| ▲ | usernametaken29 a day ago |
| 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… |
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| ▲ | timster6442 a day ago | parent | next [-] |
| 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). |
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| ▲ | usernametaken29 2 hours ago | parent | next [-] | | If I remember correctly there are some paradigms in which you can show it in fMRI quite clearly but the trouble is of course MRIs are not accessible to a wide public. I will have to go dig through papers though, I have not read into MRI based diagnostics in a long while | |
| ▲ | hbarka 20 hours ago | parent | prev | next [-] | | There’s a doctor who goes by Russell Barkley, PhD on his popular YouTube channel and claims to be able to brainscan for ADHD with certainty. Is his claim legitimate? | | |
| ▲ | timster6442 3 hours ago | parent | next [-] | | He's a legit researcher though I haven't seen his work on youtube. In terms of how accurate brain scans are at diagnosing adhd you can look at recent meta analyses (gold standard of evidence based medicine pyramid). In a 2024 meta-analysis of MRI/fMRI machine-learning studies for ADHD, the average pooled sensitivity was 74% (the ability to correctly identify people who actually have ADHD) and the average pooled specificity was 75% (the ability to correctly identify people who do not have ADHD), that also means that there is a 26% false-negative rate (miss/Type II error) and a 25% false-positive rate (accidental diagnosis/Type I error) [https://doi.org/10.1016/j.jad.2024.03.111]. Though there is no set standards but under 80% is pretty low for a clinically useful test but can still be used in some conditions such as to supplement diagnosis. To give some numbers the rapid antigen covid tests had 72% sensitivity and 98.9% specificity. (note the lower sensitivity was acceptable at the time but the CDC guideline was for symptomatic people to retest 48 hours. Viral load and other staging factors could all confound.) [https://doi.org/10.1371/journal.pmed.1004011] | |
| ▲ | RossBencina 19 hours ago | parent | prev | next [-] | | Russel Barkley is a pioneer in the field of ADHD research. I have heard of such a claim, but not from Russel Barkley. Could you provide a link of Russel Barkley making the claim please? | | |
| ▲ | hellweaver666 16 hours ago | parent [-] | | It's somewhere in this talk (broken down as a playlist). It's been a while since I've watched it but I do recall him saying that they can see physically differences in the brain of adhd folks https://www.youtube.com/watch?v=BzhbAK1pdPM&list=PLzBixSjmbc... | | |
| ▲ | nairboon 13 hours ago | parent [-] | | Seeing physical differences in brain volume, connectivity or activity between groups of many adhd folks and non-adhd folks is one thing and that can be done. However, performing a clinical diagnosis of adhd in an individual, solely based on a brain scan, is a completely different thing. |
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| ▲ | breezybottom 15 hours ago | parent | prev [-] | | This is the intelligence of the average American voter. No wonder we got Trump. |
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| ▲ | genxy a day ago | parent | prev [-] | | ADHD also evolutionary advantages, so there is unlikely to be a single gene that encodes for it. | | |
| ▲ | wredcoll a day ago | parent | next [-] | | Evo-psych is impossible to falsify. | | | |
| ▲ | Quarrel a day ago | parent | prev | next [-] | | What are they? Are there papers on this? | | |
| ▲ | steve_adams_86 a day ago | parent | next [-] | | 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. | | |
| ▲ | Weryj 20 hours ago | parent [-] | | I’ve always thought, it’s not absurd to think there different development routes which the brain takes depending on the environment it develops in. With your foraging example, it does make me think ADHD is a small group/individual optimisation. Prioritising high vigilance and individual productivity over social cohesion. I speak with no authority. I don’t even know how such a theory could be tested. | | |
| ▲ | thaumasiotes 19 hours ago | parent [-] | | > I’ve always thought, it’s not absurd to think there different development routes which the brain takes depending on the environment it develops in. What do you think nutritional stunting means? https://en.wikipedia.org/wiki/Stunted_growth | | |
| ▲ | Weryj 18 hours ago | parent [-] | | I don’t mean from a nutritional standpoint, but a behavioural perspective. Smaller groups would have an higher percentage of responsibility per individual to be vigilant and proactive. It would make sense to me that evolutionary there would be different mental development paths depending on the requirements of their situation. This is coming from my understanding that ADHD is more prevalent in stressful upbringings. | | |
| ▲ | psd1 16 hours ago | parent [-] | | If adhd is heritable, then the stressful upbringing could be symptomatic of the parent's condition instead of causal. |
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| ▲ | wao0uuno 13 hours ago | parent | prev | next [-] | | A psychiatrist told me that people with ADHD perform better under extreme pressure and chaos. No idea if that's true. Personally I don't even think of ADHD as a deficiency. It's just a trait that is not compatible with modern society and workplace. | | |
| ▲ | animal531 10 hours ago | parent | next [-] | | A common meme you'll see on ADHD in online posts are about how people with it are perfectly calm during emergencies, but then when any inconsequential thing happens such as e.g. breaking a shoelace and they'll just unravel and/or take forever to deal with it. | |
| ▲ | hirvi74 12 hours ago | parent | prev [-] | | There might be a correlation, but I doubt causation. I would argue people with ADHD, like myself, tend to end up in situations where extreme pressure and chaos is more common. Thus, we have more exposure than the average person. I imagine it can be a trainable trait in many people. | | |
| ▲ | tccole 11 hours ago | parent [-] | | Yeah, I think this is the key point. I am better at handling chaos because I grew up around chaos (my mom has adhd and so do I) so I am much better at handling things falling apart. |
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| ▲ | idnexjwnfodnn 20 hours ago | parent | prev | next [-] | | I don't know about papers but I had a doctor tell me they are overrepresented among snipers in the military. ADD could be an advantage to hunting. | | |
| ▲ | bmacho 15 hours ago | parent [-] | | Or ADD just sucks there less than in other areas. Like being physically weak is not an advantage in white collar jobs. |
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| ▲ | erlich 17 hours ago | parent | prev [-] | | ChatGPT's take was that 10 ADHD people/animals would go exploring and if one produced a new source of food then it would be advantageous for the group, but the other 9 could fail and be completely useless. A bit like venture capital funds haha. So there is still room for complete failure in life, and maybe its a lot of luck/environment that some ADHD people succeed naturally. |
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| ▲ | akoboldfrying a day ago | parent | prev [-] | | 1. How is it advantageous? 2. Assuming it really is: Why would this make it unlikely to be encoded on a single gene? As a layman, the only condition I'm aware of with this "downside but also upside" quality is sickle cell anaemia (downside is anaemia, upside is increased resistance to malaria), which is decided by a single nucleotide change on chromosome 11. | | |
| ▲ | timster6442 2 hours ago | parent | next [-] | | Am biologist and keeping genes that are "advantageous" is the most common trap that people fall into about evolution. Evolution isint actually about keep advantageous traits the real idea is about differences in reproductive success, not about evolution systematically preserving only traits that are beneficial to the individual. In fact Darwin's theory of evolution is kind of outdated as well. We now understand genetic drift and things like the neutral theory of molecular evolution from moto kimura and the nearly neutral theory of evolution from tomoko ohta may give some sort of explanation to polygenic nature of adhd. | |
| ▲ | ipsod 12 hours ago | parent | prev | next [-] | | Sometimes the upside is just being different. I heard about a group of cattle, and one of them was ill, while the others feasted. The feed was tainted, and so only the sick one survived. Though, with ADHD, I think it's definitely more than that. It doesn't just make it hard to focus, it makes it hard to focus on what you need to, until the moment that it is obviously now or never. Focus, though - there's tons of that, flitting about, and sometimes grabbing you up and running away with you - sometimes for months. I would imagine that there are a lot of novel discoveries attributable to it. | |
| ▲ | thaumasiotes 19 hours ago | parent | prev | next [-] | | > As a layman, the only condition I'm aware of with this "downside but also upside" quality is sickle cell anaemia Essentially all traits that you might think of as "traits" and not "features of the species" have downsides and also upsides. Where there's any significant imbalance, the genes for that trait will be purged from the gene pool (if the trait is basically all negatives) or sweep to become universal (if all positives). | |
| ▲ | ndsipa_pomu 16 hours ago | parent | prev [-] | | By seeking out novelty, someone could be a more effective forager or better able to spot predators/prey hiding. ADHD often comes with a high attention to detail, so there's lots of advantages that could come with that (e.g. that twig wasn't broken before, something has passed through here). Also, having different sleeping patterns can mean that the people with ADHD are likely better equipped to keep a fire burning overnight and possibly be alert for predators. | | |
| ▲ | hackable_sand 9 hours ago | parent | next [-] | | This isn't funny | |
| ▲ | hirvi74 12 hours ago | parent | prev [-] | | > ADHD often comes with a high attention to detail Per the DSM-5, one of the core symptoms of ADHD: "often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities | | |
| ▲ | ndsipa_pomu 12 hours ago | parent [-] | | Yes, it's both a lack of attention to details in "boring" tasks and an exceptional attention to details in "interesting" tasks. | | |
| ▲ | hirvi74 4 hours ago | parent [-] | | I think there is a conflation between attention and attention to details. I understand attention control can vary depending on the engagement value of a task. I have experienced the condition my entire life, I am well aware. I am not aware of any data that supports being interested in a task lessens the likelihood of making mistakes. If you have any data, I will gladly read it. |
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| ▲ | sedivy94 21 hours ago | parent | prev | next [-] |
| 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. |
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| ▲ | usernametaken29 2 hours ago | parent | next [-] | | I’m going to say that as you perform more clinical tests typically your chances of a wrong diagnosis will decrease proportionally. However particularly in the case of ADHD tests, if you know the test questions and the symptom description I think you could cheat your way to a diagnosis. If you went to all of these tests in earnest, without looking them up, just providing spontaneous responses, and all of them come back positive, I’d say chances are you have ADHD. | |
| ▲ | legacynl 15 hours ago | parent | prev | next [-] | | > 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. | |
| ▲ | LocalPCGuy 12 hours ago | parent | prev [-] | | Be careful and approach `HealthyGamerGG` with a bit of healthy skepticism. I have benefited from a number of his videos, but recently small things have lead to me growing concerned that as his reach/influence grows, the same motivations that existed early on mutate as with many influencers. Not suggesting anything negative per se, just recommending a variety of sources and validating his claims. For another source, Dr. Barkley's videos are very good. |
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| ▲ | anamexis a day ago | parent | prev | next [-] |
| ADHD is not an autism spectrum disorder, is it? |
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| ▲ | usernametaken29 a day ago | parent | next [-] | | 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/ | | |
| ▲ | BirdieNZ 19 hours ago | parent | next [-] | | 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 19 hours ago | parent | prev | next [-] | | 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 18 hours ago | parent | prev [-] | | > 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. |
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| ▲ | poopmonster a day ago | parent | prev | next [-] | | No, however they are often comorbid. | |
| ▲ | great_wubwub a day ago | parent | prev [-] | | Autism Disorder with High Distractability? | | |
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| ▲ | Brybry a day ago | parent | prev [-] |
| 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/ [2] https://pmc.ncbi.nlm.nih.gov/articles/PMC5835722/ |
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| ▲ | usernametaken29 2 hours ago | parent [-] | | 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 |
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