It honestly sounds like OP got the answer to her question but refuses to accept it. I guess there's also Cognitive Disengagement Syndrome, but there's not a lot of research into how it differs from just inattentive ADHD and no real effort has been made towards finding treatment besides stimulants and atomoxetine, so she might as well go with ADHD as the answer. That's the answer she's been given twice by professionals but rejects it, and she rejects even trying the treatment for some reason.
I agree with you overall, but interestingly, research really has found a link between lower Vitamin B12/B6/B2 levels and ADHD. Also lower Vitamin D, and delayed circadian rhythm. You certainly can't use supplements as a replacement for stimulants but they may help.
I don't think ADHD in particular is caused by unrelated stuff. The heritability findings are pretty strong.
> A study of 894 ADHD probands and 1135 of their siblings aged 5–17 years old found a ninefold increased risk of ADHD in siblings of ADHD probands compared with siblings of controls [2]. Adoption studies suggest that the familial factors of ADHD are attributable to genetic factors rather than shared environmental factors [3, 4] with the most recent one reporting rates of ADHD to be greater among biological relatives of non-adopted ADHD children than adoptive relatives of adopted ADHD children. The adoptive relatives had a risk for ADHD like the risk in relatives of control children [4].
> Twin studies rely on the difference between the within-pair similarities of monozygotic (MZ) twin pairs, who are genetically identical, and dizygotic (DZ) twin pairs, who share, on average, 50% of their segregating genes. The mean heritability across 37 twin studies of ADHD or measures of inattentiveness and hyperactivity is 74% (Fig. 1). A similar heritability estimate of around 80% was seen in a study of MZ and DZ twins, full siblings, and maternal and paternal half-siblings [5]. The heritability is similar in males and females and for the inattentive and hyperactive-impulsive components of ADHD [6,7,8].
"ADHD has been clearly linked with numerous environmental risk factors, particularly around the prenatal and perinatal period. Some of the most robust risk factors identified are maternal prenatal health conditions and psychological distress (e.g. hypertension, obesity, pre-eclampsia, immune activation), in utero exposure to poor diet (with critical factors still being determined), teratogenic effects of certain medications (e.g. acetaminophen) and environmental exposures (e.g. lead), as well as neonatal factors such as prematurity and low birth weight [27]. Other extreme exposures in the postnatal environment (such as extreme infant emotional neglect) have also been associated with an ADHD syndrome [28, 29]."
Cecil, C. A. M., & Nigg, J. T. (2022). Epigenetics and ADHD: Reflections on Current Knowledge, Research Priorities and Translational Potential. Molecular diagnosis & therapy, 26(6), 581–606. https://doi.org/10.1007/s40291-022-00609-y
"The convincing evidence for genes as risk factors for ADHD does not exclude the environment as a source of etiology. The fact that twin estimates of heritability are less than 100% asserts quite strongly that environmental factors must be involved. ADHD’s heritability is high, and that estimate encompasses gene by environment interaction. Thus, it is possible that such interactions will account for much of ADHD’s etiology. Environmental risk factors likely work through epigenetic mechanisms, which have barely been studied in ADHD [148]. The importance of the environment can also be seen in the fact that, as for other complex genetic disorders, much of ADHD’s heritability is explained by SNPs in regulatory regions rather than coding regions [149]."
Faraone, S. V., & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder. Molecular psychiatry, 24(4), 562–575. https://doi.org/10.1038/s41380-018-0070-0
Isnt this explained simply by families who are aware of, willing, capable of disgnosing their children are more likely to tske another child to a diagnosis vs a random child?
Granted they did have a control for adopted siblings
"twin studies fail to separate the effects of genes and the prenatal environment. This failure casts doubt on claims of the relative effects of genes and environment on intelligence, psychiatric disorders, personality and other psychological variables, and other conditions."
"Although many twin studies have been conducted (which is quite an understatement; there are almost 9,000 hits for “twin study” on PubMed!), there have long been critics who argue that they are scientifically worthless."
"Because heritability is defined by both genetic and environmental influences, it is not a fixed characteristic of a disease or trait, but a population-specific estimate, analogous to, for example, the mean height, cholesterol level or life expectancy in a population. It also cannot be interpretated at the family or individual level."
Kaprio J. (2012). Twins and the mystery of missing heritability: the contribution of gene-environment interactions. Journal of internal medicine, 272(5), 440–448. https://doi.org/10.1111/j.1365-2796.2012.02587.x
(How) did they control for parental influence vs. genetic heritability? I grew up with a pathologically anxious mother. I still remember having to counteract her behaviour to avoid it leaking into my world, before I managed to move out. She is still a trigger for me, 30 years later. I can only stand having her around me for at max. 2 hours, then my vessel is full. IMO, I am not convinced that a sibling study rules out environmental influences.
They had a control for adoptive siblings. The critic in me says, ok what was their age of adoption, do parents perhaps treat adopted children differently, do adopted children perhaps grow behaviors unindicative of ADHD, does the knowledge that its genetic influence the diagnoses themself?
The age of adoption seems crucial to rule out early childhood trauma induced by the parents. I actually know mine, although it took me 35 years to get my mother to admit what happened. My point, I am very skeptical when it comes to parents reflecting on the bad influences they might have had on the development of their child. After all, bad parenting has a pretty harsh stigma in society (and it should!)
"twin studies fail to separate the effects of genes and the prenatal environment. This failure casts doubt on claims of the relative effects of genes and environment on intelligence, psychiatric disorders, personality and other psychological variables, and other conditions."
"Although many twin studies have been conducted (which is quite an understatement; there are almost 9,000 hits for “twin study” on PubMed!), there have long been critics who argue that they are scientifically worthless."
"Because heritability is defined by both genetic and environmental influences, it is not a fixed characteristic of a disease or trait, but a population-specific estimate, analogous to, for example, the mean height, cholesterol level or life expectancy in a population. It also cannot be interpretated at the family or individual level."
Kaprio J. (2012). Twins and the mystery of missing heritability: the contribution of gene-environment interactions. Journal of internal medicine, 272(5), 440–448. https://doi.org/10.1111/j.1365-2796.2012.02587.x
In studies of monozygotic twins (shared genetic predisposition), typically the twins were raised in different environments (adoption, etc.). If behavior among the twins is divergent then environmental factors are likely predominant. OTOH if concordance of traits is strongly evident, behavior is attributable to genetic factors.
My understanding is that separating children from their biological parents has wide-reaching consequences, even if done in a non-traumatic way, and even if they are ultimately raised by a different set of parents. I would imagine the trauma originating from having to be adopted could be a uniquely triggering factor for genetic predisposition in the case of only one of the twins. How would twin studies be able to account for that?
I agree. Also, the prenatal environment (9 months of development!) and circumstances of birth, which both twins share, is not accounted for at all. Or rather, it is accounted for as "heritability" by twin studies, which is plainly wrong.
No need for family separation. You simply compare the correlation between monozygotic ("identical") twins vs dizygotic ("non-identical") twins.
For example, monozygotic twins will always have the same eye color (99+% correlation), while dizygotic twins do not. Thus we can conclude eye color is genetic. Both twins are raised by their respective parents, so it's unlikely parenting is causing this difference in eye-color-correlation.
A one time, 5g “heroic dose” did the trick for me. I’ve had a few more trips at that dose since that initial one but mostly because there’s a whole lot for me to explore in that space, rather than me trying to “cure” something.
It took me as a real surprise when, after that first trip, all my ADHD symptoms simply vanished, never to reappear.
>My hypothesis about this for a long time has been stimulants help everyone be more productive (with some tradeoffs)
Of course they do. They're stimulants, that's what they do. Some people just need them to be closer to normal, or whatever's considered normal in post-Industrial society. Modafinil promotes wakefulness in everyone, not just narcolpetics. Anxiolytics calm down everyone, not just the anxious, and psilocybin makes everyone feel euphoric, not just the depressed. It would be weird if stimulants only had an effect of ADHD patients.
> and ADHD is kind of a weakly differentiated diagnosis that could apply to most people.
I don't think we really understand it yet, but it's not something most people have. As the article mentions, people ADHD have a higher rate of transportation accidents, lower life expectancy, higher crime rates, higher addiction rates, etc. The differences show up in brain scans, performance tests, genetic biomarkers, heritability/twin studies, etc. Whether you think of it as a disability, or brain type, or whatever - ADHD is something real.
> Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.
Yes, and this is possibly why 35-55% of adults with ADHD smoke today, compared to 19% of the population. Studies have shown that nicotine is helpful for everyone but particularly helpful for those with ADHD. Nicotine-derived formulations are still being explored.
> It would be weird if stimulants only had an effect of ADHD patients
One example of this actually happening is the concept of a "stimulant nap" in people with ADHD, where stimulants actually make them sleepier. Also manifesting as "I tried coke once, it didn't do anything, I just felt sleepy"
I find the claim (repeated verbatim in some of the comments here) that people with ADHD process stimulants differently particularly specious. Are there any medical studies/not-reddit threads that suggest anything like this?
Essentially the idea is that there is an "optimal" amount of alertness (inverted U curve). People with ADHD start below the optimal point, and stimulants move them up towards the optimal point. People without ADHD are typically closer to the optimal point, and stimulants move them past it.
Someone with ADHD taking a large dose will therefore feel the same as someone without ADHD taking a small(er) dose.
> Compared to [non-adhd] controls untreated [adhd] patients showed increased nocturnal activity, reduced sleep efficiency, more nocturnal awakenings and reduced percentage of REM sleep. Treatment [of those with adhd] with methylphenidate resulted in increased sleep efficiency as well as a subjective feeling of improved restorative value of sleep.
I can't find a corresponding paper studying the effect of stimulants on sleep in healthy adults. I would assume it hasn't been studied because it's common knowledge and it's not worth the risk of making healthy people take stimulants. I also don't think that's the part you were disputing.
It doesn’t happen to everyone with ADHD, but the majority.
The effect itself was prominent/notable as early as WW1, as the drugs were widely used by all parties to help fight fatigue and drowsiness. However, a small percentage of the population would end up with the opposite effect - ending up tired, even sleepy, and often calmer instead of more alert.
It took awhile however, before wider implications of sub-population differences in drug effects like this were studied or applied.
ADHD is a well-established, highly heritable neurodevelopmental disorder. Large-scale twin, genetic, neuroimaging, and longitudinal studies consistently show distinct brain, behavioral, and outcome differences compared to the general population. While we don’t yet understand every mechanism or subtype, the condition is robustly characterized and recognized by all major medical bodies. The World Federation of ADHD International Consensus Statement concludes: “ADHD is a genuine neurodevelopmental disorder with a well-documented genetic and neurobiological basis” and emphasizes that claims to the contrary are “contrary to scientific evidence and risk causing harm” [1].
Medical and psychological professionals are VERY confident that ADHD is a real condition—on par with the confidence they have in diagnoses like major depressive disorder or generalized anxiety disorder.
Across psychiatry, ADHD, depression, and anxiety are all among the best-documented psychiatric conditions. There is more skepticism about disorders with fuzzier boundaries (e.g., “personality disorders” or “internet addiction”), but ADHD is NOT in that category.
I believe ADHD is stigmatized in our culture because our modern world makes us all feel distracted at times; therefore, it seems like people with the diagnosis are perhaps getting a “free ride” by blaming their poor behavior on a “condition”. But ADHD is so much more than just having a hard time focusing because of social media and phones. It manifests as a spectrum of extreme challenges that lead over time to sufferers having a significantly harder time navigating life than people without ADHD.
Merely having a hard time concentrating does not make you an ADHD candidate. You must experience a range of symptoms that interfere materially in multiple areas of life.
⸻
Reference
[1] Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience and Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
