[jglauche]

"We could still have a principled definition of ADHD. It would be something like “People below the 5th percentile in ability to concentrate, as measured by this test.” Instead, we use the DSM, which advises us to diagnose people with ADHD if they say they have at least five symptoms from a list. "

I'm in Germany and I've been diagnosed with ADHD-PI lately (I am in my 30s) after seeing a private specialist about this topic. In addition to that DSM test and 3 other questionnaires, they ran a computer test measuring my ability to concentrate which was repeated after a couple of weeks on medication. The test results were very conclusive and I think that is the strongest diagnosis criteria that I have as it's actually measurable.

It was actually really hard for me to find a doctor to actually diagnose me. I called several doctors and it was either "we're not taking any more patients because diagnosis takes too long" or "we can't tell you if we can diagnose it, you can't make an appointment here, so come in but you might have to wait half a day". Not to mention that by the time you get to your doctor, un-medicated, you will forget to tell about half of your symptoms.

[_m7bj]

>Not to mention that by the time you get to your doctor, un-medicated, you will forget to tell about half of your symptoms.

This is actually a major problem. I was diagnosed with ADD as a child but gave up the medication in my late teens because it had side-effects I didn't enjoy.

Late last year, I thought it might be worth trying it again, maybe with a milder dose. I booked an appointment with a doctor, who referred me to a psychiatrist. The psychiatrist told me there was a two week waiting period and that they'd call me back in a few weeks, and never did. It was two months before I remembered to follow it up.

I don't bore you with the rest of the details, but the short version is every medical professional I spoke to (and I spoke to about 5 during this saga) told me to wait and that they would organize something for me, and then didn't. Turns out if you lie to someone with ADD and leave the organization ball in their court like that, they'll never get treatment, because they struggle with the very thing you're asking them to do. It's pretty much the worst thing you can do for them.

Anyway, I've just realized I was planning to talk to the doctor about it again 4 months ago to try to get the ball rolling again. It's Christmas now, they won't be back at work until mid January. I'd better send myself an email, wish me luck.

[CydeWeys]

A better system of tracking tasks is useful for everyone, not just ADHD. Try setting a calendar entry for a date on which you'll follow up if you haven't heard anything back, and use something like Google Keep (key point is it has a mobile app and webpage) to organize to-do lists.

[_m7bj]

>Try setting a calendar entry for a date on which you'll follow up if you haven't heard anything back

Thanks for the advice, but surprisingly I have actually tried just not having ADD. This simple advice doesn't work very well for me, which is why I'm attempting to pursue medication again. The calendar entry goes off, I try to contact the doctor, maybe they're not in today, it's half way through the work day, I go to set another, I spot an email while I'm doing it and start following up on that, and then 4 months later it never happened.

[CydeWeys]

The point of a to-do list (or reminder in Google Calendar) is that it's constantly staring at you until you actually complete it. It sounds like you're using one-off calendar entries.

I'm not suggesting that "try not having ADD", just suggesting you use mechanisms to remind you to do stuff that are persistent and thus work.

[chimeracoder]

> The point of a to-do list (or reminder in Google Calendar) is that it's constantly staring at you until you actually complete it. It sounds like you're using one-off calendar entries. I'm not suggesting that "try not having ADD", just suggesting you use mechanisms to remind you to do stuff that are persistent and thus work.

No offense, but from what you're saying, it's pretty clear you don't understand how ADHD works. ADHD is a disorder that affects executive function; the whole problem is that the system you're describing will fail for someone with even moderate but untreated ADHD, let alone more severe cases.

Maybe you don't mean it this way, but it's actually rather insulting to say that these mechanisms "are persistent and thus work", or that OP try a to-do list because "it's constantly staring at you until you actually complete it". ADHD means that you can't assume that those systems work, and it means that "constantly starting at you until you complete it" isn't actually a viable solution.

Hence, that's why OP read your post as "try not having ADD", because you're literally suggesting solutions that presume that they not have ADHD in the first place.

[YeGoblynQueenne]

>> Hence, that's why OP read your post as "try not having ADD", because you're literally suggesting solutions that presume that they not have ADHD in the first place.

To be fair, the article does make the point pretty strongly that it is very hard to separate ADHD from natural variations of attention, concentration etc:

  But “ability to concentrate” is a normally distributed trait, like IQ. We draw a 
  line at some point on the far left of the bell curve and tell the people on the far 
  side that they’ve “got” “the disease” of “ADHD”. This isn’t just me saying this. 
  It’s the neurostructural literature, the the genetics literature, a bunch of other 
  studies, and the the Consensus Conference On ADHD. This doesn’t mean ADHD is “just 
  laziness” or “isn’t biological” – of course it’s biological! Height is biological! 
  But that doesn’t mean the world is divided into two natural categories of “healthy 
  people” and “people who have Height Deficiency Syndrome“. Attention is the same 
  way. Some people really do have poor concentration, they suffer a lot from it, and 
  it’s not their fault. They just don’t form a discrete population.

Also, if attention etc is a "normally distributed trait", any behavioural intervention that can help someone near the middle of the distribution has a pretty good chance of helping someone near the extremes, also. To take the example of height again, just because someone is short doesn't mean they won't look taller with high heels.

In fact, if you think about it, such interventions are designed exactly to help people with poor executive function, as you say. Assuming that this is basically a description of what ADHD is, I don't see why behavioural interventions can't make a dent in it.

[CydeWeys]

How does a persistent in-your-face reminder that does not go away until completed fail? I suppose severe procrastination or complete lack of willpower would do it, but are these not different from ADHD?

[akvadrako]

That seems like an odd test. Of course everybody will score better on a concentration test while on medication for concentration.

[mickronome]

Maybe everyone will score better, although I don't believe so because the tests are trivial for people without ADHD.

In any case they certainly won't have anything like the kind of improvements people with ADHD has, improving from spectacularly bad to (usually) only slightly below normal.

It's a common mistake made by both professionals and laypeople that ADHD is a condition with only slight deficiencies in focus, when in reality they are often staggering.

Anecdotally, everyone with ADHD I've met understand the concept of things being so boring it becomes physically painful to do them. Everyone else think they heard me wrong.

For me the computerised test was almost impossible at the end, because my bored brain refused to even see the images on the screen. All I saw unless I blinked and tilted my head was a white, blank screen, only that it wasn't blank.

With methyl phenidate it was hard to understand it could have ever been hard, and that even though I still have significantly below average concentration even with medication.

[leesalminen]

I’ve long held the belief that ADHD is wildly over diagnosed (in the US, at least).

Your anecdote has helped solidify this belief. 8/10 Adderall users I know are able to concentrate and complete complex, intricate tasks without the pills. The pills just put them in jet-speed mode.

It sounds like you truly have ADHD and are benefitting from proper medication. I wish nothing but the best for you.

However, I also wish the doctors would remove their heads from their ass and attempt to find a better method of diagnosis.

During my friend’s 3rd year of study at University, he realized many of his classmates were taking Adderall. Not only that, but those students had less trouble completing the crushing work load on time. So, he visited the local pill dispensing psychiatrist and walked out with his very own prescription.

Now we’re here, several years later, and he’s convinced that he really does have ADHD because the doctor keeps renewing his prescription. He chooses to forget that he initially got the prescription by regurgitating bullet points out of the DSM.

This is just one example. I’ve seen it countless times.

Is it really just me that thinks having oodles of young adults taking amphetamines daily is OK? I just can’t seem to wrap my head around it.

[Pica_soO]

Competition, till nothing is left of us. Makes me grateful every day, that brain implants are not yet here. Every day before that is a present, else we would have our heads chopped up on the altar of progress to become twitching, spasming prosthetic gods for the common good, until there was nothing left to ask why we did this to ourselves in the first place.

[ianai]

They want to measure the benefits of medication.

[garmaine]

That’s missing the point. ADHD meds make everybody concentrate better, regardless of whether the person actually has ADHD.

[ianai]

And even that would give them a measure of the benefits. If it’s the same benefit that actual ADHD receives then it’s still a useful metric. If it’s less than the benefit when used for actual cases then, in aggregate, the benefits would be a low bar. Arguably that’s a better bias as it would make the benefits/costs decision more conservative. They’re taking the difference in measurements for each individual.

[eternauta3k]

I think his point was that the test saturates at a normal person's level of concentration. So medicating normal people does not improve their score.

[ianai]

For ceteris paribus you need data on all variables for all observations. The more variety the better, too.

[jglauche]

They compared the error rates of working+short time memory to values that non-adhd people score. My score was significantly lower than average at my first test and on my second test above average on medication.

[kazagistar]

It depends on where you set the bar. If you make it easy for 80% of the population to ace it, then the only people who will fail are the ones with serious deficiencies.

[ma2rten]

I am also from Germany, but moved to the US for work. I am 29. Recently someone suggested to me I might have ADHD. After learning more about it, I had a feeling that many adults with ADHD have: I suddenly felt like my life story made sense.

People below the 5th percentile in ability to concentrate, as measured by this test.

My health insurance made me take a CPT test and it indicated that I don't have ADHD. This means that they refuse to diagnose me despite that I have ALL of the inattentive symptoms. I did a lot of research on ADHD after that. Those tests have a 40-50% false negative rate. Luckily I am changing insurance next year. I already made an appointment with another doctor who is an expert in adult ADHD.

I don't know false positive rates off-hand, but they are properly much higher. Pretty much any mental or psychical illness causes inattention. There is no reliable test for ADHD. ADHD is not primarily about inability to concentrate, but executive function.

Instead, we use the DSM, which advises us to diagnose people with ADHD if they say they have at least five symptoms from a list.

This not true.

1. You need to have them "often" (approx. 5th percentile in the population)

2. You need to have them since childhood.

3. They may not be better explained by other disorders.

4. Need to have significant impairment in work, school or personal life.

Those criteria are based on decades of scientific research. They are the best way to diagnose ADHD. There has been promising research in computer tests, genetic tests and brain imaging, but none of those are reliable. A good doctor should spend significant time talking to the patient. Ideally they should also talk to other people who know them and review documents such as grade cards from school.

[Yvain]

1. Are you finding "approximately 5th percentile in the population" somewhere in the DSM, or did you make it up?

2. This is no longer considered true; see any of the recent research on adult ADHD.

The last two are obviously good ideas, but they don't really winnow down the pool very much.

[ma2rten]

I am not an expert, I just did some research on my own. If you know more than I do please share.

1. There are normed rating scales. I assume OP was also tested on one when s/he filled out those additional forms. If I recall correctly they use the 5th percentile.

2. DSM-5 still requires symptom onset before the age of 12. As far as I know some researchers advocate raising the age limit further into adolescence, but don't want to get rid of it.

[ma2rten]

https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.20...

[adderaldecade]

This is all a bullshit facade. 60% of ADHD adderall prescriptions are from people who realize they can work better by using it.

So they fake the symptoms, and get those advantages. That's what's refreshing about this posted article; it points out how ridiculous continuing this whole charade is.

Adderall is just becoming the new coffee.

[thonos]

Also from Germany but moved to Japan for work. I never suspected ADHD until someone here on hackernews hinted at it, and even then the idea just seemed absurd. Went to a doc and they suggested doing a "NIRS scan" while I perform a basic task (in my case playing rock paper scissors). I only later read that NIRS scans are only being trialed for ADHD so it seemed more like a quick money grab, but in either way my result graph looked a lot different than what an average graph should look like, hinting at depression and ADHD.

Had a conversation with my doctor about my symptoms and how I feel and concluded that yes, I pretty obviously have ADHD and that it might be the cause of my depression. Went to a second doc for a second opinion as well and he also concluded ADHD. So yeah, I was a little shocked but as someone else said "I suddenly felt like my life story made sense". A lot of the problems that I attributed to my personality felt explained. I talked to older classmates as well and even they said that yes, looking back it was pretty obvious that I have ADHD.

He directly prescribed me a test batch of Atomoxetine (strattera) for trying. At this point I still didn't think I actually had it but went with it anyway.

The side effects were nuts for a couple days but I pulled through. Because of the slow onset it's very hard to actually 'see' a difference but oh man, it feels like life became a lot more manageable: Less arguing in my head, less impulsive behavior, I can keep habits like going to the gym up without getting bored, less of a fight to start a task and so on.

Atomoxetine allows me to be myself, minus a few of the ADHD quirks. I still have attention issues, or am jumpy and hyper, but it is less than before and more manageable by me.

I am worried that once I go to a different country I will have exactly what you described: That I will be in a long queue waiting for my turn, or that clinics are just full and reject me. My current advantage is that I speak Japanese and that ADHD here is still a kind-of new field. Not many Japanese adults go to get diagnosed, so the Japanese docs are free while the English clinics are booked out months in advance.

[walshemj]

As I understand it ADHA is one of those spectrum conditions like Dyslexia so a single diagnostic test may not be enough.

For example I have a stellar reading ability but my written work and spelling is awful.

[PoachedSausage]

I've often wondered if Dyslexia and attention deficit disorders are connected and/or occur together. I was diagnosed with Dyslexia when I was quite young but it was before the greater awareness of AD-disorders. I've not tried Adderall but have tried Modafinil which worked as advertised.

[walshemj]

Me too as I am not the best at short term memory etc I once ended up on a train to Wembley when I was supposed to be in Wimbeldon :-)

[rdtsc]

Someone I know was diagnosed with both as well. You might be on to something there.