5 ms·

I spent a decent amount working on ADHD diagnostics and unfortunately it sucks. To my knowledge, to this day, there isn’t a single reliable biomarker that ident

I spent a decent amount working on ADHD diagnostics and unfortunately it sucks. To my knowledge, to this day, there isn’t a single reliable biomarker that identifies autism spectrum disorders. It’s usually correlation studies paired with questionnaires which for lack of better words can be described as “incidental” at best. Most z scored tests I know are also developed with small samples, a hundred participants with an outgroup of 20 would already be a LARGE sample. The standard ADHD questionnaire was validated on some 35 people. There might be some hope in deep learning, particularly in observing eye movement components to deliver reliable biomarkers in the future, but I’m not so confident any time soon. It’s dreadful and fascinating at the same time that defining and testing for ADS has been so elusive for so long…

anamexis 25d ago
ADHD is not an autism spectrum disorder, is it?
- usernametaken29 25d ago
  That’s my bad for conflating the two. Indeed they are not the same in ICT-11 but! diagnostics is moving towards the direction of treating them the same. ADHD and ASD have extremely high comorbidity and it has been proposed many times to classify them together because the symptoms overlap (difficulties at school, aggressive behaviour or temper, lack of social skills, etc). In fact it has become so difficult to find distinctive features of ADHD both in diagnostics AND treatment (both are usually treated with cognitive behavioural therapy and in more severe cases medication) that it has been proposed numerous times to drop their distinction in the ICT, but this hasn’t happened yet. Good paper to the point: https://pmc.ncbi.nlm.nih.gov/articles/PMC4654237/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4654237/
  - BirdieNZ 25d ago
    I don't think that's the conclusion of the paper you linked, although there are papers suggesting that ADHD and autism are essentially subtypes of a single overarching disorder. The more common view is that because prevalence of attentional deficit in autism is so high, it's rare to find someone with autism who isn't also able to fit an ADHD diagnosis. This might mean a shared common ancestor as it were, or perhaps autism has attentional deficit as an intrinsic part of the disorder rather than people with autism also often having ADHD. The other direction is the amount of people who have ADHD who also have autism. In this case, while the overlap is higher than the general population, it is easy to find people with ADHD who do not meet the diagnostic criteria for autism. Put more simply, people with ADHD aren't necessarily autistic, but people with autism are usually ADHD.
  - RossBencina 25d ago
    CBT is not a first line treatment for ADHD in Australia. Indeed standard CBT is contra-indicated because it requires the kind of "homework" that ADHDers struggle with. There are CBT variants tailored for ADHD however.
  - applfanboysbgon 25d ago
    > distinctive features of ADHD both in diagnostics AND treatment (both are usually treated with cognitive behavioural therapy and in more severe cases medication) Uh, what? How exactly could treatment be more distinct than ADHD people being indicated for a highly-regulated drug like amphetamines, which are extremely effective to the point of being life-changing treatment? Meanwhile nobody would consider prescribing Adderall to treat autism. What a bizarre conflation of two completely different disorders.
- poopmonster 25d ago
  No, however they are often comorbid.
- great_wubwub 25d ago
  Autism Disorder with High Distractability?
  - pstuart 25d ago
    I believe AuDHD is the common term.
    - tacticus 25d ago
      The gold edition
timster6442 25d ago
From a molecular neuroscience perspective, for both ADHD and ASD (autism) you're unlikely to find any pure biomarkers as clean as a disease like huntingtons disease whose mechanism is clearly understood as extra CAG repeats on the HTT gene (a clean mendelian disorder). ADHD is defined by behavior/cognitive symptoms and most all behavior/cognitive diseases are multifactoral, which ADHD is. WES/WGS and GWAS has been done and for familial ADHD and unlike ASD there is mostly no clear monogenic mutation (a single gene that would explain the phenotype) [note monogenic mutations are usually a very small subset of cases but give scientists a look into what pathway/mechanism is causing a multifactoral disease]. Thus it is not for a lack of looking classically, and deficit is speculated to likely manifest as a neural circuit organization or synaptic issue (though the latter is more closely linked to ASD). This is currently impossible (basically) to measure in alive human brain as it requires nanoscopic imaging, note how challenging the fly map was (incomplete IMO as well).
- genxy 25d ago
  ADHD also evolutionary advantages, so there is unlikely to be a single gene that encodes for it.
  - Quarrel 25d ago
    What are they? Are there papers on this?
    - steve_adams_86 25d ago
      There are only papers which suggest this could be true, none that conclusively prove it. That I’m aware of. There are some cool studies done where people with a without ADHD are tasked to forage berries. The people with ADHD do better and adhere to foraging patterns which existing theories suggest would be more optimal. A lot of the studies like that indicate the individual with the condition might benefit more from ADHD than the group they’re in, but I’m not sure that studies have explored group benefits very much. There’s an often cited paper in which nomadic men who carry a certain ADHD-related allele (DRD4-7R, a dopamine reception variant with ADHD traits and novelty seeking) tend to have better nutritional status. I can’t recall much about it or how high quality it is.
Brybry 25d ago
Isn't this true of nearly all mental disorders in DSM-5 and ICD-11? We don't really know what mental disorders are and so we don't have objective diagnostic tests for them. [1] We just have treatments that sometimes work for some people (and with the replication crisis[2] that sometimes is probably a lower value than expected). [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC6732705/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6732705/ [2] https://pmc.ncbi.nlm.nih.gov/articles/PMC5835722/ https://pmc.ncbi.nlm.nih.gov/articles/PMC5835722/
- usernametaken29 24d ago
  I concur that many of the diagnostics methods are small sample sized for psychological tests. However I believe we have a lot more neurological evidence for underlying conditions and mechanisms in some. Schizophrenia for example has clear neurological hypothesis relating to agency and we can clearly tell these patients in a standard MRI. The same cannot be said for ADHD or ASD
sedivy94 25d ago
32 y/o male. I took an in-person assessment earlier this year. It was an 8 hour battery of tests split across two days. In no particular order: - Clinical Interview - Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV) - Wechsler Memory Scale – Fourth Edition (WMS-IV) - Conners Continuous Performance Test – Third Edition (CPT-3) - Delis-Kaplan Executive Functioning System, selected subtests - Wisconsin Card Sorting Test (WCST) Are you familiar with any of those? I did some research after receiving my report and apparently the combination of tests listed above are well-respected, about as good as it gets. I’m curious what your take is. The subjective part of the assessment was actually the clinician making sense of the data. My cognitive assessment (IQ and its subtypes) scored fairly high, I averaged something like 115 (84th percentile). But my memory assessment scores (audio/visual memory/working memory, immediate/delayed memory) tanked tremendously, I averaged around 90 (30th percentile). My positive diagnosis was based on the variability of scores and the clear cognition-memory gap. The results made sense, aligned with my experience in life (I fell asleep in almost every lecture in college, sustaining attention while taking notes was a heavy audio-visual working memory exercise for me). I personally haven’t adopted any of this as my identity but it opened a door to do some metacognition and reflect on how I interface with the world. Also the stimulant medication didn’t magically fix everything, sometimes the hyper focus is worse, but there was one HUGE benefit that I didn’t realize I was missing - emotional regulation. I’m a heavy ruminator and pretty much suffered in silence most of my life, my inner dialog is much more organized and calm, and I can comb through my thoughts easier now. P.S. I cannot recommend enough - check out “HealthyGamerGG” on YouTube. He does some deep dives on ADHD and other diagnoses. Classically trained psychiatrist with something like 5 years of training as a Buddhist monk. Very insightful guy who’s both data-driven and spiritual, helping a lot of people.
- legacynl 25d ago
  > I’m curious what your take is. I'm not OP but that seems like a very respectable diagnostic track. No test is 100% reliable, so you'd want multiple tests. Even then the results can realistically only be interpreted by a psychologist that is familiar with your situation (hence the clinical interview). So this seems perfectly proper. > Also the stimulant medication didn’t magically fix everything Sadly there is no medication that fixes adhd. The only thing these medication does is make it easier to deal with by alleviating (some of) the symptoms. Personally I've noticed from my medication (methylphenidate) that it make it easier to stay focused on whatever task I'm doing, but if that happens to be scrolling reddit, I can still waste hours, perhaps even more since I would have otherwise distracted myself from reddit long before. So it's not perfect, but it does enable me to concentrate 8h+ at work, and that's ultimately the main benefit it brings me.

anamexis 25d ago

ADHD is not an autism spectrum disorder, is it?

usernametaken29 25d ago
That’s my bad for conflating the two. Indeed they are not the same in ICT-11 but! diagnostics is moving towards the direction of treating them the same. ADHD and ASD have extremely high comorbidity and it has been proposed many times to classify them together because the symptoms overlap (difficulties at school, aggressive behaviour or temper, lack of social skills, etc). In fact it has become so difficult to find distinctive features of ADHD both in diagnostics AND treatment (both are usually treated with cognitive behavioural therapy and in more severe cases medication) that it has been proposed numerous times to drop their distinction in the ICT, but this hasn’t happened yet. Good paper to the point: https://pmc.ncbi.nlm.nih.gov/articles/PMC4654237/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4654237/
- BirdieNZ 25d ago
  I don't think that's the conclusion of the paper you linked, although there are papers suggesting that ADHD and autism are essentially subtypes of a single overarching disorder. The more common view is that because prevalence of attentional deficit in autism is so high, it's rare to find someone with autism who isn't also able to fit an ADHD diagnosis. This might mean a shared common ancestor as it were, or perhaps autism has attentional deficit as an intrinsic part of the disorder rather than people with autism also often having ADHD. The other direction is the amount of people who have ADHD who also have autism. In this case, while the overlap is higher than the general population, it is easy to find people with ADHD who do not meet the diagnostic criteria for autism. Put more simply, people with ADHD aren't necessarily autistic, but people with autism are usually ADHD.
- RossBencina 25d ago
  CBT is not a first line treatment for ADHD in Australia. Indeed standard CBT is contra-indicated because it requires the kind of "homework" that ADHDers struggle with. There are CBT variants tailored for ADHD however.
- applfanboysbgon 25d ago
  > distinctive features of ADHD both in diagnostics AND treatment (both are usually treated with cognitive behavioural therapy and in more severe cases medication) Uh, what? How exactly could treatment be more distinct than ADHD people being indicated for a highly-regulated drug like amphetamines, which are extremely effective to the point of being life-changing treatment? Meanwhile nobody would consider prescribing Adderall to treat autism. What a bizarre conflation of two completely different disorders.
poopmonster 25d ago
No, however they are often comorbid.
great_wubwub 25d ago
Autism Disorder with High Distractability?
- pstuart 25d ago
  I believe AuDHD is the common term.
  - tacticus 25d ago
    The gold edition

timster6442 25d ago

From a molecular neuroscience perspective, for both ADHD and ASD (autism) you're unlikely to find any pure biomarkers as clean as a disease like huntingtons disease whose mechanism is clearly understood as extra CAG repeats on the HTT gene (a clean mendelian disorder). ADHD is defined by behavior/cognitive symptoms and most all behavior/cognitive diseases are multifactoral, which ADHD is. WES/WGS and GWAS has been done and for familial ADHD and unlike ASD there is mostly no clear monogenic mutation (a single gene that would explain the phenotype) [note monogenic mutations are usually a very small subset of cases but give scientists a look into what pathway/mechanism is causing a multifactoral disease]. Thus it is not for a lack of looking classically, and deficit is speculated to likely manifest as a neural circuit organization or synaptic issue (though the latter is more closely linked to ASD). This is currently impossible (basically) to measure in alive human brain as it requires nanoscopic imaging, note how challenging the fly map was (incomplete IMO as well).

genxy 25d ago
ADHD also evolutionary advantages, so there is unlikely to be a single gene that encodes for it.
- Quarrel 25d ago
  What are they? Are there papers on this?
  - steve_adams_86 25d ago
    There are only papers which suggest this could be true, none that conclusively prove it. That I’m aware of. There are some cool studies done where people with a without ADHD are tasked to forage berries. The people with ADHD do better and adhere to foraging patterns which existing theories suggest would be more optimal. A lot of the studies like that indicate the individual with the condition might benefit more from ADHD than the group they’re in, but I’m not sure that studies have explored group benefits very much. There’s an often cited paper in which nomadic men who carry a certain ADHD-related allele (DRD4-7R, a dopamine reception variant with ADHD traits and novelty seeking) tend to have better nutritional status. I can’t recall much about it or how high quality it is.

Brybry 25d ago

Isn't this true of nearly all mental disorders in DSM-5 and ICD-11? We don't really know what mental disorders are and so we don't have objective diagnostic tests for them. [1] We just have treatments that sometimes work for some people (and with the replication crisis[2] that sometimes is probably a lower value than expected). [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC6732705/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6732705/ [2] https://pmc.ncbi.nlm.nih.gov/articles/PMC5835722/ https://pmc.ncbi.nlm.nih.gov/articles/PMC5835722/

usernametaken29 24d ago
I concur that many of the diagnostics methods are small sample sized for psychological tests. However I believe we have a lot more neurological evidence for underlying conditions and mechanisms in some. Schizophrenia for example has clear neurological hypothesis relating to agency and we can clearly tell these patients in a standard MRI. The same cannot be said for ADHD or ASD

sedivy94 25d ago

32 y/o male. I took an in-person assessment earlier this year. It was an 8 hour battery of tests split across two days. In no particular order: - Clinical Interview - Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV) - Wechsler Memory Scale – Fourth Edition (WMS-IV) - Conners Continuous Performance Test – Third Edition (CPT-3) - Delis-Kaplan Executive Functioning System, selected subtests - Wisconsin Card Sorting Test (WCST) Are you familiar with any of those? I did some research after receiving my report and apparently the combination of tests listed above are well-respected, about as good as it gets. I’m curious what your take is. The subjective part of the assessment was actually the clinician making sense of the data. My cognitive assessment (IQ and its subtypes) scored fairly high, I averaged something like 115 (84th percentile). But my memory assessment scores (audio/visual memory/working memory, immediate/delayed memory) tanked tremendously, I averaged around 90 (30th percentile). My positive diagnosis was based on the variability of scores and the clear cognition-memory gap. The results made sense, aligned with my experience in life (I fell asleep in almost every lecture in college, sustaining attention while taking notes was a heavy audio-visual working memory exercise for me). I personally haven’t adopted any of this as my identity but it opened a door to do some metacognition and reflect on how I interface with the world. Also the stimulant medication didn’t magically fix everything, sometimes the hyper focus is worse, but there was one HUGE benefit that I didn’t realize I was missing - emotional regulation. I’m a heavy ruminator and pretty much suffered in silence most of my life, my inner dialog is much more organized and calm, and I can comb through my thoughts easier now. P.S. I cannot recommend enough - check out “HealthyGamerGG” on YouTube. He does some deep dives on ADHD and other diagnoses. Classically trained psychiatrist with something like 5 years of training as a Buddhist monk. Very insightful guy who’s both data-driven and spiritual, helping a lot of people.

legacynl 25d ago
> I’m curious what your take is. I'm not OP but that seems like a very respectable diagnostic track. No test is 100% reliable, so you'd want multiple tests. Even then the results can realistically only be interpreted by a psychologist that is familiar with your situation (hence the clinical interview). So this seems perfectly proper. > Also the stimulant medication didn’t magically fix everything Sadly there is no medication that fixes adhd. The only thing these medication does is make it easier to deal with by alleviating (some of) the symptoms. Personally I've noticed from my medication (methylphenidate) that it make it easier to stay focused on whatever task I'm doing, but if that happens to be scrolling reddit, I can still waste hours, perhaps even more since I would have otherwise distracted myself from reddit long before. So it's not perfect, but it does enable me to concentrate 8h+ at work, and that's ultimately the main benefit it brings me.