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I highly recommend reading about the opinion of this doctor that ADD doesn't exist as a separate condition. It is, instead, a symptom of many other possible conditions.


This is consistent with my own experience with people who believe they have ADD. Many of them turned out to have untreated anxiety and depression.

It's also interesting to note that there's a lot of research supporting the idea that mindfulness can decrease the effects of ADD. That seems to support the idea that ADD isn't a physiological fact, but a curable behavioral issue.

I read your article, and I agree with some of the points. I don't think stimulants are much of a solution either, if I could wake up one day and be "cured" of my ADD that would be fantastic. For me, distraction is a compulsion, one that I wish to be rid of.

However I really resent the suggestion that I could somehow cure myself with "mindfullness" or if I "just tried harder." It is really easy for a person who has never suffered from ADD to think this way, but neither are legitimate solutions. Sure I try hard, sure I meditate at least once a day. I do it because it helps me. That doesn't mean that one day, somehow, I'll be able to function on that alone. It is only with medication, and help from a psychologist, I can lead a normal life.

Honestly, when people suggest that I somehow could cure myself I feel terrible. I feel like flawed person, like I'm failing at the basic life skills everyone else has mastered. But worse than that, I dread that someone else will be exposed to that, before being diagnosed. I was blessed to be diagnosed at a young age, and I can't imagine going through school, and into the workplace without help.

There are many illnesses that are considered very treatable or curable, but that doesn't mean every case can be improved. I definitely wasn't implying that people with ADD aren't trying hard enough!

A great example of the above is OCD. People with the illness have to work extremely hard to experience improvement, and not every case improves. But it's still considered to be something that people can recover from nearly completely.

I think it's clear at this point that ADHD is vastly over-diagnosed, particularly among people who self-diagnose after using the internet to confirm their beliefs.

However, ADHD and other executive disorders are very real and very debilitating for a small portion of the general population. I've unfortunately experienced this first-hand after a serious traumatic brain injury took me from normally-functioning adult to ADHD adult overnight. (Part of the reason I'm using a throwaway is that I prefer not to make this fact well-known).

> This is consistent with my own experience with people who believe they have ADD. Many of them turned out to have untreated anxiety and depression.

This mirrors my experience somewhat, although I believe many people simply confuse normal human behaviors as ADHD symptoms. It's perfectly normal to prefer to focus on subjects you enjoy while experiencing difficulty when forced to focus on uninteresting topics, but somehow this has been construed as a symptom of ADHD on the internet. (As I've commented elsewhere, hyperfocus is not actually a symptom of official ADHD definitions but it's very popular on internet forums).

> It's also interesting to note that there's a lot of research supporting the idea that mindfulness can decrease the effects of ADD. That seems to support the idea that ADD isn't a physiological fact, but a curable behavioral issue.

I have to disagree on several of your definitions here: There is plenty of research in to potential biological contributing factors to ADHD-type behaviors. However, the brain is remarkably plastic and capable of learning good or bad behaviors. Unfortunately, modern life tends to train us toward ADHD-like behaviors, with constant bombardments of stimuli and companies working overtime to develop products that distract us and are carefully designed to capture our attention.

As someone with ADD, self-diagnoses is incredibly frustrating. It drives a really unhealthy perception of the disease.

My understanding of professional ADD diagnoses is that they look at the diagnostic criteria, ask whether the patient fits, and then make the diagnosis. It's not like there's an objective test.

Do you disagree? What makes it more difficult for someone to self diagnose than for a professional?

A professional has a cohort of other patients to compare you against and they can rank the severity of your symptoms against everyone else they see.

People who self diagnose can't do that.

Most MH diagnostic criteria have a bunch of words that sound like everyday English but which are jargon words with specific meaning (although the ADHD criteria are better than, eg, Borderline PD).

It's a trope that people with symptoms will self-diagnose with some terrible illness when they have a bit of a cold. This is true in mental illness.

uh, years of medical school?

What do you learn in medical school that makes you, an external person, better at knowing whether someone's thoughts/feelings are aligned with diagnostic criteria?

Take a look at the diagnostic criteria for ADD. There's nothing in them that doesn't involve observing someone's behavior. It's not like you're examining their organs or running tests.

Does your ADD have any overlap with ego? Rather than answer (directly) an honest question, you leave a sarcastic non-answer. Seems like you are pretty insulted by his query, perhaps your sense of self identifies a bit with your diagnosis of ADD.

You're right that I was a bit short, I apologize. I'm a little touchy about self-diagnoses as I explained above.

Others' answer (question) seems highly relevant. And the sarcasm was well applied.

When people more or less ask why a person with years of training for a job is betterqualified than a layman I think a gentle nudge towards humbleness should be appreciated.

Years of training in what? We don't even have an objective, widely-agreed-upon scientific definition of ADD yet. Years of medical training don't help you do the impossible, which is to understand what it's like to be in someone else's head.

And we're not talking about just any layman. We're talking about the person actually experiencing the symptoms.

It was an honest question: what in a medical doctor's training makes them better at diagnosing ADD than the person suffering from it? Like the sarcastic post, you're taking a position without explaining your reasoning.

Years of training in understanding whatever little we know about ADHD etc.

> We're talking about the person actually experiencing the symptoms.

Yeah, me too. That makes me an expert, right? The fact is, I didn't even know until 5 years ago. You can make a qualified guess before asking a doctor yes, but at least here it seems a doctor has to rule out a lot of options, including sleep apnea before he they go with ADHD.

Also, as has been mentioned before, practicing d/p tend to see a few cases every year and has at least some background to say what is normal and not.

All this should be obvious, shouldn't it? It is not like anything I have written so far requires huge leaps of faith, no?

"Every few days I get bored and can't focus, I have ADD". No...that's called being bored.

ADD is wanting to focus on something, but just having no capability of doing so...let alone being able to do so on the shit that bores you.

I had a similar situation - I didn't discover that I had ADHD until after an accident and possible brain injury brought it to my attention. Though my Drs were very skeptical that the accident caused ADHD, more that the shock threw it into overdrive.

After being diagnosed and doing some more thorough research I realized that ADHD had been present my entire life and may also run in my family, it just got much much worse after my accident.

What lazy drs, popular self-help and cheap internet content writing really botch when discussing ADHD is having us focus on the distraction portion and not the underlying reason for why - the portion of the brain responsible for executive function is diminished. This is a neurological problem. Part of the ADHD brain is malfunctioning.

Successfully coping with ADHD is more about learning mechanisms for how to react to stimuli without having the fully developed executive function abilities that others have. But people want to believe they don't have a problem, that they're not disabled. And the disorder doesn't manifest itself very visibly, so it's easy to deny, dismiss or ignore. So they write it off as an environmental problem, something that can be corrected with "proper thinking". This is false. It's a disability, and the solution is coping with the problem.

I like how you say that ADD is over diagnosed but fail to see that you arrive at that conclusion in the same way that other wrongly self diagnose themselves.

I'm not agreeing with your or disagreeing with you, but you don't have any evidence to back up your claims.

What in your background makes you qualified to make this assertion vs decades of peer reviewed science?

It's fine to have opinions, it's not fine to spread mis-information.

No one can tell by looking at or talking to someone whether they are self diagnosed or not. The fact is that ADHD is very challenging to treat as not all cases respond the same way to the medication and therapy. Executive function is quite complex and deeply related to environment as well as genetics. For example, if your parents blame you for being "lazy" vs helping you find coping strategies, that's bound to impact confidence and thus performance.

When lay people such as yourself pass judgement it makes it harder for those of us with the condition to get the accommodations we are legally entitled to.

I will remind you that ADHD is more heritable than height. Many adults over a certain age were actually under diagnosed.

Please also note that ADHD has one of the highest co-morbidity rates of any mental condition, that is, it is most likely to be accompanied by anxiety and depression for the precise reason that others like to judge people for character on things like forgetting small details. If you treat for anxiety and depression and NOT ADHD you can have very serious, long lasting problems.

ADHD is a lack of control of attention, and hyperfocus is an example of that. IT's usually a reason people go undiagnosed. the parents say, "oh johnny can focus when he wants to, he's just lazy."

I encourage anyone who thinks they have this condition to first read "driven to distraction" and then use its advice to seek out a qualified psychiatrist for a proper evaluation. Do NOT rely on family doctors or your average therapist. Get a specialist. It's worth it.

Now while I'm at it, to your point on "modern life." We all get depressed some times, but there's a wide gulf between that and clinical depression, which I'm sure you would agree with me on.

To that end, here's a post by one of the top ADHD writers, Gina Pera, based in silicon valley, on this very topic:


I quote:

"Does that mean, however, our fast-paced life causes ADHD? No, Quinn says. Too much stress can impair anyone’s brain function, but it doesn’t cause ADHD. She offers this bottom line: “When you remove stressors, people with ADHD still have ADHD. In other words, it’s not purely stress that inhibits their functioning. It’s the lack of skills required to meet challenges.”

Moreover, our fast-paced world can make someone with ADHD function worse than they might have in earlier times. In fact, some experts say, that is another reason ADHD is being more widely diagnosed: because modern life is demanding more of us than ever before."

edited to add this additional quote:

"Moreover, ADHD’s recorded history might span at least 2,500 years. That’s when the Greek physician-scientist Hippocrates apparently observed a condition sounding suspiciously like ADHD. He described patients who had “quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression.” No mention of cell phones and video games as causative factors."

> What in your background makes you qualified to make this assertion vs decades of peer reviewed science?

I think you've misinterpreted my post.

I'm specifically avoiding revealing my background here for several reasons, but my basis begins with DSM-V and ICD-10 criteria as well as a large body of research on the underlying biology of the disorder.

If you want external confirmation, please search for the term "Hyperfocus" in PubMed, or through psychiatry textbooks, or any other well-vetted source of information. It's not there. However, you will find the term heavily used on internet forums as well as in seminars and books from a handful of doctors/authors who see ADHD everywhere, but the problem is that they're usually trying to sell you something (seminars, books, products, etc.).

You seem to have taken offense at my comment, but I please realize that I was defending the concept of ADHD as an actual diagnosis. The parent comment was the one insisting that ADHD was not a real diagnosis. I personally have relatively severe ADHD as a result of a traumatic brain injury, so I'm perhaps uniquely qualified having personally experienced both sides of the diagnosis.

I understand that you think you are uniquely qualified and "have been on both sides." I also clearly understood you are defending the concept of actual diagnosis. At the same time your comments seemed to suggest that you had disdain for others who didn't manifest the condition in a way you thought was appropriate.

Please note that those of us who were born with this have a very different life experience, and greatly outnumber those who acquired the condition through a head trauma, infection or other acute condition. Women manifest very differently than men. For example, girls are way underdiagnosed relative to boys at approximately 10:1 though it is improving I hear lately to 3:1. Why? because hyperactivity in girls manifests often as over talkativeness, and instead of screening the girl for the condition, her parents and teachers shame her for "talking too much." I was one of those girls. Boys who talk too much rarely get that criticism but because ADHD leads me to act outside of gender norms, the backlash is far greater for girls than it is for boys in many, many cases.

ADHD also manifests very, very differently in many people due to the various ways executive function develops in children. I have no difficulty getting places on time, but some ADHD folks couldn't get anywhere on time without significantly more effort.

When you say hyperfocus is only used by those who want to sell you something, I question your veracity. Hyperfocus is listed, if not a symptom in the DSM, then as one possible manifestation/result of the condition that is commonly seen. Others can include emotional outbursts, driving accidents, drug abuse, etc. For clarity's sake of those reading: hyperfocus is defined as the inability to direct one's attention to what is desired; being drawn into something in an irresistible way in a way that impacts functioning. Hyperfocus can also manifest as being incapable of switching away from that which is undesired.

This means that while the presence of hyperfocus doesn't definitively diagnose ADHD, it is a common presentation.

I see one of the world's top specialists in the matter, an MD who is the head of the department at a major teaching hospital in the Bay Area. He is a scientist first and foremost, which is why I picked him. He's very clear and direct with me about what we know and what is unknown. I want you to understand that the presence of uncontrollable hyperfocus is absolutely a manifestation of the disorder that is very commonly seen.

Without apology I do take what you say personally, because you are talking about a condition I have lived with my whole life, that has affected nearly every corner of my life in ways that were surprising to me and to everyone around me from my parents to my closest friends. You have only had the condition in your adult years and most likely do not have the same form I have. So yes, I do resent any suggestion that there is one way to have this disorder.

Net: I'm explaining to you regardless of your intent, you are spreading misinformation that can be used against people with the condition to further perceptions that this is "made up" and thus the conditions to which we are legally entitled should be withheld.

So please, stop. You are qualified to speak of your own experience and should, but when you generalize to the rest of us, you are doing real harm.

     That seems to support the idea that ADD isn't a physiological
     fact, but a curable behavioral issue.
That's a false dichotomy; those aren't mutually exclusive things. Why suggest that something isn't a "physiological fact" because it can be successfully treated with mindfulness, CBT, or anything else?

Physiological issues affect behavior and vice-versa. That's why treatments like mindfulness and CBT are so effective.

     Many of them turned out to have untreated anxiety and 
Sure. Absolutely. There is zero doubt in anybody's mind that ADD is comorbid with anxiety and depression, nor that those things can contribute to ADD.

     This is consistent with my own experience 
My own experience is this: I can assure you that ADD has been a constant thing in my life for 39 years and that depression and anxiety have not been.

It seems we agree on everything except semantics, but I'll respond anyway.

When I said "physiological fact", I meant to suggest a category including things like Down's Syndrome. I did not mean things like depression or other mental illnesses that may be observable using brain imaging and/or caused by physiological circumstances.

I won't get into the problems with trying to draw generalizations from brain imaging (easy enough to Google it), but I also have a problem with the idea that observable, physiological problems can't be fixed through behavioral means. We definitely agree on that.

> I can assure you that ADD has been a constant thing in my life for 39 years and that depression and anxiety have not been.

I should have been clear that I don't think ADD is only a symptom of depression and anxiety. I was just sharing the theory that ADD is a common symptom of many conditions, rather than a true condition in itself. In my experience, the cause has been depression and anxiety, but that's obviously not an exhaustive or scientific sample.

> I was just sharing the theory that ADD is a common symptom of many conditions, rather than a true condition in itself

Or that, like many mental conditions, others can mask or appear to be ADD/ADHD. There are plenty of individuals diagnosed with ADD, in which it manifests as a singular facet to an otherwise normal mind. Then there are plenty where it's a manifestation of combinatory factors from other mental illness. It is important to note though, that even as a singular facet, many of the resultant symptoms of ADD overlap with depression, anxiety and Bipolar Disorder (depending on the individual); despite the different effects and regions of the brain targeted. I would actually argue that this is one of the main culprits of its overdiagnosis in the US.

I would recommend reading into Russell Barkley's work. He's one of, if not the, preeminent experts on the Attention Deficit scope of disorders and studied their effects on the brain and really defined the modern idea of what ADD/ADHD are.

>That seems to support the idea that ADD isn't a physiological fact, but a curable behavioral issue.

Are those contradictory positions? For example, consider lactose intolerance. It is true that a change in diet can "cure" lactose intolerance (in the sense of you never experience any symptoms), but lactose intolerance is still physiological.

Similarly, is there any research that mindfulness actually cures ADD, rather than acts as a coping mechanism to reduce the symptoms of ADD.

I didn't say that mindfulness would cure ADD. I just said mindfulness has been shown to decrease the effects. It's a not-very-well-defined condition to begin with, so I wouldn't believe a study claiming that something could cure it.

At the moment, there's no way to measure whether someone is cured. It may even be that "curing" ADD has some unintended/negative consequences -- perhaps some people have good qualities that are linked to their ADD. I really don't know.

I've a few such pieces, including this one. It might very well be true that people who believe they have ADD, actually have one or more other psychiatric problems. Many people who believe they have ADD don't, and many diagnoses are invalid.

Unfortunately it's hard to prove to someone who can't experience it that ADD exists. Its symptoms are too easy to explained away with quite a few different theories. Unfortunately ADD is not just another overmedicalized normal condition. Even though far too many well intentioned people who can't understand assert that it is.

I do have problems with anxiety and depression, and they are not untreated. They are related to but distinct from ADD.

And mindfulness can help, like it can almost anything, because it's a tool for controlling your thoughts. This can be directed as willpower. While not without side-effects, willpower can overcome most of the problems associated with ADD in high enough doses.

I personally don't have as much of an issue with the diagnosis of ADD as I do with the definition. I think the weak, unscientific definition drives the misdiagnosis.

I believe that in the future, the medical community will have a better understanding of the many things that can cause ADD, and the diagnosis of "primary ADD" will mostly be replaced by other diagnoses.

I have no idea if most of these will be depression/anxiety diagnoses or not. I was just talking about my own, very limited experience.

> Unfortunately ADD is not just another overmedicalized normal condition.

I actually do think it might be overmedicalized in children. I grew up with many children who would be diagnosed with it today, but weren't at the time. Whether they had it or not, they grew into functioning adults without ADD.

Here is information about current Israeli medical research that indicates a physical marker is close to being identified--by involuntary eye movements.


Given that the condition was described over 2500 years ago by Hippocrates himself, I think you're parroting something that is akin to anti-vaccination theory. No credible science supports you.

I will also add, as I said below:

1) ADHD is more heritable than height. If it were "made up" that couldn't be true. Many parents are getting diagnosed when their kids come in, because those of us in the 70s and 80s were very under diagnosed.

2) ADHD has one of the highest co-morbidities of any mental condition, for the precise reason that we don't look "sick" --like depression or schizophrenia--so people assume things like talking too much, bouncing our legs,forgetting details, messy desks and so on, are signs of a character flaw. From the time we were small children our parents and teachers may have constantly berated us, calling us lazy, or stupid. That can give you a raging case of anxiety and/or depression and the science does show that if you treat for ADHD, the depression and anxiety often lift.

I never suggested ADD is made up. I simply posted an interesting opinion that it's defined in a problematic way. Nothing I said (or linked to) suggests that there are no physiological markers for ADD, or that it doesn't exist.

The headline was: Doctor: ADHD doesn't exist.

When it comes to science, opinions are not helpful. this article is akin to vaccine denial, no matter how "interesting" you found it.

I know hacker news isn't for this kind of debate though, so I will stop at just pointing out the total inaccuracy of your statement.

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