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.
Literally the key defining feature of whether something is a disorder is whether it “impedes” your life, and that could be literally anything
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.
Not having enough sex is hard to formalize as a diagnostic criterium.
Joke aside (which is on me), I have doubts that it's about psychiatry being an epistemic mess. And when I say "that it's (not) about", I mean that it's not (or is) relevant to the framing of the problem.
a) it's only been almost 200 hundred years, most of which were spend building crowd control rather than exploring minds, so it's not an issue of semantics and 'mental' x 'neural' topologies defined in as unambiguous terms as possible. psychology drew lines for the wrong reasons but men, who build and still run the field, are, ... well ... not very manly, are they? nobody is, these days. Some mafia says jump & people jump, you read it in studies and subtext all the time, and in real life, just look at the the amounts of highly functioning autistic people just rolling with the rules of conformity in 'realms' with 'grander'--meaning, in context, requiring high education (not the half baked kind)--purpose. It's weird.
b) "regulation" implies continuity, which requires literally no more than 2 things:
1. learning a few rules, which is an active thing, much easier for ADHD and other people than the thing they have no control over whatsoever, which is
2. brain circuits that don't (or do) constantly break continuity of ... all the things that return thoughts and emotions even though the "main" function isn't done, or any (or only some) of the concurrent, async functions called by the "main" function are or are not done, (yet), all while all the 'context and reality and "presence" sustaining functions' are just stable enough ... (minus that cool part of the CNS that does it's thing no matter what)
All that said, I have to check the study in detail. We should never forget that the personalities of parents (and other involved parties) play a 1337% more important role than the subtype of ADHD or whatever symptoms a person "shows".
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.
So suddenly the task seems totally overwhelming, when I could just… not do it. So I find a time later I can attempt it and after a few times it is no longer novel and I forget about it.
If anything is hyper-active, it’s the executive function part of my brain that is driven to plan out every tiny, hypothetical detail before I can start.
What’s missing is the reward and internal incentives for doing things when there are other things that do feel good to do (that aren’t what I need to do).
1. Relentlessly make distractions high friction. Block websites, go to the office if you get distracted at home, etc.
2. Use time-based daily planning instead of goal-based (stuff like pomodoro helps). If I put "create work plan for project Z" on my to-do list, it is ambiguous and I will put it off forever. If I just say "Spend 25 minutes on work plan for project Z, no pressure on outcome/output", I make tons of progress (and often can continue the task for a while)
3. music
4. the obvious diet/sleep/meds advice
I eventually discovered that the adrenaline response from extreme stress ('if I don't get this fucking thing done by 7:30am I'm fired' kind of thing) allows me to lock in and do the thing.
I went the other way. I knew from the start that this "trick" helped me work. It took until my 30s to learn that that's ADHD and that I can skip the stress with medication. God knows how many years of life I've robbed myself of with the stress spikes.
that I can skip the stress with medication
The ADHD manager has one extra responsibility. Make the thing due 1 week earlier.
I've always considered it Too Much Attention Disorder.
The way I like to think about it is that neurotypical people have a beam of light shining out in front of them, wherever they turn their head the light shines and that's where their attention is. Nothing else distracts them from where the light is shining.
With ADHD (for me at least) it's like 50 beams of light scanning the entire room constantly for 'something'. This is too much attention to things that I'm not really interested in, but can distract me from anything I'm trying to do or wan't to do.
For things that I am really interested in (like writing code) the 50 beams of light all manage to synchronise and focus in the same place and that's hyperfocus.
But the hyper-focus can be magical when it targets the task you need to do!
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?
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.
Guess we’ll see how my diagnosis goes.
I'm also reminded that "Obsessive-Compulsive Disorder" and "Obsessive-Compulsive Personality Disorder" are different in kind but necessarily in magnitude.
The former comcerns more localized obsessions and the latter is more of a global "default state of perfectionism".
You manage to pry them apart, but it goes flying through the air and only to get stuck on an even stronger magnet still. And on it goes, over and over, until the magnet is stuck on the biggest, strongest magnet.
Your attention is constantly being repelled from less engaging activities to more highly engaging activities, and eventually you land on whatever the most engaging activity is nearby. Sometimes without even realizing it
Another interesting thing that's not in the DSM - very high likelihood of balance / motor control problems (clumsiness, falling).
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.
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.
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.
Glad I wasn't just a weird, overly sensitive kid.
Oh we are, just we have neurological reasons for it :D
...
> 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
2: https://en.wikipedia.org/wiki/Oppositional_defiant_disorder
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.
https://www.sciencedirect.com/science/article/pii/S014976342...
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.
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
It’s great that you can get through the entirety of something because I think that deserves a high form of respect.
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.
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-biotype...
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.
[1] - https://archive.is/3a4VZ