[raccoonDivider]

Is there an actual consensus on what ADHD _is_, besides a catch-all for some common concentration and hyperactivity symptoms?

People online assert a lot of things, such as "it's a dysfunction of dopamine pathways", "it's genetic", "it's a sort of autism", "it's a brain chemistry problem". But never anything that looked like a real definition backed by good science.

My own psychiatrist's diagnosis was a bunch of obvious questions that I couldn't answer honestly even if I tried. The conversation boils down to: "I have trouble concentrating and wonder if I have ADHD, I have [common symptoms backed by anecdotal evidence]. - OK, they have to affect your life severely enough to qualify. Do you think they are? - I guess, that's what I'm here to find out. - OK, let's try Ritalin." It was only helpful in that I needed to focus during a semester of studies and the stimulants did it.

It feels like I had a cough, got diagnosed with cough syndrome, and went through cough medications until they started helping the cough, and now I can describe myself as a cough syndrome sufferer. Where's the virus?

[Emutopia]

It's an executive functioning disorder, the DSM-V is the relevant authority and describes it in the linked document.

It is clearly defined and operationalised for medical diagnostic purposes.

https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_to...

It's causes are understood to be a combination of genetic risk factors (its heritable and follows family trees), and environmental factors such as child abuse increase the odds of an ADHD diagnosis being made.

[luckydata]

https://www.sciencedirect.com/science/article/pii/S014976342...

[raccoonDivider]

Thanks for that paper, but I find it weird:

- There is no common definition of ADHD, just a list of two hundred unrelated claims made by papers that were found with a search engine. That makes them impossible to compare or relate to each other. This is not a review that concludes anything, just "look at our HUNDREDS of sources!" Basically shock and awe.

- What kind of paper brags about how many continents approved of them? Is this some kind of claim to authority? Why do I care that "366 people" agree with it? In particular, why is this the entirety of their "results" summary?

- The very first highlight is "ADHD occurs in 5.9 % of youth and 2.5 % of adults." I find it ridiculous to dump such a precise number as their main claim when the rates vary so much depending on whether one uses the DSM or ICD, which country one lives in, and which doctor one see. My personal experience with a recently-minted psychiatrist from a reputable university doesn't give me confidence in any kinds of incidence rates either: the state of the art of diagnostic criteria seems to be a questionnaire a 12-year-old could fake.

- In a hypothetical world in which ADHD were known to be an ill-defined "syndrome" with no scientific basis, I would be surprised if "The World Federation of ADHD International Consensus" admitted to it. You don't organize a large international conference to make your subfield less reputable.

[corobo]

To answer your question: Not that I know of.

To waffle freely:

I believe it's lower than normal background levels of dopamine.

Obligatory disclaimer I am in no way a doctor or scientist. This is probably wrong. Pinches of salt all round. This is a theory I'm kicking around now and then but I don't have the knowledge to confirm/deny the hypothesis yet.

When a normal person tackles a regular task they'll get a little squirt of dopamine leading up to the task (anticipation) and then a corresponding signal when the task is done (I did the thing correctly, woohoo).[0]

When a normal person tackles a task and gets a better than expected result, they get a fresh squirt of dopamine upon completion (Oh wow, that went really well! I should consider doing this again!)

When someone with the ADHD-type brain wiring tackles a regular task they'll get the initial anticipation squirt, but upon completing the task they'll get a lesser amount (in dopamine language: that didn't go as well as I thought it would)

Compound that effect over $age years and you get someone with no real motivation to do anything, often distracted by random things that might be interesting, anxious, depression, imposter syndrome, all that good stuff - they rarely get a "I did good" signal, so nothing feels worth doing and they don't feel like they've had much success in life. Also might explain why a lot of ADHD folks have some sort of dopamine loop going on - alcohol, smoking, drugs, overeating, absolutely covering every meal in salt, etc. Something that brings up their background level of dopamine.

You do get positive effects from this - it's not all doom and gloom! - quick learners, jack of all trades, outside the box thinking, anything that might give a better dopamine response than the day to day routines

Might also explain all the "ADHD people were great as cavemen" stories that pop up now and then - nothing gives more dopamine than "holy fuck, I survived", the modern day doesn't really have many of those moments.

Feels like this would also explain why someone with ADHD can take stimulant medication and not bounce off the walls like a normal person would on the same medication - their background level of dopamine is being brought up to normal levels by the medication which in turn allows the rest of the system works as it does in normal people.

[0]: I actually found this theory while looking into AI stuff, haha: https://deepmind.google/discover/blog/dopamine-and-temporal-...

The quick summary from https://en.wikipedia.org/wiki/Dopamine

> Within the brain, dopamine functions partly as a global reward signal. An initial dopamine response to a rewarding stimulus encodes information about the salience, value, and context of a reward. In the context of reward-related learning, dopamine also functions as a reward prediction error signal, that is, the degree to which the value of a reward is unexpected. According to this hypothesis proposed by Montague, Dayan, and Sejnowski, rewards that are expected do not produce a second phasic dopamine response in certain dopaminergic cells, but rewards that are unexpected, or greater than expected, produce a short-lasting increase in synaptic dopamine, whereas the omission of an expected reward actually causes dopamine release to drop below its background level.

[firecall]

To add, it’s not just stimulants as such.

Drugs like Ritalin are an effective dopamine re-uptake inhibitor. Other stimulants may not be.

Just in case any one reading this I the future is self-diagnosed and is considering self-medicating with Amphetamine/Speed!

[nvarsj]

This is basically the pop science explanation of ADHD. There is actually no scientific explanation for it.

[Emutopia]

There very much is a definition and Psychologists have studied it extensively

It is clearly defined and operationalised for medical diagnostic purposes.

https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_to...

There seems to be a lack of mental health expertise in the hacker community, so feel free to ask any specific questions and I'll do my best to assist you :)

[corobo]

Is this actually a definition though? ADHD seems to be more a list of symptoms and then if you have enough of them yup you've got the ADHD, here's some treatments that might work or not.

I don't mean the current definition or diagnosis, if diagnoses were locked in forever we'd still be on the first DSM, I mean an actual explanation for the disorder.

Currently it feels like the equivalent of diagnosing diabetes by making a list of symptoms like "dies when eats too much sugar", "went a bit blind with no other explanation", "is super thirsty all the time" and if you tick enough of the boxes they'll try injecting you with insulin and that may or may not treat the symptoms.

Is there an actual diagnosis or agreed upon description that is the equivalent to diabetes' "either the pancreas not producing enough insulin, or the cells of the body becoming unresponsive to the hormone's effects"?

That's what I mean when I say there's no agreed upon diagnosis - yes technically a doctor will say you've got it and yes technically that's a diagnosis but it's still a little archaic in that the diagnosis comes from checking enough boxes from a list of symptoms rather than telling you the actual root cause of the disorder

[corobo]

Well aye, if there was one everyone agreed on I'd have just cited it instead of going on a mad ramble that doesn't answer the question :P

> There is actually no scientific explanation for it.

Yet! :)

[slenk]

Reading this was eerie. You described me to a T.

I have suspected for a while, but since I got good grades as a kid I never got tested.

Smoked and drank for years. Had to quit that. Still smoke weed...

Well shit.

[navjack27]

It's less hyperactivity and concentration and more motivation issues