    - siva7 1y ago
      The DSM is an international expert collection of acknowledged diseases - it just answers briefly the "what is this?" question, nothing more while the medical societies in your respective country implement the actual guidelines on how to diagnose and treat the diseases by using the recent scientific conclusions. So a MD isn't using the DSM to diagnose and treat you - this is a common misconception.

cardanome 1y ago

That is why we do differential diagnosis. Any ADHD diagnosis includes checking for any other mental or physical issue that could explain the symptoms. Any when anything else is ruled out AND it can be established that the person always struggled with those symptoms (ideally that they were present in childhood) will you get a diagnosis. Furthermore we know that ADHD has a genetic link. You have a 40% chance to have it when your parent has it. While we don't know every detail about how ADHD develops, we know it is something you are born with. I am so sick that people pretend that ADHD is some vague concept. No, it is vague for you because you are ignorant about it. Yes, ADHD can show up very differently in people. Which is not surprising because people happen to be different. Covid-19 can have widely different symptoms between people, doesn't mean it is not real. As an ADHD person when I interact with other with ADHD people, yes there are huge differences but there is always a shared understanding. I never have the feeling the person has a completely different thing. There is always shared understanding.

siva7 1y ago

That's understood by physicians and is also the reason why they are doing many questionnaire's with you (if they follow diagnostic guidelines) which might seem first confusing to the patient like unrelated to your actual symptoms but it's to rule out many other common diseases.

andoando 1y ago
Unrelated? Theyre so in your face its ridicously easy to get the diagnosis you're looking for