One thing that I can’t seem to parse from the article is why the researchers assume that this is an unresearched part of ADHD and not a different disorder entirely. I’m sure they have their reasons, but I don’t think it’s written in the article.
To me it seems that if it’s not „treatable“ the same way ADHD is, I’m not sure if it’s useful to categorize it as such. On the other hand, I’m happy if kids with this disorder can get a diagnosis and treatment that actually helps them sometime in the future due to this research.
You have a set of diagnosis criteria, and matching those criteria gets you the ADHD diagnosis. This study takes people who fit the diagnosis, and says there's a test you can do to split those people into three groups.
But yes, once they have a better understanding of what that difference means, the next step might well be to split the ADHD diagnosis into two separate disorders, or even that, like cancer, ADHD is actually a whole range of separate but related conditions.
> why the researchers assume that this is an unresearched part of ADHD and not a different disorder entirely
Whether or not the extreme dysregulation is a different disorder in its own right or not, is not relevant here. They are grouping ADHD matches; clinically recognized ADHD presentations plus MRI recognized ADHD which have a distinct brain sub-pattern occurring in people that have the same distinct behavioral traits. ADHD frequently has co-occurring conditions.
"Identifying “specific subtypes” of ADHD will make it easier to treat these children effectively". Having a more objective way to diagnosis for things like that seems to be the focus of the approach. They expect it to keep evolving, so I wouldn't say they are assuming anything about absolute labels -- just grouping what they now know to be true, that certain external traits match certain distinct brain patterns that are within the larger adhd brain structure.
Also, I think it's not that it is "not treatable" as ADHD, it's that ADHD can be treated in many different ways and currently the wide variety of responses to such is still a black box. Adderall instant release could briefly make me tired, I would sometimes break off a small piece and use it as a sleep aid. Some other `treatments` (I prefer societal alignment coping aid) resulted in what seemed like an expensive joke. Subtypes may eventually be able to show which options work best for which types and to start there first, instead of the current default iteration.
They've basically "reinvented" DSM-IV ADHD-PH, -PI, and -C more or less, but at least someone's examined the organ responsible rather than treat it like a magical black box.
It reminds me that ADHD is really not that useful of a name, executive function disorder would be a more accurate name from when I was looking into ADHD in the past. It's not about attention deficit per se, as that's downstream of struggling with executive functioning. At least it's the definition that lines up with my experience best (I have ADHD). I'll make lists in order to keep track of important tasks (which in theory would help with attention deficit) but then I'll sit down to do the things on the list and... can't. It's such a hard thing to explain, but no amount of attention hacks can get me over the hump of doing the tasks I'm dreading. That seems much more related to executive functioning.
I find similar behaviour in myself, particularly that dreading a task makes it significantly more difficult to start. I find that if I can manage to do just a little bit, even just open the application and maybe look around a bit at what I need to do, it really gets the momentum going for me.
Do you think there's anything that differentiates what we might call "general task dread" that perhaps anyone experiences to a certain degree from a more broad executive function disorder? Or is it that dreading leading to task paralysis is one of many symptoms of an executive function disorder?
Yeah, it’s a common topic of discussion in the various adhd discussion groups across the internet. Unfortunately changing the name would have some unintended effects because a bunch of regulations and other things are using the current denomination
In my mental model of ADHD, executive functioning is at the center of an hourglass-shaped graph. The bottom half consists of multiple "internal" layers/systems (neurological, psychological), in which some deficiency or deficiencies cause a lack of executive functioning (arrows point up from layers down below upwards to the central element of "executive functioning" to visualize the direction of causation). The upper half shows the outward facing layers/system behavior, social relationships, skills; the arrows point only upwards. I don't have any scientific source for this graph, but I never experienced any "ADHD"-related problem that I couldn't understand through this lens. Happy to share my sketch if anyone is interested.
Ah man I feel you. What helped a bit for me is relentlessly trying to get your career focused on only fun things. It's a long term strategy, but I am now a not-so-successful-yet entrepreneur but I do love about 95% of what I do and that makes me do things fast and without it feeling like effort.
I experience the same thing very frequently. I likened it to activation energy in a reaction, that no matter what I did I couldn't create the required electrochemical bias in my brain needed to put ideas into action. It's like being stranded in your own mind, you know what you need to do, but the 'go' just never arrives.
I eventually discovered that the adrenaline response from extreme stress ('if I don't get this fucking thing done by 7:30am I'm fired' kind of thing) allows me to lock in and do the thing.
For me it’s that as soon as I intend to begin a task, I start thinking about every step, and everything that might go wrong at every step, and planning contingencies for every hypothetical problem, and on and on.
So suddenly the task seems totally overwhelming, when I could just… not do it. So I find a time later I can attempt it and after a few times it is no longer novel and I forget about it.
If anything is hyper-active, it’s the executive function part of my brain that is driven to plan out every tiny, hypothetical detail before I can start.
What’s missing is the reward and internal incentives for doing things when there are other things that do feel good to do (that aren’t what I need to do).
Executive function problems are symptoms of ADHD, therefore renaming it as executive function disorder would omit the root cause. Dr. Edward Hallowell proposes Variable Attention Stimulus Trait (VAST) as a better name.
I've always considered it Too Much Attention Disorder.
The way I like to think about it is that neurotypical people have a beam of light shining out in front of them, wherever they turn their head the light shines and that's where their attention is. Nothing else distracts them from where the light is shining.
With ADHD (for me at least) it's like 50 beams of light scanning the entire room constantly for 'something'. This is too much attention to things that I'm not really interested in, but can distract me from anything I'm trying to do or wan't to do.
For things that I am really interested in (like writing code) the 50 beams of light all manage to synchronise and focus in the same place and that's hyperfocus.
It was even called "minimal brain damage" at one point early on!
I'm also reminded that "Obsessive-Compulsive Disorder" and "Obsessive-Compulsive Personality Disorder" are different in kind but necessarily in magnitude.
The former comcerns more localized obsessions and the latter is more of a global "default state of perfectionism".
I always picture it like trying to force and hold a strong magnet flush against the like pole of another. It seems like it will be easy at first, but the closer they get, the harder it becomes and just as you are about to manage it, they fly apart and the magnet gets stuck to an even stronger one nearby.
You manage to pry them apart, but it goes flying through the air and only to get stuck on an even stronger magnet still. And on it goes, over and over, until the magnet is stuck on the biggest, strongest magnet.
Your attention is constantly being repelled from less engaging activities to more highly engaging activities, and eventually you land on whatever the most engaging activity is nearby. Sometimes without even realizing it
It’s that I try and then can’t. When stuck in bed I can feel this momentum building in my head to push for movement and the a surge of will and then nothing. I didn’t reach the threshold of exerting my will and now I’m waiting for the next wave.
to me it is definitely "attention deficit", and it is a deficit in attention in two distinct ways:
1) it's a deficit in that i can't put my attention where i want to put it when i want to put it there. this is definitely "attention deficit" to me.
2) when my attention wants to focus on something on its own somehow, i can't prevent it from putting its attention on that; that thing becomes my main focus for some amount of time that I can't really control. that's also definitely "attention deficit" to me, but in another way than the first way.
Someone else who describes it like I do. You sit down to do a task, and there's an "invisible wall" between you and the objective. You physically CAN'T type on the keyboard if it pertains to the task at hand. You get up to go on a walk, and all of a sudden CANNOT WAIT to get back home to start the task. It sounds like the most enjoyable thing ever! Until... you get home and are greeted by the "invisible wall" again...
I recall someone posting that the human brain is essentially "overclocked". I don't recall if that was the phrasing but the gist was that our level of intelligence can only exist by skirting the fringes of sanity. Like some set of dynamic differential equations where, if you bump a coefficient, it spins off into chaos.
Perhaps this Brave New World, as opposed to the more agrarian one our species had been accustomed to, pushes many of us over that threshold.
No science to back this but my first diagnosis was explained similarly. The claim was that the brain consumed all the neurotransmitter chemicals quickly and runs out. Amphetamines speed up production, so you have any instead of none. Idk how correct that is but it seems to work.
I think this is me. I was diagnosed with “regular” ADHD a few years ago, but I’ve had issues with rejection sensitive dysphoria my whole life. As a kid I would have a lot of meltdowns when I couldn’t get something right on the first try or made any kind of mistake.
The meltdowns stopped, but I still have issues spiralling into thoughts of failure and being a horrible person when I feel like I’ve disappointed family or friends.
Guanfacine has helped though. Tried a bunch of medications and this is the only one that seems to have made an impact.
Melissa DelBello, a professor of psychiatry and pediatrics at the University of Cincinnati, said that while brain imaging holds promise, it is still impractical to conduct such scans broadly in clinical settings because they are too expensive and not yet precise enough at the level of the individual.
As if questionnaires and slot-machine prescription medicine treatments are accurate. I don't want to generalize for lack of statistical data, but reports of psychiatrists 'just phoning it in' while providing little actual patient engagement are widespread.
> Some physicians and researchers have argued for years that emotional dysregulation is not peripheral to ADHD but a central, overlooked part of the condition. Yet this symptom does not appear in the formal diagnostic criteria for ADHD in the manual that doctors use to classify mental disorders. That gap has left clinicians without a clear way to categorize what they’re seeing: Are these children best understood as having severe anxiety, as being on the autism spectrum, or as something else entirely? Or does ADHD itself need to be more broadly defined?
Again and again and again. Psychiatry is an epistemic mess.
Psychiatrists are touristic guides of the Paris catacombs that orient themselves with a map of the subway.
ADHD is interesting. I think ADHD is mainly an executive dysfunction and reward centre dysfunction, from my own experience.
And a bit of nature, a bit of nurture.
It’s a real double edged sword for me.
On one hand relationships and “boring” tasks feel insurmountable. When I say boring I don’t even mean boring in the traditional sense, I just mean “not novel” - so even something like playing my favourite ever video game gets extremely difficult once the novelty is gone.
On the other hand, as a software developer, working on novel concepts or exploring novel concepts or ideas is basically like crack-cocaine, I literally can’t stop or put them down.
Double edged sword is struggling with most basic tasks, but excelling at the peripheries.
> “They are simmering volcanoes basically,” Rosen said. “When things go wrong, they explode. These are kids who will have hour-long meltdowns, throw things and hit and break things.”
...
> For children with this extreme form of ADHD, standard behavioral strategies may fall short. DelBello said that widely used approaches such as positive reinforcement — like giving prizes or other trinkets, or extra recess for good behavior — do not always have the intended effect.
I'm a former foster parent who adopted kids from foster care. Two of them were diagnosed with RAD[1]. This "extreme form" of ADHD aligns with both my personal experience of RAD and a subset of the symptoms described by clinicians. Attachment issues in general are either commonly comorbid with, or misdiagnosed as ADHD and ODD[2] (the latter of which also somewhat matches the symptoms from TFA).
I don't really have a point here, just an observation I wanted to make.
I've described the field of Psychiatry as trying to describe a building, using only its shadow (projection from high dimensional space to 2d space), with only a handful of choices for the building type. Ultimately only the building (the patient) really knows the full scope of complexity, but a doctor has to be careful in how they get info out.
I don't have a solution, as its an inherently hard problem with a lot of risks (like giving medicine to the wrong person). But I also think this desire to have nice categories for things can be counterproductive in a lot of cases.
I personally think rebranding aspergers + Autism to the autism spectrum was a mistake, as there's a huge difference between someone who's really good at their job but weird and despises certain workplace nonsense - and someone who can't take care of themselves.
ADHD is another great example of a bucket that makes non sense. We were evolved to be hunter gatherers that get many hours of walking or running, and other physical activity every day. Then we act surprised when 11 year olds don't want to sit still 6 hours a day, or getting people like me to write a JIRA ticket is like pulling teeth.
I think separating out these large categories into smaller ones is a good step, but ultimately I think the categories are a counterproductive solution to our human urge to find a logical explanation to things.
I was surprised by how cleanly our results came together,” said Pan, a neuroimaging expert with the West China Hospital of Sichuan University and the Turner Institute for Brain and Mental Health at Monash University in Australia. “We used no clinical information whatsoever in the clustering, and yet the three biotypes that emerged mapped well onto clinically recognized ADHD presentations.
Really cool that this worked out. Now I want to get my brain scanned...
I’ve always found the evolutionary biology lens very compelling for ADHD — consider hunters and gatherers. Hunters benefit greatly from the ability to quickly and sharply shift attention in an instant. They thrive at night and can hyper-focus on the thrill of the hunt. As civilization progressed, society was optimized for the majority (gatherers), and the hunters are marked as “disordered” for systemic incompatibilities.
I'm always sceptical of studies which look at a single diagnosis rather than pooling multiple related diagnoses, because the boundaries between them are so fuzzy
I'm a little confused. ADD & ADHD started as children's issues, if I understand it. Adults had already developed beyond it (was where I thought it started). Then later it got combined into only "ADHD" and adults where recognized (not sure which was first). This article only speaks of children. Has it reverted back to children only? I got diagnosed, only a few years ago.
It does look like they are going the right direction. I year or more ago, I looked up my symptoms on the WHO list of diagnosis and most were on both the ADHD and the spectrum list. I don't believe I've ever had a thorough diagnosis, so I was trying to understand better where I might fit. All I ended up with is that there were a lot of symptoms that border lined.
It felt like it was a bit under defined, like IBS (which I was falsely diagnosed with once) because they just didn't know another one that fit. Anyway, I would love more understanding. The "beyond" is common in people I've spoken with, so is the emotional dysregulation...
Does anyone have experience with the emotional dysregulatiom bit and what that looks like as an adult?
I have friends with adhd tell me that I have it, but my parents have suggested there was nothing present to indicate I had it as a child, which seems to be a binary input for diagnosis.
But I do seem to way overreact to the silliest things. For example, if my toddler trips and falls, my mind immediately races to "they definitely knocked all their teeth out and will be in pain and will have dentures forever and will never enjoy life again", and that seems to short circuit my reaction into a total panic/meltdown before I've even looked at the kid's face (which never hit the ground). And the advice of the internet such as deep breathing, stepping away, etc. is totally unhelpful as it seems my reaction is instantaneous. Then there's the crash and shame that follows it once the initial surge passes, which feels like my brain is lurching forward in my skull when I can feel it happening or stop it. And then I vow to never do it again, but then it happens.
I seem to mostly exist as a normal human otherwise. I can hyperfocus on coding, but that could just be normal focus because that's what I do all day.
My suspicion is that I have depression since the symptoms are overlapped, and I've never scored below a 20 on the phq-9.
Recently when I've crashed, I've started considering seeing a psychiatrist, but my motivation seems to run out quickly after I start considering it or looking them up. I also don't want to be involuntarily detained and lose my tsa precheck.
Edit: Not sure this is relevant, but I do tend to hit/slap my face when I get in these overwhelmed states, which my wife has pointed out is not normal nor okay.
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[ 4.7 ms ] story [ 32.6 ms ] threadTo me it seems that if it’s not „treatable“ the same way ADHD is, I’m not sure if it’s useful to categorize it as such. On the other hand, I’m happy if kids with this disorder can get a diagnosis and treatment that actually helps them sometime in the future due to this research.
But yes, once they have a better understanding of what that difference means, the next step might well be to split the ADHD diagnosis into two separate disorders, or even that, like cancer, ADHD is actually a whole range of separate but related conditions.
Whether or not the extreme dysregulation is a different disorder in its own right or not, is not relevant here. They are grouping ADHD matches; clinically recognized ADHD presentations plus MRI recognized ADHD which have a distinct brain sub-pattern occurring in people that have the same distinct behavioral traits. ADHD frequently has co-occurring conditions.
"Identifying “specific subtypes” of ADHD will make it easier to treat these children effectively". Having a more objective way to diagnosis for things like that seems to be the focus of the approach. They expect it to keep evolving, so I wouldn't say they are assuming anything about absolute labels -- just grouping what they now know to be true, that certain external traits match certain distinct brain patterns that are within the larger adhd brain structure.
Also, I think it's not that it is "not treatable" as ADHD, it's that ADHD can be treated in many different ways and currently the wide variety of responses to such is still a black box. Adderall instant release could briefly make me tired, I would sometimes break off a small piece and use it as a sleep aid. Some other `treatments` (I prefer societal alignment coping aid) resulted in what seemed like an expensive joke. Subtypes may eventually be able to show which options work best for which types and to start there first, instead of the current default iteration.
This link adds more about their research. https://medicalxpress.com/news/2026-03-distinct-adhd-biotype...
Do you think there's anything that differentiates what we might call "general task dread" that perhaps anyone experiences to a certain degree from a more broad executive function disorder? Or is it that dreading leading to task paralysis is one of many symptoms of an executive function disorder?
I eventually discovered that the adrenaline response from extreme stress ('if I don't get this fucking thing done by 7:30am I'm fired' kind of thing) allows me to lock in and do the thing.
So suddenly the task seems totally overwhelming, when I could just… not do it. So I find a time later I can attempt it and after a few times it is no longer novel and I forget about it.
If anything is hyper-active, it’s the executive function part of my brain that is driven to plan out every tiny, hypothetical detail before I can start.
What’s missing is the reward and internal incentives for doing things when there are other things that do feel good to do (that aren’t what I need to do).
I've always considered it Too Much Attention Disorder.
The way I like to think about it is that neurotypical people have a beam of light shining out in front of them, wherever they turn their head the light shines and that's where their attention is. Nothing else distracts them from where the light is shining.
With ADHD (for me at least) it's like 50 beams of light scanning the entire room constantly for 'something'. This is too much attention to things that I'm not really interested in, but can distract me from anything I'm trying to do or wan't to do.
For things that I am really interested in (like writing code) the 50 beams of light all manage to synchronise and focus in the same place and that's hyperfocus.
I'm also reminded that "Obsessive-Compulsive Disorder" and "Obsessive-Compulsive Personality Disorder" are different in kind but necessarily in magnitude.
The former comcerns more localized obsessions and the latter is more of a global "default state of perfectionism".
You manage to pry them apart, but it goes flying through the air and only to get stuck on an even stronger magnet still. And on it goes, over and over, until the magnet is stuck on the biggest, strongest magnet.
Your attention is constantly being repelled from less engaging activities to more highly engaging activities, and eventually you land on whatever the most engaging activity is nearby. Sometimes without even realizing it
Guess we’ll see how my diagnosis goes.
1) it's a deficit in that i can't put my attention where i want to put it when i want to put it there. this is definitely "attention deficit" to me.
2) when my attention wants to focus on something on its own somehow, i can't prevent it from putting its attention on that; that thing becomes my main focus for some amount of time that I can't really control. that's also definitely "attention deficit" to me, but in another way than the first way.
Perhaps this Brave New World, as opposed to the more agrarian one our species had been accustomed to, pushes many of us over that threshold.
https://www.sciencedirect.com/science/article/pii/S014976342...
The meltdowns stopped, but I still have issues spiralling into thoughts of failure and being a horrible person when I feel like I’ve disappointed family or friends.
Guanfacine has helped though. Tried a bunch of medications and this is the only one that seems to have made an impact.
As if questionnaires and slot-machine prescription medicine treatments are accurate. I don't want to generalize for lack of statistical data, but reports of psychiatrists 'just phoning it in' while providing little actual patient engagement are widespread.
Again and again and again. Psychiatry is an epistemic mess.
Psychiatrists are touristic guides of the Paris catacombs that orient themselves with a map of the subway.
And a bit of nature, a bit of nurture.
It’s a real double edged sword for me.
On one hand relationships and “boring” tasks feel insurmountable. When I say boring I don’t even mean boring in the traditional sense, I just mean “not novel” - so even something like playing my favourite ever video game gets extremely difficult once the novelty is gone.
On the other hand, as a software developer, working on novel concepts or exploring novel concepts or ideas is basically like crack-cocaine, I literally can’t stop or put them down.
Double edged sword is struggling with most basic tasks, but excelling at the peripheries.
...
> For children with this extreme form of ADHD, standard behavioral strategies may fall short. DelBello said that widely used approaches such as positive reinforcement — like giving prizes or other trinkets, or extra recess for good behavior — do not always have the intended effect.
I'm a former foster parent who adopted kids from foster care. Two of them were diagnosed with RAD[1]. This "extreme form" of ADHD aligns with both my personal experience of RAD and a subset of the symptoms described by clinicians. Attachment issues in general are either commonly comorbid with, or misdiagnosed as ADHD and ODD[2] (the latter of which also somewhat matches the symptoms from TFA).
I don't really have a point here, just an observation I wanted to make.
1: https://en.wikipedia.org/wiki/Reactive_attachment_disorder
2: https://en.wikipedia.org/wiki/Oppositional_defiant_disorder
I don't have a solution, as its an inherently hard problem with a lot of risks (like giving medicine to the wrong person). But I also think this desire to have nice categories for things can be counterproductive in a lot of cases.
I personally think rebranding aspergers + Autism to the autism spectrum was a mistake, as there's a huge difference between someone who's really good at their job but weird and despises certain workplace nonsense - and someone who can't take care of themselves.
ADHD is another great example of a bucket that makes non sense. We were evolved to be hunter gatherers that get many hours of walking or running, and other physical activity every day. Then we act surprised when 11 year olds don't want to sit still 6 hours a day, or getting people like me to write a JIRA ticket is like pulling teeth.
I think separating out these large categories into smaller ones is a good step, but ultimately I think the categories are a counterproductive solution to our human urge to find a logical explanation to things.
Another interesting thing that's not in the DSM - very high likelihood of balance / motor control problems (clumsiness, falling).
Here's a similar study from some years back which doesn't have that flaw: https://pmc.ncbi.nlm.nih.gov/articles/PMC6880188/
It does look like they are going the right direction. I year or more ago, I looked up my symptoms on the WHO list of diagnosis and most were on both the ADHD and the spectrum list. I don't believe I've ever had a thorough diagnosis, so I was trying to understand better where I might fit. All I ended up with is that there were a lot of symptoms that border lined.
It felt like it was a bit under defined, like IBS (which I was falsely diagnosed with once) because they just didn't know another one that fit. Anyway, I would love more understanding. The "beyond" is common in people I've spoken with, so is the emotional dysregulation...
I have friends with adhd tell me that I have it, but my parents have suggested there was nothing present to indicate I had it as a child, which seems to be a binary input for diagnosis.
But I do seem to way overreact to the silliest things. For example, if my toddler trips and falls, my mind immediately races to "they definitely knocked all their teeth out and will be in pain and will have dentures forever and will never enjoy life again", and that seems to short circuit my reaction into a total panic/meltdown before I've even looked at the kid's face (which never hit the ground). And the advice of the internet such as deep breathing, stepping away, etc. is totally unhelpful as it seems my reaction is instantaneous. Then there's the crash and shame that follows it once the initial surge passes, which feels like my brain is lurching forward in my skull when I can feel it happening or stop it. And then I vow to never do it again, but then it happens.
I seem to mostly exist as a normal human otherwise. I can hyperfocus on coding, but that could just be normal focus because that's what I do all day.
My suspicion is that I have depression since the symptoms are overlapped, and I've never scored below a 20 on the phq-9.
Recently when I've crashed, I've started considering seeing a psychiatrist, but my motivation seems to run out quickly after I start considering it or looking them up. I also don't want to be involuntarily detained and lose my tsa precheck.
Edit: Not sure this is relevant, but I do tend to hit/slap my face when I get in these overwhelmed states, which my wife has pointed out is not normal nor okay.
Funny how "attention" in transformers (a.k.a LLMs these days) can help overcome the activation energy barrier due to attention deficit in humans.