I spent a decent amount working on ADHD diagnostics and unfortunately it sucks. To my knowledge, to this day, there isn’t a single reliable biomarker that identifies autism spectrum disorders.
It’s usually correlation studies paired with questionnaires which for lack of better words can be described as “incidental” at best. Most z scored tests I know are also developed with small samples, a hundred participants with an outgroup of 20 would already be a LARGE sample. The standard ADHD questionnaire was validated on some 35 people.
There might be some hope in deep learning, particularly in observing eye movement components to deliver reliable biomarkers in the future, but I’m not so confident any time soon.
It’s dreadful and fascinating at the same time that defining and testing for ADS has been so elusive for so long…
Isn't this true of nearly all mental disorders in DSM-5 and ICD-11?
We don't really know what mental disorders are and so we don't have objective diagnostic tests for them. [1]
We just have treatments that sometimes work for some people (and with the replication crisis[2] that sometimes is probably a lower value than expected).
From a molecular neuroscience perspective, for both ADHD and ASD (autism) you're unlikely to find any pure biomarkers as clean as a disease like huntingtons disease whose mechanism is clearly understood as extra CAG repeats on the HTT gene (a clean mendelian disorder). ADHD is defined by behavior/cognitive symptoms and most all behavior/cognitive diseases are multifactoral, which ADHD is. WES/WGS and GWAS has been done and for familial ADHD and unlike ASD there is mostly no clear monogenic mutation (a single gene that would explain the phenotype) [note monogenic mutations are usually a very small subset of cases but give scientists a look into what pathway/mechanism is causing a multifactoral disease]. Thus it is not for a lack of looking classically, and deficit is speculated to likely manifest as a neural circuit organization or synaptic issue (though the latter is more closely linked to ASD). This is currently impossible (basically) to measure in alive human brain as it requires nanoscopic imaging, note how challenging the fly map was (incomplete IMO as well).
This comment is so funny to me, because I imagine you being distracted to make the comment before making it to the end where the psych did indeed review the new results.
Well I only know that because I skipped to the end. Then, while scrolling up I realised I missed the whole side-quest about promising to not cheat the test again, taking the test again, but then "accidentally" finding an exploit the system, and then cheating the test again, but this time cheating even more to see the results.
Then, scrolling up more I see that this whole thing started with seeing stars and then buying a telescope on amazon (probably at 3am).
And here I am commenting on HN instead of replying to an email...
I know this is a joke, but I'd be careful about assuming: I had a trained therapist diagnose me with ADHD ... incorrectly.
It turns out, there are other conditions out there that can appear to be be ADHD. If a trained therapist can confuse them, outside observers certainly can too, so it is possible that "very ADHD-acting" person you know might not have it.
(Or, especially for females, the reverse can be true, as not everyone with ADHD manifests with the same trademark hyperactivity.)
No questions, but feedback for you from an engineer in a similar situation (late diagnosis), make sure you go back and get them to check for every other thing under the sun. You really don't want to dive into the ADHD side and find out it was something else (other things can masquerade as ADHD), so a good neuropsychologist is critical. And "body medicine", too, for example adrenal disorders. It's worth being extremely thorough at this point - you're off the standard path, embrace it.
Also, congratulations, once you figure it out your life is going to change for the better in a way you can't currently understand (literally, lacking the brain regions and/or development for it, take it from me), but the process can kinda suck a lot, so stick with it, it's worth it in the end, wherever you end up.
I have a question (and please take it in jest)! In between buying a telescope, seeking out an opinion on ADHD, accidentally hacking an online test, and then blogging about it, how many things on your todo list(s) did you not do?
Have you got some fancy scroll thing for your blog? Something in my brain is noticing that scrolling feels smoother than your average site, though maybe im crazy.
Following through on the top comment, surely you realized when you decided to forgo the back half of the test that, had the program compensated for it, you were consciously leaning into the ADHD diagnosis, right?
That was my first thought. I only wish my type was to put in the work for a blog post instead of just thinking on it and getting overwhelmed with all I need to get done.
> This performance pattern^H^H^H^H^H^H BLOG POST may indicate attentional difficulties, and taken together with other findings, an increased likelihood for the existence of ADHD.
ADHD is way more complex than just an attention issue, I mean just the amount of average daydreaming and "rumination" and the constant multi-threading of thoughts... is just next level, I believe it's not properly explained to outsiders that might just think that X guy just have a hard time going in the flow but in reality it's much more catastrophic than this and will create many more mental health issues if left unmanaged.
Most ADHD people that have jumped on some sort of strong treatment (stimulants in general) are discovering a new world in pretty much 1 hour, the first time the mind goes "quiet" is incredible. I advise everyone to read more on this website https://www.adxs.org/en - it's also friendly to scrape to be used with LLMs.
ADHD isn't a good thing to have imo, it's a serious dysfunction and it's sad to see that it's being romanticized lately in social media or plainly discredited by some people/media, and while treated ADHD can make you productive "all the time", you end up addicted and pretty much permanently require drugs to function well.
I agree that ADHD is a serious condition for many people, and that it's overly romanticized and that isn't good when it comes to getting help for those that do need it.
To that point, I'm going push back on this language just a bit:
> you end up addicted and pretty much permanently require drugs to function well
That is negatively framing medication, which if taken properly as prescribed is no different than any other medication someone might take to help with a chronic health condition. It slightly encourages and leans into the idea that ADHD is "fixable" without medication and so taking medication is a problem (or due to a weakness, etc).
I'm not discounting the value of other forms of non-medical treatment, but in many case medication IS appropriate as part of the overall treatment that a person requires to manage their ADHD. We should not use language that stigmatizes treatment that should be between a person and their doctor.
> it's a serious dysfunction [...] treated ADHD can make you productive "all the time", you end up addicted and pretty much permanently require drugs to function well
On its own, its not "a serious dysfunction". Within the context of operating within the current societal setup for a paycheck that provides basic survival needs, yeah.
It allows me to sit down and do 'something' without being taken completely off task for the rest of the day because someone kept knocking on the door or reading a hostile/complaint email. What that 'something' is is not always 'productive' but now I can do it without everyday things or upcoming events throwing me in a completely different direction.
Meds helps with the alignment issue. If you are taking meds and its making you "productive all the time" and you find yourself addicted to it, I suggest talking to your doctor about that. I had to work with CBT just to form a habit of remembering to take the medication, and it took a few years before I finally started to remember regularly. I still forget on days that dont fit into that routine
> it's a serious dysfunction and it's sad to see that it's being romanticized lately in social media or plainly discredited by some people/media
The author of the article is contributing to this by using their medical diagnosis to "outsmart" the system for writing material. Presenting a proper ADHD assessment as merely an online test just adds fuel to the fire (and if this is the only interaction they had I am skeptical of the assessment procedure).
> and while treated ADHD can make you productive "all the time", you end up addicted and pretty much permanently require drugs to function well
That's an unfair and sweeping characterization of the immediate therapeutic benefits and long-term health outcomes of individuals.
I spent a decent amount working on ADHD diagnostics and unfortunately it sucks. To my knowledge, to this day, there isn’t a single reliable biomarker that identifies autism spectrum disorders. It’s usually correlation studies paired with questionnaires which for lack of better words can be described as “incidental” at best. Most z scored tests I know are also developed with small samples, a hundred participants with an outgroup of 20 would already be a LARGE sample. The standard ADHD questionnaire was validated on some 35 people.
There might be some hope in deep learning, particularly in observing eye movement components to deliver reliable biomarkers in the future, but I’m not so confident any time soon.
It’s dreadful and fascinating at the same time that defining and testing for ADS has been so elusive for so long…
Isn't this true of nearly all mental disorders in DSM-5 and ICD-11?
We don't really know what mental disorders are and so we don't have objective diagnostic tests for them. [1]
We just have treatments that sometimes work for some people (and with the replication crisis[2] that sometimes is probably a lower value than expected).
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC6732705/
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC5835722/
From a molecular neuroscience perspective, for both ADHD and ASD (autism) you're unlikely to find any pure biomarkers as clean as a disease like huntingtons disease whose mechanism is clearly understood as extra CAG repeats on the HTT gene (a clean mendelian disorder). ADHD is defined by behavior/cognitive symptoms and most all behavior/cognitive diseases are multifactoral, which ADHD is. WES/WGS and GWAS has been done and for familial ADHD and unlike ASD there is mostly no clear monogenic mutation (a single gene that would explain the phenotype) [note monogenic mutations are usually a very small subset of cases but give scientists a look into what pathway/mechanism is causing a multifactoral disease]. Thus it is not for a lack of looking classically, and deficit is speculated to likely manifest as a neural circuit organization or synaptic issue (though the latter is more closely linked to ASD). This is currently impossible (basically) to measure in alive human brain as it requires nanoscopic imaging, note how challenging the fly map was (incomplete IMO as well).
ADHD is not an autism spectrum disorder, is it?
I took a similar ADHD test. It seemed so easy and simple that I always wondered how it was actually supposed to catch me.
Good to know that neurotypical people mostly likely test differently than I did.
I found myself trying to come up with a system that used the position of my hands to “solve” the problem for me.
But then I worried if my system worked, I would be misdiagnosed.
It didn’t work. I was 98th percentile.
Thanks for sharing this!
this sounds interesting! would love to hear more about this
> At the end, she told me she would review my exam and have the results ready in a few days.
Yeah man I can go ahead and let you know early if you want.
This comment is so funny to me, because I imagine you being distracted to make the comment before making it to the end where the psych did indeed review the new results.
Well I only know that because I skipped to the end. Then, while scrolling up I realised I missed the whole side-quest about promising to not cheat the test again, taking the test again, but then "accidentally" finding an exploit the system, and then cheating the test again, but this time cheating even more to see the results.
Then, scrolling up more I see that this whole thing started with seeing stars and then buying a telescope on amazon (probably at 3am).
And here I am commenting on HN instead of replying to an email...
I know this is a joke, but I'd be careful about assuming: I had a trained therapist diagnose me with ADHD ... incorrectly.
It turns out, there are other conditions out there that can appear to be be ADHD. If a trained therapist can confuse them, outside observers certainly can too, so it is possible that "very ADHD-acting" person you know might not have it.
(Or, especially for females, the reverse can be true, as not everyone with ADHD manifests with the same trademark hyperactivity.)
hi! author here, please let me know if you have any questions :-)
No questions, but feedback for you from an engineer in a similar situation (late diagnosis), make sure you go back and get them to check for every other thing under the sun. You really don't want to dive into the ADHD side and find out it was something else (other things can masquerade as ADHD), so a good neuropsychologist is critical. And "body medicine", too, for example adrenal disorders. It's worth being extremely thorough at this point - you're off the standard path, embrace it.
Also, congratulations, once you figure it out your life is going to change for the better in a way you can't currently understand (literally, lacking the brain regions and/or development for it, take it from me), but the process can kinda suck a lot, so stick with it, it's worth it in the end, wherever you end up.
Would you mind sharing the test platform?
I have a question (and please take it in jest)! In between buying a telescope, seeking out an opinion on ADHD, accidentally hacking an online test, and then blogging about it, how many things on your todo list(s) did you not do?
Have you got some fancy scroll thing for your blog? Something in my brain is noticing that scrolling feels smoother than your average site, though maybe im crazy.
Following through on the top comment, surely you realized when you decided to forgo the back half of the test that, had the program compensated for it, you were consciously leaning into the ADHD diagnosis, right?
What a lovely mini journey. Turns something possibly stressful into something weird and fun.
Opening up devtools during ADHD test is so ADHD, almost as if he didn't even need the psychiatrist to explain the results :D
That doesn't have to be ADHD, could be the *tism too. The tells are usually somewhat overlapping.
In general, if you are in the industry, save yourself (and your kids) some trouble and get diagnosed before it becomes a problem.
Add: I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
That was my first thought. I only wish my type was to put in the work for a blog post instead of just thinking on it and getting overwhelmed with all I need to get done.
I didn't think of this until after haha
This is basically what I did to every online based quiz in school. Big respect lol.
this method works more often than not :P
> This performance pattern^H^H^H^H^H^H BLOG POST may indicate attentional difficulties, and taken together with other findings, an increased likelihood for the existence of ADHD.
There's a well-known issue of "construct validity" in neuroscience.
Oh hilarious and well done Null ptrs.
And brilliant picture.
Ahahah the end got me laughing
Great article!
ADHD is way more complex than just an attention issue, I mean just the amount of average daydreaming and "rumination" and the constant multi-threading of thoughts... is just next level, I believe it's not properly explained to outsiders that might just think that X guy just have a hard time going in the flow but in reality it's much more catastrophic than this and will create many more mental health issues if left unmanaged.
Most ADHD people that have jumped on some sort of strong treatment (stimulants in general) are discovering a new world in pretty much 1 hour, the first time the mind goes "quiet" is incredible. I advise everyone to read more on this website https://www.adxs.org/en - it's also friendly to scrape to be used with LLMs.
ADHD isn't a good thing to have imo, it's a serious dysfunction and it's sad to see that it's being romanticized lately in social media or plainly discredited by some people/media, and while treated ADHD can make you productive "all the time", you end up addicted and pretty much permanently require drugs to function well.
I agree that ADHD is a serious condition for many people, and that it's overly romanticized and that isn't good when it comes to getting help for those that do need it.
To that point, I'm going push back on this language just a bit:
> you end up addicted and pretty much permanently require drugs to function well
That is negatively framing medication, which if taken properly as prescribed is no different than any other medication someone might take to help with a chronic health condition. It slightly encourages and leans into the idea that ADHD is "fixable" without medication and so taking medication is a problem (or due to a weakness, etc).
I'm not discounting the value of other forms of non-medical treatment, but in many case medication IS appropriate as part of the overall treatment that a person requires to manage their ADHD. We should not use language that stigmatizes treatment that should be between a person and their doctor.
> it's a serious dysfunction [...] treated ADHD can make you productive "all the time", you end up addicted and pretty much permanently require drugs to function well
On its own, its not "a serious dysfunction". Within the context of operating within the current societal setup for a paycheck that provides basic survival needs, yeah.
It allows me to sit down and do 'something' without being taken completely off task for the rest of the day because someone kept knocking on the door or reading a hostile/complaint email. What that 'something' is is not always 'productive' but now I can do it without everyday things or upcoming events throwing me in a completely different direction.
Meds helps with the alignment issue. If you are taking meds and its making you "productive all the time" and you find yourself addicted to it, I suggest talking to your doctor about that. I had to work with CBT just to form a habit of remembering to take the medication, and it took a few years before I finally started to remember regularly. I still forget on days that dont fit into that routine
> > you end up addicted and pretty much permanently require drugs to function well
No? First, even when I was taking it almost every day for three years, I kept forgetting to take it. Today, my last refill was in February this year.
I recommend against raw-dogging reality with ADHD without meds. At least so you have baseline "this is what normal feels like"
> it's a serious dysfunction and it's sad to see that it's being romanticized lately in social media or plainly discredited by some people/media
The author of the article is contributing to this by using their medical diagnosis to "outsmart" the system for writing material. Presenting a proper ADHD assessment as merely an online test just adds fuel to the fire (and if this is the only interaction they had I am skeptical of the assessment procedure).
> and while treated ADHD can make you productive "all the time", you end up addicted and pretty much permanently require drugs to function well
That's an unfair and sweeping characterization of the immediate therapeutic benefits and long-term health outcomes of individuals.