6 ms·

Brain scans reveal 3 ADHD subtypes

138 points by brandonb 6mo ago

https://archive.is/3a4VZ https://archive.is/3a4VZ

phantompeace 6mo ago
Paywalled/emailwalled
- Bender 6mo ago
  Archive [1] [1] - https://archive.is/3a4VZ https://archive.is/3a4VZ
chrisldgk 6mo ago
One thing that I can’t seem to parse from the article is why the researchers assume that this is an unresearched part of ADHD and not a different disorder entirely. I’m sure they have their reasons, but I don’t think it’s written in the article. To me it seems that if it’s not „treatable“ the same way ADHD is, I’m not sure if it’s useful to categorize it as such. On the other hand, I’m happy if kids with this disorder can get a diagnosis and treatment that actually helps them sometime in the future due to this research.
- halper 6mo ago
  It is a good point and I also struggled with that bit somewhat. It is different in so many ways, have different symptoms, does not respond (as well) to the same medication, and affect different parts of the brain. The jump from there to "subtype" was not too logical for me ...
- ivewonyoung 6mo ago
  Diabetes has a similar issue, with type 1 and type 2 having very different causes and pathologies.
- pdpi 6mo ago
  You have a set of diagnosis criteria, and matching those criteria gets you the ADHD diagnosis. This study takes people who fit the diagnosis, and says there's a test you can do to split those people into three groups. But yes, once they have a better understanding of what that difference means, the next step might well be to split the ADHD diagnosis into two separate disorders, or even that, like cancer, ADHD is actually a whole range of separate but related conditions.
- 1659447091 6mo ago
  > why the researchers assume that this is an unresearched part of ADHD and not a different disorder entirely Whether or not the extreme dysregulation is a different disorder in its own right or not, is not relevant here. They are grouping ADHD matches; clinically recognized ADHD presentations plus MRI recognized ADHD which have a distinct brain sub-pattern occurring in people that have the same distinct behavioral traits. ADHD frequently has co-occurring conditions. "Identifying “specific subtypes” of ADHD will make it easier to treat these children effectively". Having a more objective way to diagnosis for things like that seems to be the focus of the approach. They expect it to keep evolving, so I wouldn't say they are assuming anything about absolute labels -- just grouping what they now know to be true, that certain external traits match certain distinct brain patterns that are within the larger adhd brain structure. Also, I think it's not that it is "not treatable" as ADHD, it's that ADHD can be treated in many different ways and currently the wide variety of responses to such is still a black box. Adderall instant release could briefly make me tired, I would sometimes break off a small piece and use it as a sleep aid. Some other `treatments` (I prefer societal alignment coping aid) resulted in what seemed like an expensive joke. Subtypes may eventually be able to show which options work best for which types and to start there first, instead of the current default iteration. This link adds more about their research. https://medicalxpress.com/news/2026-03-distinct-adhd-biotypes-brain-driven.html https://medicalxpress.com/news/2026-03-distinct-adhd-biotype...
burnt-resistor 6mo ago
They've basically "reinvented" DSM-IV ADHD-PH, -PI, and -C more or less, but at least someone's examined the organ responsible rather than treat it like a magical black box.
- smj-edison 6mo ago
  I think the article was honing in on emotional dysregulation which iirc isn't a big component of the DSM-IV definition.
ur-whale 6mo ago
https://archive.ph/iAqUj https://archive.ph/iAqUj
smj-edison 6mo ago
It reminds me that ADHD is really not that useful of a name, executive function disorder would be a more accurate name from when I was looking into ADHD in the past. It's not about attention deficit per se, as that's downstream of struggling with executive functioning. At least it's the definition that lines up with my experience best (I have ADHD). I'll make lists in order to keep track of important tasks (which in theory would help with attention deficit) but then I'll sit down to do the things on the list and... can't. It's such a hard thing to explain, but no amount of attention hacks can get me over the hump of doing the tasks I'm dreading. That seems much more related to executive functioning.
- Extropy_ 6mo ago
  I find similar behaviour in myself, particularly that dreading a task makes it significantly more difficult to start. I find that if I can manage to do just a little bit, even just open the application and maybe look around a bit at what I need to do, it really gets the momentum going for me. Do you think there's anything that differentiates what we might call "general task dread" that perhaps anyone experiences to a certain degree from a more broad executive function disorder? Or is it that dreading leading to task paralysis is one of many symptoms of an executive function disorder?
  - hirvi74 6mo ago
    I think the frequency and level of impairment is what differentiates normal executive dysfunction from an executive functioning disorder. Perhaps a bit rhetorical, but how often does this task dread occur? Does it also ever occur for things you want to do, not just obligated to do? For me, I experience this issue for many tasks everyday. Then again, I have never had a normal executive functioning, so I cannot claim to know what it is like for normies. I’ll also add that ADHD is more than just executive dysfunction too.
    - Extropy_ 6mo ago
      I'm really bad at it for things that aren't novel or really interesting, especially repetitive tasks, like doing illustrations for a customer for example, I know what to do, I've done it hundreds of times, but I'd just rather be doing something else. It does also happen for things I want to do but only usually if it's something I'm not confident about. Like I want to do a really comprehensive gardening setup this year, I've done all the research and planning, I just have no experience sewing seeds or growing vines, or how to setup indoor seed hatching, and I'm just dreading the whole starting process and have put it off too long- I should've started mid-April.
JKCalhoun 6mo ago
I recall someone posting that the human brain is essentially "overclocked". I don't recall if that was the phrasing but the gist was that our level of intelligence can only exist by skirting the fringes of sanity. Like some set of dynamic differential equations where, if you bump a coefficient, it spins off into chaos. Perhaps this Brave New World, as opposed to the more agrarian one our species had been accustomed to, pushes many of us over that threshold.
- Ey7NFZ3P0nzAe 6mo ago
  https://en.wikipedia.org/wiki/Critical_brain_hypothesis https://en.wikipedia.org/wiki/Critical_brain_hypothesis
  - mday27 6mo ago
    Given that this includes rat and mouse studies, it seems like this theory is more around the idea that criticality is a characteristic of how brains work in general, not that human brains hit criticality as a peculiarity of our particularly high intelligence
  - jona-f 6mo ago
    So that article does not support the "overclocked" thesis, rather that this critical state is needed for optimal performance. I do agree with the original sentiment, that we are not exactly well adapted to our environment. Or our environment to us, cause this is the main point I think that is missing from this discourse about adhd or other modern frequent mental conditions: too high expectations. Cause of our inherent human narcissism we think we are more attentive and logical than we actually are, so naturally those with lower attention become noticeable first. Or whatever other metric we are measuring leading to whatever condition (depression, autism, ...). At least that mechanism seems underreported in the public. Anyone familiar with how this is viewed on in academia?
- Qem 6mo ago
  > I don't recall if that was the phrasing but the gist was that our level of intelligence can only exist by skirting the fringes of sanity. https://www.sciencedirect.com/science/article/pii/S0149763424001052 https://www.sciencedirect.com/science/article/pii/S014976342...
thesmtsolver2 6mo ago
[dead]
msarnoff 6mo ago
I think this is me. I was diagnosed with “regular” ADHD a few years ago, but I’ve had issues with rejection sensitive dysphoria my whole life. As a kid I would have a lot of meltdowns when I couldn’t get something right on the first try or made any kind of mistake. The meltdowns stopped, but I still have issues spiralling into thoughts of failure and being a horrible person when I feel like I’ve disappointed family or friends. Guanfacine has helped though. Tried a bunch of medications and this is the only one that seems to have made an impact.
- kposehn 6mo ago
  Might be worth giving Qelbree a shot as well. I switched to it last year and...yeah, it' was a complete game changer. Hard to get insurance to cover, but it's been well worth it.
  - hirvi74 6mo ago
    Do you have to take it everyday?
- copper-float 6mo ago
  Hey, you've basically described me to a tee as a boy. I had the exact same temperament: meltdowns when I thought I disappointed people, putting myself down all the time for failures and mistakes. My parents weren't even particularly strict. Glad I wasn't just a weird, overly sensitive kid.
  - oliyoung 6mo ago
    "Glad I wasn't just a weird, overly sensitive kid." Oh we are, just we have neurological reasons for it :D
anigbrowl 6mo ago
Melissa DelBello, a professor of psychiatry and pediatrics at the University of Cincinnati, said that while brain imaging holds promise, it is still impractical to conduct such scans broadly in clinical settings because they are too expensive and not yet precise enough at the level of the individual. As if questionnaires and slot-machine prescription medicine treatments are accurate. I don't want to generalize for lack of statistical data, but reports of psychiatrists 'just phoning it in' while providing little actual patient engagement are widespread.
pygy_ 6mo ago
> Some physicians and researchers have argued for years that emotional dysregulation is not peripheral to ADHD but a central, overlooked part of the condition. Yet this symptom does not appear in the formal diagnostic criteria for ADHD in the manual that doctors use to classify mental disorders. That gap has left clinicians without a clear way to categorize what they’re seeing: Are these children best understood as having severe anxiety, as being on the autism spectrum, or as something else entirely? Or does ADHD itself need to be more broadly defined? Again and again and again. Psychiatry is an epistemic mess. Psychiatrists are touristic guides of the Paris catacombs that orient themselves with a map of the subway.
- exq 6mo ago
  "With DSM-V, psychiatry firmly regressed to early 19th-century medical practice. Despite the fact that we know the origins of many of the problems it identifies, its diagnoses describe surface phenomena but completely ignore the underlying causes. Even before DSM-V was released, the American Journal of Psychiatry published the results of validity tests of various new diagnoses which indicated that the DSM largely lacks what, in the world of science is known as, 'reliability', that is, the ability to produce consistent, replicable results. In other words, it lacks scientific validity." ― Bessel Van Der Kolk, M.D.
  - AndrewKemendo 6mo ago
    That’s because psychiatry is intended to revert people to the cultural average so that they fit in and don’t have a bad time Literally the key defining feature of whether something is a disorder is whether it “impedes” your life, and that could be literally anything
    - deleted 6mo ago
      [deleted]
- doright 6mo ago
  That "something else entirely" for me was trauma. which has no search hits in this comment thread so far. I was given an ADHD diagnosis as a child before it was in vogue. From my (admittedly) biased perspective I was given this as a result of hyperactivity which might have stabilized on its own given enough time, but my caretakers reacting poorly to my early behavior caused long-lasting traumatic symptoms which happen to line up with many symptoms of ADHD. So I just assumed that ADHD was the case the whole time. I started to suspect something was off when stimulants did not help my problems, but unfortunately it was not enough to escape the sphere of trying to solve my issues with ineffective ADHD-centric solutions until long into my adulthood. Childhood trauma on top of misdiagnosis on top of continuing familial issues was an awful combination for me and I can't say that I've made that much progress from therapy, only that at this point I can survive with full awareness of the reality of how I was treated. It felt like I had been living in an alternate reality for decades and now I can't stop thinking about what I've found out.
purple-leafy 6mo ago
ADHD is interesting. I think ADHD is mainly an executive dysfunction and reward centre dysfunction, from my own experience. And a bit of nature, a bit of nurture. It’s a real double edged sword for me. On one hand relationships and “boring” tasks feel insurmountable. When I say boring I don’t even mean boring in the traditional sense, I just mean “not novel” - so even something like playing my favourite ever video game gets extremely difficult once the novelty is gone. On the other hand, as a software developer, working on novel concepts or exploring novel concepts or ideas is basically like crack-cocaine, I literally can’t stop or put them down. Double edged sword is struggling with most basic tasks, but excelling at the peripheries.
- dyauspitr 6mo ago
  When you put it that way this might be one of the greatest disabilities ever. Humans that don’t complete things they begin and chase novelty are hard to respect because it’s common and trite. Persevering through failure and the hard bits is essentially the crux of achievement, productivity and success.
  - purple-leafy 6mo ago
    I don’t agree as greatest disability ever as in “most-disabling” I’d say it’s the greatest potential modifier disability there is. Some scenarios I loathe having it, but when I’m in the flow state I love it. It’s made my life-path very non-standard (huge swings up and down), but it’s also created insane opportunities (when paired with high-drive and completing things/discipline) I personally don’t consider it a disability in my case, but I’m definitely at a disadvantage in a typical work environment compared to my peers. So I understand completely why it’s generally classed as a disability in today’s society and societal expectations. Like autism, it can produce insane outcomes (think savants etc), and if you can find the right environment for you, you can outperform more neurotypical peers. I for instance finish all my software projects, because I force myself through discipline. My work output is probably the same or slightly less-good than my peers. But my personal projects where I have full creative control of the outcomes I’d say far exceeds my peers. I mean in my own case, I’ve achieved far more than my friends and peers - whether that be in business success or other creative areas, but at massive cost - they have much more stability than me, whereas my path is a very non-linear path. I either do exceptionally well or exceptionally shit, no in-between, very black and white
SubiculumCode 6mo ago
Anyone know to what paper this article refers? I don't have WaPo
- aidenn0 6mo ago
  https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2845158 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...
aidenn0 6mo ago
> “They are simmering volcanoes basically,” Rosen said. “When things go wrong, they explode. These are kids who will have hour-long meltdowns, throw things and hit and break things.” ... > For children with this extreme form of ADHD, standard behavioral strategies may fall short. DelBello said that widely used approaches such as positive reinforcement — like giving prizes or other trinkets, or extra recess for good behavior — do not always have the intended effect. I'm a former foster parent who adopted kids from foster care. Two of them were diagnosed with RAD[1]. This "extreme form" of ADHD aligns with both my personal experience of RAD and a subset of the symptoms described by clinicians. Attachment issues in general are either commonly comorbid with, or misdiagnosed as ADHD and ODD[2] (the latter of which also somewhat matches the symptoms from TFA). I don't really have a point here, just an observation I wanted to make. 1: https://en.wikipedia.org/wiki/Reactive_attachment_disorder https://en.wikipedia.org/wiki/Reactive_attachment_disorder 2: https://en.wikipedia.org/wiki/Oppositional_defiant_disorder https://en.wikipedia.org/wiki/Oppositional_defiant_disorder
bshaughn 6mo ago
I've described the field of Psychiatry as trying to describe a building, using only its shadow (projection from high dimensional space to 2d space), with only a handful of choices for the building type. Ultimately only the building (the patient) really knows the full scope of complexity, but a doctor has to be careful in how they get info out. I don't have a solution, as its an inherently hard problem with a lot of risks (like giving medicine to the wrong person). But I also think this desire to have nice categories for things can be counterproductive in a lot of cases. I personally think rebranding aspergers + Autism to the autism spectrum was a mistake, as there's a huge difference between someone who's really good at their job but weird and despises certain workplace nonsense - and someone who can't take care of themselves. ADHD is another great example of a bucket that makes non sense. We were evolved to be hunter gatherers that get many hours of walking or running, and other physical activity every day. Then we act surprised when 11 year olds don't want to sit still 6 hours a day, or getting people like me to write a JIRA ticket is like pulling teeth. I think separating out these large categories into smaller ones is a good step, but ultimately I think the categories are a counterproductive solution to our human urge to find a logical explanation to things.
- 3836293648 6mo ago
  Merging autism and aspergers was not a mistake. There wasn't at the time enough science to separate them. There are separations to be made within autism, absolutely 100%, but the separations they hade made were also definitely 100% wrong.
sudosteph 6mo ago
The DSM seems pretty far behind the research by now, but I'd be surprised if emotional dysregulation was not mentioned in the next one. Another interesting thing that's not in the DSM - very high likelihood of balance / motor control problems (clumsiness, falling).
eutropia 6mo ago
I was surprised by how cleanly our results came together,” said Pan, a neuroimaging expert with the West China Hospital of Sichuan University and the Turner Institute for Brain and Mental Health at Monash University in Australia. “We used no clinical information whatsoever in the clustering, and yet the three biotypes that emerged mapped well onto clinically recognized ADHD presentations. Really cool that this worked out. Now I want to get my brain scanned...
- trueno 6mo ago
  same. any way to do this without being part of some clinical trial? my shit is busted it'd be nice to understand how feel like that would be meaningful in awareness
- jampekka 6mo ago
  It's not really usable for assessing individuals. The "biotype" explains roughly 1% of variation in symptoms.
braebo 6mo ago
I’ve always found the evolutionary biology lens very compelling for ADHD — consider hunters and gatherers. Hunters benefit greatly from the ability to quickly and sharply shift attention in an instant. They thrive at night and can hyper-focus on the thrill of the hunt. As civilization progressed, society was optimized for the majority (gatherers), and the hunters are marked as “disordered” for systemic incompatibilities.
skissane 6mo ago
I'm always sceptical of studies which look at a single diagnosis rather than pooling multiple related diagnoses, because the boundaries between them are so fuzzy Here's a similar study from some years back which doesn't have that flaw: https://pmc.ncbi.nlm.nih.gov/articles/PMC6880188/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6880188/
smeg_it 6mo ago
I'm a little confused. ADD & ADHD started as children's issues, if I understand it. Adults had already developed beyond it (was where I thought it started). Then later it got combined into only "ADHD" and adults where recognized (not sure which was first). This article only speaks of children. Has it reverted back to children only? I got diagnosed, only a few years ago. It does look like they are going the right direction. I year or more ago, I looked up my symptoms on the WHO list of diagnosis and most were on both the ADHD and the spectrum list. I don't believe I've ever had a thorough diagnosis, so I was trying to understand better where I might fit. All I ended up with is that there were a lot of symptoms that border lined. It felt like it was a bit under defined, like IBS (which I was falsely diagnosed with once) because they just didn't know another one that fit. Anyway, I would love more understanding. The "beyond" is common in people I've spoken with, so is the emotional dysregulation...
hellojesus 6mo ago
Does anyone have experience with the emotional dysregulatiom bit and what that looks like as an adult? I have friends with adhd tell me that I have it, but my parents have suggested there was nothing present to indicate I had it as a child, which seems to be a binary input for diagnosis. But I do seem to way overreact to the silliest things. For example, if my toddler trips and falls, my mind immediately races to "they definitely knocked all their teeth out and will be in pain and will have dentures forever and will never enjoy life again", and that seems to short circuit my reaction into a total panic/meltdown before I've even looked at the kid's face (which never hit the ground). And the advice of the internet such as deep breathing, stepping away, etc. is totally unhelpful as it seems my reaction is instantaneous. Then there's the crash and shame that follows it once the initial surge passes, which feels like my brain is lurching forward in my skull when I can feel it happening or stop it. And then I vow to never do it again, but then it happens. I seem to mostly exist as a normal human otherwise. I can hyperfocus on coding, but that could just be normal focus because that's what I do all day. My suspicion is that I have depression since the symptoms are overlapped, and I've never scored below a 20 on the phq-9. Recently when I've crashed, I've started considering seeing a psychiatrist, but my motivation seems to run out quickly after I start considering it or looking them up. I also don't want to be involuntarily detained and lose my tsa precheck. Edit: Not sure this is relevant, but I do tend to hit/slap my face when I get in these overwhelmed states, which my wife has pointed out is not normal nor okay.
- exogenousdata 6mo ago
  Preface: I'm sorry to hear that you've been experiencing this. Please try and see a doctor and/or a mental health professional in order to explain what's been going on. I realize that prioritizing self-care becomes even more difficult when you are dealing with a toddler. However your physical & mental health is super important to your child's wellbeing. What you're describing sounds like an 'intrusive thought'. There are a number of causes for intrusive thoughts including depression (as you mentioned). My best friend has these. It got a lot worse after the birth of their kid. Sometimes an intrusive thought would linger for a week. Things like their toddler getting near a street corner and then an intrusive thought of them getting into an accident with a car. If what you're experiencing turns out to be intrusive thoughts, there are a number of therapies that can attempt to make these more manageable and give you a greater degree of control over your state of mind. I wish you the best!
cvs268 6mo ago
https://en.wikipedia.org/wiki/Attention_Is_All_You_Need https://en.wikipedia.org/wiki/Attention_Is_All_You_Need ;-) Funny how "attention" in transformers (a.k.a LLMs these days) can help overcome the activation energy barrier due to attention deficit in humans.

138 points by brandonb 6mo ago

https://archive.is/3a4VZ https://archive.is/3a4VZ

phantompeace 6mo ago

Paywalled/emailwalled

Bender 6mo ago
Archive [1] [1] - https://archive.is/3a4VZ https://archive.is/3a4VZ

chrisldgk 6mo ago

One thing that I can’t seem to parse from the article is why the researchers assume that this is an unresearched part of ADHD and not a different disorder entirely. I’m sure they have their reasons, but I don’t think it’s written in the article. To me it seems that if it’s not „treatable“ the same way ADHD is, I’m not sure if it’s useful to categorize it as such. On the other hand, I’m happy if kids with this disorder can get a diagnosis and treatment that actually helps them sometime in the future due to this research.

halper 6mo ago
It is a good point and I also struggled with that bit somewhat. It is different in so many ways, have different symptoms, does not respond (as well) to the same medication, and affect different parts of the brain. The jump from there to "subtype" was not too logical for me ...
ivewonyoung 6mo ago
Diabetes has a similar issue, with type 1 and type 2 having very different causes and pathologies.
pdpi 6mo ago
You have a set of diagnosis criteria, and matching those criteria gets you the ADHD diagnosis. This study takes people who fit the diagnosis, and says there's a test you can do to split those people into three groups. But yes, once they have a better understanding of what that difference means, the next step might well be to split the ADHD diagnosis into two separate disorders, or even that, like cancer, ADHD is actually a whole range of separate but related conditions.
1659447091 6mo ago
> why the researchers assume that this is an unresearched part of ADHD and not a different disorder entirely Whether or not the extreme dysregulation is a different disorder in its own right or not, is not relevant here. They are grouping ADHD matches; clinically recognized ADHD presentations plus MRI recognized ADHD which have a distinct brain sub-pattern occurring in people that have the same distinct behavioral traits. ADHD frequently has co-occurring conditions. "Identifying “specific subtypes” of ADHD will make it easier to treat these children effectively". Having a more objective way to diagnosis for things like that seems to be the focus of the approach. They expect it to keep evolving, so I wouldn't say they are assuming anything about absolute labels -- just grouping what they now know to be true, that certain external traits match certain distinct brain patterns that are within the larger adhd brain structure. Also, I think it's not that it is "not treatable" as ADHD, it's that ADHD can be treated in many different ways and currently the wide variety of responses to such is still a black box. Adderall instant release could briefly make me tired, I would sometimes break off a small piece and use it as a sleep aid. Some other `treatments` (I prefer societal alignment coping aid) resulted in what seemed like an expensive joke. Subtypes may eventually be able to show which options work best for which types and to start there first, instead of the current default iteration. This link adds more about their research. https://medicalxpress.com/news/2026-03-distinct-adhd-biotypes-brain-driven.html https://medicalxpress.com/news/2026-03-distinct-adhd-biotype...

burnt-resistor 6mo ago

They've basically "reinvented" DSM-IV ADHD-PH, -PI, and -C more or less, but at least someone's examined the organ responsible rather than treat it like a magical black box.

smj-edison 6mo ago
I think the article was honing in on emotional dysregulation which iirc isn't a big component of the DSM-IV definition.

ur-whale 6mo ago

https://archive.ph/iAqUj https://archive.ph/iAqUj

smj-edison 6mo ago

It reminds me that ADHD is really not that useful of a name, executive function disorder would be a more accurate name from when I was looking into ADHD in the past. It's not about attention deficit per se, as that's downstream of struggling with executive functioning. At least it's the definition that lines up with my experience best (I have ADHD). I'll make lists in order to keep track of important tasks (which in theory would help with attention deficit) but then I'll sit down to do the things on the list and... can't. It's such a hard thing to explain, but no amount of attention hacks can get me over the hump of doing the tasks I'm dreading. That seems much more related to executive functioning.

Extropy_ 6mo ago
I find similar behaviour in myself, particularly that dreading a task makes it significantly more difficult to start. I find that if I can manage to do just a little bit, even just open the application and maybe look around a bit at what I need to do, it really gets the momentum going for me. Do you think there's anything that differentiates what we might call "general task dread" that perhaps anyone experiences to a certain degree from a more broad executive function disorder? Or is it that dreading leading to task paralysis is one of many symptoms of an executive function disorder?
- hirvi74 6mo ago
  I think the frequency and level of impairment is what differentiates normal executive dysfunction from an executive functioning disorder. Perhaps a bit rhetorical, but how often does this task dread occur? Does it also ever occur for things you want to do, not just obligated to do? For me, I experience this issue for many tasks everyday. Then again, I have never had a normal executive functioning, so I cannot claim to know what it is like for normies. I’ll also add that ADHD is more than just executive dysfunction too.
  - Extropy_ 6mo ago
    I'm really bad at it for things that aren't novel or really interesting, especially repetitive tasks, like doing illustrations for a customer for example, I know what to do, I've done it hundreds of times, but I'd just rather be doing something else. It does also happen for things I want to do but only usually if it's something I'm not confident about. Like I want to do a really comprehensive gardening setup this year, I've done all the research and planning, I just have no experience sewing seeds or growing vines, or how to setup indoor seed hatching, and I'm just dreading the whole starting process and have put it off too long- I should've started mid-April.

JKCalhoun 6mo ago

I recall someone posting that the human brain is essentially "overclocked". I don't recall if that was the phrasing but the gist was that our level of intelligence can only exist by skirting the fringes of sanity. Like some set of dynamic differential equations where, if you bump a coefficient, it spins off into chaos. Perhaps this Brave New World, as opposed to the more agrarian one our species had been accustomed to, pushes many of us over that threshold.

Ey7NFZ3P0nzAe 6mo ago
https://en.wikipedia.org/wiki/Critical_brain_hypothesis https://en.wikipedia.org/wiki/Critical_brain_hypothesis
- mday27 6mo ago
  Given that this includes rat and mouse studies, it seems like this theory is more around the idea that criticality is a characteristic of how brains work in general, not that human brains hit criticality as a peculiarity of our particularly high intelligence
- jona-f 6mo ago
  So that article does not support the "overclocked" thesis, rather that this critical state is needed for optimal performance. I do agree with the original sentiment, that we are not exactly well adapted to our environment. Or our environment to us, cause this is the main point I think that is missing from this discourse about adhd or other modern frequent mental conditions: too high expectations. Cause of our inherent human narcissism we think we are more attentive and logical than we actually are, so naturally those with lower attention become noticeable first. Or whatever other metric we are measuring leading to whatever condition (depression, autism, ...). At least that mechanism seems underreported in the public. Anyone familiar with how this is viewed on in academia?
Qem 6mo ago
> I don't recall if that was the phrasing but the gist was that our level of intelligence can only exist by skirting the fringes of sanity. https://www.sciencedirect.com/science/article/pii/S0149763424001052 https://www.sciencedirect.com/science/article/pii/S014976342...

thesmtsolver2 6mo ago

[dead]

msarnoff 6mo ago

I think this is me. I was diagnosed with “regular” ADHD a few years ago, but I’ve had issues with rejection sensitive dysphoria my whole life. As a kid I would have a lot of meltdowns when I couldn’t get something right on the first try or made any kind of mistake. The meltdowns stopped, but I still have issues spiralling into thoughts of failure and being a horrible person when I feel like I’ve disappointed family or friends. Guanfacine has helped though. Tried a bunch of medications and this is the only one that seems to have made an impact.

kposehn 6mo ago
Might be worth giving Qelbree a shot as well. I switched to it last year and...yeah, it' was a complete game changer. Hard to get insurance to cover, but it's been well worth it.
- hirvi74 6mo ago
  Do you have to take it everyday?
copper-float 6mo ago
Hey, you've basically described me to a tee as a boy. I had the exact same temperament: meltdowns when I thought I disappointed people, putting myself down all the time for failures and mistakes. My parents weren't even particularly strict. Glad I wasn't just a weird, overly sensitive kid.
- oliyoung 6mo ago
  "Glad I wasn't just a weird, overly sensitive kid." Oh we are, just we have neurological reasons for it :D

anigbrowl 6mo ago

Melissa DelBello, a professor of psychiatry and pediatrics at the University of Cincinnati, said that while brain imaging holds promise, it is still impractical to conduct such scans broadly in clinical settings because they are too expensive and not yet precise enough at the level of the individual. As if questionnaires and slot-machine prescription medicine treatments are accurate. I don't want to generalize for lack of statistical data, but reports of psychiatrists 'just phoning it in' while providing little actual patient engagement are widespread.

pygy_ 6mo ago

> Some physicians and researchers have argued for years that emotional dysregulation is not peripheral to ADHD but a central, overlooked part of the condition. Yet this symptom does not appear in the formal diagnostic criteria for ADHD in the manual that doctors use to classify mental disorders. That gap has left clinicians without a clear way to categorize what they’re seeing: Are these children best understood as having severe anxiety, as being on the autism spectrum, or as something else entirely? Or does ADHD itself need to be more broadly defined? Again and again and again. Psychiatry is an epistemic mess. Psychiatrists are touristic guides of the Paris catacombs that orient themselves with a map of the subway.

exq 6mo ago
"With DSM-V, psychiatry firmly regressed to early 19th-century medical practice. Despite the fact that we know the origins of many of the problems it identifies, its diagnoses describe surface phenomena but completely ignore the underlying causes. Even before DSM-V was released, the American Journal of Psychiatry published the results of validity tests of various new diagnoses which indicated that the DSM largely lacks what, in the world of science is known as, 'reliability', that is, the ability to produce consistent, replicable results. In other words, it lacks scientific validity." ― Bessel Van Der Kolk, M.D.
- AndrewKemendo 6mo ago
  That’s because psychiatry is intended to revert people to the cultural average so that they fit in and don’t have a bad time Literally the key defining feature of whether something is a disorder is whether it “impedes” your life, and that could be literally anything
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doright 6mo ago
That "something else entirely" for me was trauma. which has no search hits in this comment thread so far. I was given an ADHD diagnosis as a child before it was in vogue. From my (admittedly) biased perspective I was given this as a result of hyperactivity which might have stabilized on its own given enough time, but my caretakers reacting poorly to my early behavior caused long-lasting traumatic symptoms which happen to line up with many symptoms of ADHD. So I just assumed that ADHD was the case the whole time. I started to suspect something was off when stimulants did not help my problems, but unfortunately it was not enough to escape the sphere of trying to solve my issues with ineffective ADHD-centric solutions until long into my adulthood. Childhood trauma on top of misdiagnosis on top of continuing familial issues was an awful combination for me and I can't say that I've made that much progress from therapy, only that at this point I can survive with full awareness of the reality of how I was treated. It felt like I had been living in an alternate reality for decades and now I can't stop thinking about what I've found out.

purple-leafy 6mo ago

ADHD is interesting. I think ADHD is mainly an executive dysfunction and reward centre dysfunction, from my own experience. And a bit of nature, a bit of nurture. It’s a real double edged sword for me. On one hand relationships and “boring” tasks feel insurmountable. When I say boring I don’t even mean boring in the traditional sense, I just mean “not novel” - so even something like playing my favourite ever video game gets extremely difficult once the novelty is gone. On the other hand, as a software developer, working on novel concepts or exploring novel concepts or ideas is basically like crack-cocaine, I literally can’t stop or put them down. Double edged sword is struggling with most basic tasks, but excelling at the peripheries.

dyauspitr 6mo ago
When you put it that way this might be one of the greatest disabilities ever. Humans that don’t complete things they begin and chase novelty are hard to respect because it’s common and trite. Persevering through failure and the hard bits is essentially the crux of achievement, productivity and success.
- purple-leafy 6mo ago
  I don’t agree as greatest disability ever as in “most-disabling” I’d say it’s the greatest potential modifier disability there is. Some scenarios I loathe having it, but when I’m in the flow state I love it. It’s made my life-path very non-standard (huge swings up and down), but it’s also created insane opportunities (when paired with high-drive and completing things/discipline) I personally don’t consider it a disability in my case, but I’m definitely at a disadvantage in a typical work environment compared to my peers. So I understand completely why it’s generally classed as a disability in today’s society and societal expectations. Like autism, it can produce insane outcomes (think savants etc), and if you can find the right environment for you, you can outperform more neurotypical peers. I for instance finish all my software projects, because I force myself through discipline. My work output is probably the same or slightly less-good than my peers. But my personal projects where I have full creative control of the outcomes I’d say far exceeds my peers. I mean in my own case, I’ve achieved far more than my friends and peers - whether that be in business success or other creative areas, but at massive cost - they have much more stability than me, whereas my path is a very non-linear path. I either do exceptionally well or exceptionally shit, no in-between, very black and white

SubiculumCode 6mo ago

Anyone know to what paper this article refers? I don't have WaPo

aidenn0 6mo ago
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2845158 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...

aidenn0 6mo ago

> “They are simmering volcanoes basically,” Rosen said. “When things go wrong, they explode. These are kids who will have hour-long meltdowns, throw things and hit and break things.” ... > For children with this extreme form of ADHD, standard behavioral strategies may fall short. DelBello said that widely used approaches such as positive reinforcement — like giving prizes or other trinkets, or extra recess for good behavior — do not always have the intended effect. I'm a former foster parent who adopted kids from foster care. Two of them were diagnosed with RAD[1]. This "extreme form" of ADHD aligns with both my personal experience of RAD and a subset of the symptoms described by clinicians. Attachment issues in general are either commonly comorbid with, or misdiagnosed as ADHD and ODD[2] (the latter of which also somewhat matches the symptoms from TFA). I don't really have a point here, just an observation I wanted to make. 1: https://en.wikipedia.org/wiki/Reactive_attachment_disorder https://en.wikipedia.org/wiki/Reactive_attachment_disorder 2: https://en.wikipedia.org/wiki/Oppositional_defiant_disorder https://en.wikipedia.org/wiki/Oppositional_defiant_disorder

bshaughn 6mo ago

I've described the field of Psychiatry as trying to describe a building, using only its shadow (projection from high dimensional space to 2d space), with only a handful of choices for the building type. Ultimately only the building (the patient) really knows the full scope of complexity, but a doctor has to be careful in how they get info out. I don't have a solution, as its an inherently hard problem with a lot of risks (like giving medicine to the wrong person). But I also think this desire to have nice categories for things can be counterproductive in a lot of cases. I personally think rebranding aspergers + Autism to the autism spectrum was a mistake, as there's a huge difference between someone who's really good at their job but weird and despises certain workplace nonsense - and someone who can't take care of themselves. ADHD is another great example of a bucket that makes non sense. We were evolved to be hunter gatherers that get many hours of walking or running, and other physical activity every day. Then we act surprised when 11 year olds don't want to sit still 6 hours a day, or getting people like me to write a JIRA ticket is like pulling teeth. I think separating out these large categories into smaller ones is a good step, but ultimately I think the categories are a counterproductive solution to our human urge to find a logical explanation to things.

3836293648 6mo ago
Merging autism and aspergers was not a mistake. There wasn't at the time enough science to separate them. There are separations to be made within autism, absolutely 100%, but the separations they hade made were also definitely 100% wrong.

sudosteph 6mo ago

The DSM seems pretty far behind the research by now, but I'd be surprised if emotional dysregulation was not mentioned in the next one. Another interesting thing that's not in the DSM - very high likelihood of balance / motor control problems (clumsiness, falling).

eutropia 6mo ago

I was surprised by how cleanly our results came together,” said Pan, a neuroimaging expert with the West China Hospital of Sichuan University and the Turner Institute for Brain and Mental Health at Monash University in Australia. “We used no clinical information whatsoever in the clustering, and yet the three biotypes that emerged mapped well onto clinically recognized ADHD presentations. Really cool that this worked out. Now I want to get my brain scanned...

trueno 6mo ago
same. any way to do this without being part of some clinical trial? my shit is busted it'd be nice to understand how feel like that would be meaningful in awareness
jampekka 6mo ago
It's not really usable for assessing individuals. The "biotype" explains roughly 1% of variation in symptoms.

braebo 6mo ago

I’ve always found the evolutionary biology lens very compelling for ADHD — consider hunters and gatherers. Hunters benefit greatly from the ability to quickly and sharply shift attention in an instant. They thrive at night and can hyper-focus on the thrill of the hunt. As civilization progressed, society was optimized for the majority (gatherers), and the hunters are marked as “disordered” for systemic incompatibilities.

skissane 6mo ago

I'm always sceptical of studies which look at a single diagnosis rather than pooling multiple related diagnoses, because the boundaries between them are so fuzzy Here's a similar study from some years back which doesn't have that flaw: https://pmc.ncbi.nlm.nih.gov/articles/PMC6880188/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6880188/

smeg_it 6mo ago

I'm a little confused. ADD & ADHD started as children's issues, if I understand it. Adults had already developed beyond it (was where I thought it started). Then later it got combined into only "ADHD" and adults where recognized (not sure which was first). This article only speaks of children. Has it reverted back to children only? I got diagnosed, only a few years ago. It does look like they are going the right direction. I year or more ago, I looked up my symptoms on the WHO list of diagnosis and most were on both the ADHD and the spectrum list. I don't believe I've ever had a thorough diagnosis, so I was trying to understand better where I might fit. All I ended up with is that there were a lot of symptoms that border lined. It felt like it was a bit under defined, like IBS (which I was falsely diagnosed with once) because they just didn't know another one that fit. Anyway, I would love more understanding. The "beyond" is common in people I've spoken with, so is the emotional dysregulation...

hellojesus 6mo ago

Does anyone have experience with the emotional dysregulatiom bit and what that looks like as an adult? I have friends with adhd tell me that I have it, but my parents have suggested there was nothing present to indicate I had it as a child, which seems to be a binary input for diagnosis. But I do seem to way overreact to the silliest things. For example, if my toddler trips and falls, my mind immediately races to "they definitely knocked all their teeth out and will be in pain and will have dentures forever and will never enjoy life again", and that seems to short circuit my reaction into a total panic/meltdown before I've even looked at the kid's face (which never hit the ground). And the advice of the internet such as deep breathing, stepping away, etc. is totally unhelpful as it seems my reaction is instantaneous. Then there's the crash and shame that follows it once the initial surge passes, which feels like my brain is lurching forward in my skull when I can feel it happening or stop it. And then I vow to never do it again, but then it happens. I seem to mostly exist as a normal human otherwise. I can hyperfocus on coding, but that could just be normal focus because that's what I do all day. My suspicion is that I have depression since the symptoms are overlapped, and I've never scored below a 20 on the phq-9. Recently when I've crashed, I've started considering seeing a psychiatrist, but my motivation seems to run out quickly after I start considering it or looking them up. I also don't want to be involuntarily detained and lose my tsa precheck. Edit: Not sure this is relevant, but I do tend to hit/slap my face when I get in these overwhelmed states, which my wife has pointed out is not normal nor okay.

exogenousdata 6mo ago
Preface: I'm sorry to hear that you've been experiencing this. Please try and see a doctor and/or a mental health professional in order to explain what's been going on. I realize that prioritizing self-care becomes even more difficult when you are dealing with a toddler. However your physical & mental health is super important to your child's wellbeing. What you're describing sounds like an 'intrusive thought'. There are a number of causes for intrusive thoughts including depression (as you mentioned). My best friend has these. It got a lot worse after the birth of their kid. Sometimes an intrusive thought would linger for a week. Things like their toddler getting near a street corner and then an intrusive thought of them getting into an accident with a car. If what you're experiencing turns out to be intrusive thoughts, there are a number of therapies that can attempt to make these more manageable and give you a greater degree of control over your state of mind. I wish you the best!

cvs268 6mo ago

https://en.wikipedia.org/wiki/Attention_Is_All_You_Need https://en.wikipedia.org/wiki/Attention_Is_All_You_Need ;-) Funny how "attention" in transformers (a.k.a LLMs these days) can help overcome the activation energy barrier due to attention deficit in humans.