The link between August birthdays and ADHD (2018)

https://www.nytimes.com/2018/11/28/opinion/august-birthdays-adhd.html

by dymk • 4 years ago

141 166 4 years ago

Non-paywall link https://web.archive.org/web/20221020023129/https://www.nytim...

klempner• 4 years ago

The flip side of this is that people who legitimately have ADHD are surely more likely to have it diagnosed if they're having to deal with the added academic difficulty of going through school almost a year earlier than their September born peers.

That is, even in a world with no overdiagnosis of ADHD, we would 100% expect an effect of the sort this article raises.

colechristensen3• 4 years ago

I think I had the opposite effect whereby ADHD symptoms were created because i was so far ahead of my peers (September birthday) that some cognitive skills never developed properly for lack of challenge. (I have test results that point to very selective cognitive skill gaps which might be attributable to that)

phnofive2• 4 years ago

I'm in the same boat - what tests are you referring to? Might be something I can learn about myself there...

montanalow• 4 years ago

The converse is also true. We may be missing diagnosis for people born in September, who may struggle but not quite meet the definitions which often include academic performance.

thomastjeffery5• 4 years ago

Even "academic performance" isn't a clear enough predictor. It isn't even a single axis!

I was a perfect student all through grade school; except I had terrible grades in almost every class. Why? Because I almost never did homework. I usually aced tests without even trying, though. And I could always provide meaningful input into class discussions. But that isn't enough for the strict traditional structure of academia.

Teachers would make me stay after school to try to catch up on homework, and I would just wait patiently until it was late enough in the evening that they would give up and let me go home. This was a recurring pattern from 4rth grade all through 12th. I only graduated high school because I finished hundreds of pages of make-up work over the last couple weeks.

The reality is I couldn't do homework. I could focus and sit still, which must have meant I don't have any attention or hyperactivity disorder...

...but that's not what ADHD is. It's an executive functioning disorder.

ADHD is being diagnosed more today because it has been incredibly under-diagnosed in the past. It's still significantly underdiagnosed in adults today.

jay_kyburz• 4 years ago

I wonder if it was a less of an issue in the past, because we would make kids with difficulties repeat a year. They would go from youngest to oldest.

I'm sure repeating brings with it all kids of other problems.

notacoward• 4 years ago

Good point, and also I wonder how many of these diagnoses are deliberately sought by parents aware of the "relative age within school year" phenomenon. Holding kids back a year because of this has become so common that it has a name: redshirting. Having them diagnosed as ADHD and either medicating or holding back seems like a natural extension.

I don't mean to suggest that anyone's faking it BTW. As the authors point out, the real problem here might be underdiagnosis of September children. But parents of August kids might be more than a little predisposed to schedule that doctor visit, listen to that diagnosis, etc. in a way that parents of September kids would not be.

phnofive2• 4 years ago

Submitted a few times in the past but never discussed.

---

An unexplored link here is No Child Left Behind and its successors; in 2001, K-12 became standardized test prep schools as grades earned funding. Bubbling certainly drove me a little batty.

fnordpiglet2• 4 years ago

As a June baby in a state with a July cut off, I was always nearly a year younger than the majority of the class. It caused me no end of difficulty in school, to the point I loathed school, barely graduated high school with a 2.0 GPA and more than the legal limit of skipped days, diagnosed with ADD, and went straight to career in the valley. It was only when I was close to 30 that I sort of realized I actually was smart and could do well in school, and quit my lucrative career to get highest honors at UIUC CS- a very difficult program where graduating with C’s was an achievement - but I pulled off a 4.0 (A+ at UIUC adds nothing to the GPA). When I had my daughter, born in late May, I held her back a year in preschool and put her in a private school that mixes multiple years in the same differentiated class. She is so happy in school, and I just hope that she doesn’t have to experience the years of misery and failure I experienced that led to an adult life filled with anxiety that I’ve only recently conquered. Public school in the US is not structured in a way that is adaptable to the various states of human maturation you see in kids that all mature in different ways at different rates. It’s factory education, and if you’re not a widget of the right shape it cuts you up.

travbrack• 4 years ago

Really inspiring story. Why did you pursue school so late in your career? Just to prove to yourself that you could do it?

owlninja• 4 years ago

What changed at 30?

brendank310• 4 years ago

Nice work, that program is no joke.

rconti• 4 years ago

Do you think there's something about the precise age (to within a few months) that a child begins school that drives this bias in diagnosis? Or would we have the same problem with a hard cutoff date, even if all kids started school an entire year later? Or is it largely a matter of how much development a child undergoes even in 1 month at such an age (eg, a combination of factors)?

I guess I ask because there will always have to be a cutoff, even if it's a soft cutoff.

As a non-parent, the best solution I can see is to give the parents the knowledge and freedom to make the choice, and to add this data to perhaps mitigate over-diagnosis (and any attached stigma).

Of course, as I write this out, it occurs to me how much of a burden on parents an extra year without school could be

em-bee• 4 years ago

the problem seems to be the difference between the oldest and the youngest kid in a class. OP had problems through his school life as they were always the youngest. so starting the same process a year later doesn't seem to help.

what would help is an adaption of the montessori model where an age range of three years is in a class, and the expectation of all kids behaving the same naturally disappears.

doing that at least in kindergarten will at least avoid a mistaken diagnosis for ADHD. but my hope is that montessori kids will also fare better in a regular school because they learned to be more independent.

alasdair_4• 4 years ago

I guess I ask because there will always have to be a cutoff, even if it's a soft cutoff.

We could ditch the "academic year" idea entirely and just have kids join the classes when they are ready for them and not force a cohort to all have to learn and progress at exactly the same rate (one which, statistically, is either too slow or too fast for essentially every student).

enobrev• 4 years ago

I have a November birthday and started school at four during the last year the "at-least five by September cut-off" was implemented. I generally felt like everyone was way ahead of me for most of my school years. I was never diagnosed with ADD, but I never tried to find out either - I certainly wouldn't be surprised. I did alright in school, but I think that was because I studied extra hard because I always felt so far behind. I can't imagine that will work for everyone.

I appreciate your post. With a little one who is about to turn three, I've been thinking about school and the affects of going too early a lot lately. I worry about holding him back in case he'd end up bored and unchallenged. I've seen quite a few really smart people make some bad turns due to boredom. But, of course, I wouldn't want my kid to spend their life chasing all the "smarter" people either. That life has not done well for my self-esteem. Regardless, mixing multiple years in the same class sounds like an excellent way forward.

omnibrain• 4 years ago

I have the feeling that for me it's the exact opposite. Born end of June, cutoff is the June the 30th, but my parents insisted to to let me start a year later. This lead to me being up to a year older than anyone else. School stuff was always too easy for me (I might be also a bit smarter than the mean, but who knows?), so I never needed to really work for school and when the topics came where rote memorization and repetition helps I always fell a bit back. To this day I never really memorized the multiplication tables for example. Ask me what 7*8 is and I have to do math in my head. And this is only the most basic example.

Because I never really pushed training the binomial formulas I later run out of time when I had to solve more complex formulas where having those ingrained helps "finding the shortcuts" instead of "brute force".

We have a saying, that I "never learned how to learn". But it may also be that I suffer from undiagnosed ADHD (on top of that).

dorchadas• 4 years ago

I think I got lucky. Late July with a school that (at the time) had a Sept 1 cutoff. There was only one person younger than me until middle school.

My kindergarten teacher, who was also a family friend, requested I do it again because I wasn't mature enough. And she was right, honestly; I'd fight against nap time, and remember no end to problems in first grade with sitting still.

However, while maturity played a roll, the problem was I was bored. I went in to kindergarten being able to add, subtract and read, and had already started doing multiplication with my mom (herself a high school teacher). Another year in kindergarten would've been torture for me. Thankfully I had an amazing first grade teacher who recognised the problem. Instead of insisting on ADHD, she gave me more challenging stuff and let me work on my own. She never called on me to read aloud, because she gave me other books to read behind the class's book. This lasted until my 4th grade year, where one of my teachers didn't like it. Thankfully by then I was mature enough to recognise what I needed to do, etc.

So really, I wonder how much of this is a mixture between multiple things and how many times kids get given ADHD diagnoses when what they really need is differentiated education. Granted, this is difficult; I was a math/science secondary school teacher (and I think it's even harder for elementary school teachers, for various reasons ranging from standards to their own competency in the subjects they teach), and it was almost impossible at times.

That said, maybe I do have ADHD. I went on an amphetamine for weight loss at one point, and there were times I noticed I could focus longer and easier. But I've always had a tendency to get bored of something easily, and I'm sure the Internet hasn't made it any better. So I avoid getting tested as it doesn't impact work or study or anything for me (anymore than the Internet itself does)

piva002• 4 years ago

Very, very similar to my experience. I'm now approaching my mid-30s and under investigation with my therapist for ADHD.

School was always a breeze, I would get hyperfocused during classes paying attention to instructors and content but could never, ever do homework. Any kind of school work outside of school hours was a struggle. Still managed to be always on top of my classes.

I never actually learned how to learn, studied statistics in university and was hit by a brick wall on how to actually learn things which depended on more than just passively absorbing content...

To this day I don't believe I have a decent strategy for learning, it's a very scattered approach where I dunk into the subject from multiple angles and slowly build a mental model based on the patterns I see repeating from multiple sources. I'll start with an introductory book to gather an overview of the subject and then will jump in between other books and more advanced sections to see earlier concepts already applied and then backtrack to the gaps I see missing in my knowledge.

Somehow this way of learning is much more motivating to me than simply parsing through a linear approach of theory building. Whenever I try to go front-to-back with a textbook I get terribly unfocused.

user_78323• 4 years ago

Interestingly my experience is a mix of your and the parent comment.

I'm born towards the end of the year, and where I'm from (Afroeurasia) there isn't a strict year based cutoff. So I had Jan-born peers almost 2 years older, and folks a year younger.

Fortunately I was always fairly bright despite probably spending a solid 30% of my time daydreaming. I could catch up quickly... until it started getting harder in high school. Uni and grad school hit me, and I finally got dx'ed some time back (still in grad school).

I think I have been lucky that in school, most teachers were fairly nice intelligent people, and I was always the good, quiet kid who'd ask good questions (because I'm interested in everything). Having a good structure at home also majorly helped.

But in retrospect? Anybody spending hours every day daydreaming... yeah, screen them for ADHD, that was kinda obvious.

fnordpiglet2• 4 years ago

That’s why I choose a school for my daughter that differentiates in the class. That means they adapt material per student by their abilities across subjects. My daughter is extraordinarily advanced in reading and math, but she is in a class of kids around her age but the material is adapted to her ability individually. The age component for me is about maturity in a social context.

johnchristopher3• 4 years ago

It’s factory education, and if you’re not a widget of the right shape it cuts you up.

That's a fitting description that matches a factoid I read about mandatory education early days: the goal was to have workers who could read and count to operate industrial machinery.

rgrieselhuber• 4 years ago

It’s even worse than that. John Taylor Gatto has written extensively on the problems with government schools.

rumpelstinkin• 4 years ago

it was also meant, like the army and later tv, to create a uniform national culture and erode local communities in favor of the newborn unnatural countries.

matsemann• 4 years ago

How does this article's findings correlate in countries with other cut offs?

Like in Norway, everyone born the same year go to school together, even though the school starts in September. (Which confused me a lot when reading Harry Potter as a kid, as some dates there didn't "add up"). We segregate sports teams that way as well, making it often better to be a jan/feb kid, as you're always the biggest/strongest, and thus get the extra attention, training opportunities etc, so a bias towards those birthdays in our sports.

krzyk• 4 years ago

Same in Poland.

There is also a strange statistics with baby borns in early January and late December. There is a high spike of births in early days of January and a strange hole in births in the last days of December.

My daughter is usually the youngest kid in class (born middle December - here we put babys born in the same year in the same class) and usually has trouble because she is not as developed as kids born 11 months earlier - this difference will be less noticeable later in life, but know when she is 6 years old it is a bit sad.

CPLX• 4 years ago

That’s also how New York City does things for what it’s worth.

oldgradstudent2• 4 years ago

How does this article's findings correlate in countries with other cut offs?

The result appears to be consistent across countries with different cutoff dates.

For example, British Columbia with a December 31 cutoff date.

https://www.cmaj.ca/content/184/7/755

philliphaydon5• 4 years ago

I was “diagnosed” with ADD and was put on ritalin which had 0 affect on me. Wasn’t until later in life I realised I didn’t have ADD I just wasn’t enjoying parts of school.

Put me in physics class, technical drawing, cooking, math, I focused and did really well. Every other class was boring and non stimulating and so I acted up.

ADD is over diagnosed.

texasbigdata• 4 years ago

The last line is logically ambiguous. In Europe, I believe in 2019, they found two effects: a significant _underdiagnosis_, offset by a tiny over diagnosis; now you could argue phones and screens artificially raise the genetic baseline, or that America is inherently different. But I will tell you ADHD meds calm me down, or when measured with a heart strap monitor over a full day fairly meaningfully lower my heart rate.

It’s perhaps a meme now that adhd is over diagnosed, but I’d guess the majority is pill seeking individuals looking to compete at school or at work and less false positive diagnoses such as yours.

Net net you seem to have solved it fairly quickly so at least that’s good: even when you get the diagnosis wrong if you can backtrack without significant cost then maybe it’s not absolutely horrible.

jon-wood• 4 years ago

Put me in physics class, technical drawing, cooking, math, I focused and did really well. Every other class was boring and non stimulating and so I acted up.

Being able to focus (sometimes to self-destructive levels) on things we enjoy are as much a part of ADD as being chronically unable to focus on things we find boring.

adastra223• 4 years ago

Put me in physics class, technical drawing, cooking, math, I focused and did really well. Every other class was boring and non stimulating and so I acted up.

I’m curious what you think ADD is, since what you describe here is practically textbook symptoms.

balfirevic3• 4 years ago

ADD is over diagnosed.

You concluded this just based on your single experience?

It could be wrongly diagnosed for many people and still be under diagnosed overall.

smittywerben• 4 years ago

It had zero affect on you 15 years ago. Is α > 0.05 comment on ADD in thread on ADHD diagnoses (2018) considered flame bait?

Traubenfuchs• 4 years ago

What were your difficulties? As the youngest in both elementary school and high school (almost a whole year of difference to the oldest), I had no struggles specific to my age. In elementary school and early highschool I overperformed and in later high school I performed averagely.

astura• 4 years ago

OTOH, I was born several months after you so I must have been the youngest in my grade, my birthday was usually after the first day of school. My parents might have even fabricated by age for all I know. My best friend in highschool was almost an entire year older than me. It didn't bother me in the least. I didn't even noticed it until I was in highschool. This caused me ZERO difficulties.

My cousin was born about a month after me and he was in a younger grade than me. We grew up together and I always felt bad for him that he couldn't get highschool over with a year sooner like me. He was jealous of me. He also got into a ton of criminal behavior and has been in and out of jail for the past 20+ years, so I could easily say that was caused by the trauma of him being a year back from me in school. Who knows.

gowld2• 4 years ago

I held her back a year in preschool

This (or backing up a year any year) might have helped you too.

and put her in a private school that mixes multiple years in the same differentiated class.

This might backfire, for the same reason that you had trouble -- differentiation is difficult to do in practice. And your childhoold school might have been less differentiable than a modern public school, which has the benefit of computerized material and automated adaptive tests.

Of course, if the private school solves it by having a far lower student:teacher ratio, then of course that's better than a public school, all else equal.

Another thing parents can do is, instead of switching to private school, put that money toward hiring PTA-sponsored assistant-teachers in the classrooms.

urthor• 4 years ago

Psychiatry & neuroscience today are some of the closest equivalents to physicians applying leeches in the 16th century.

Through no fault of their own.

We, simply, have legitimately very little knowledge of those fields of science. Our understanding of the human brain is just not there.

So much of Psychiatry is throwing pills at symptoms after talking about your life.

That's often the state of the art in the field.

Genetic sequencing, and the ability to use genetic markers to diagnose illness, hopefully will change things. A cheap and effective diagnostic tool that isn't based on guesswork and "tell me your life story."

29athrowaway• 4 years ago

If a neuroscientist can explain a truly brain, they would be able to explain a much simpler thing such as a CPU or GPU. But, can they? No, they can't.

Psychology is in great part pseudoscience. Lots of studies that are neither falsifiable or reproducible.

Psychiatrists are the modern equivalent of barber surgeons, or trying to make fine jewelry with a chisel and a hammer.

throwaway0asd• 4 years ago

Diamonds are still cut with chisel and hammer. Most of your comment sounds like a bunch of logical fallacies.

111111101101• 4 years ago

Leeches actually work though and we still use them today.

WhyCause• 4 years ago

Cupping is probably a better analogy. Also, there was a long stretch of time there where we didn't use leeches, at least in part due to the stigma associated with the older practice.

Hnrobert422• 4 years ago

I agree. I have thought that in 200 years, people will look back at mental health care at this time with a mixture of horror and pity.

Spivak5• 4 years ago

ADHD is actually one of the things that’s actually rigorously and quickly testable (assuming you’re willing to take self-reported effects / observations, you can’t read a number off a lab test) but it’s never done because it involves giving someone without any medical diagnosis a schedule 2 drug and we moralize that for some reason.

You just give the person a stimulant and see what happens. If they get really awake, hyperactive, excited, anxious, shaky, hyperfocused, etc. then nope, if they get calm, content, or sleepy then yes. And it’s not like this is crazy in general, we do “just treat it and see if they get better” as the test for plenty of things.

Nobody bats an eye when we do the same thing for depression, it’s super common for people who exhibit the symptoms to be asked to try a few antidepressants and see if they work.

I get that some people abuse stimulants but they suuuuuuck. Life changing because they allow you to function but you will also curse them for it. The side effects are awful. So much so that I tried a bunch of non-stimulant medications until I found one that worked. Nobody who doesn’t have ADHD is gonna wanna regularly take adderall or vyvanse just because it would be miserable and that’s before the fact that they aren’t cheap.

Edit: /rant Mental health is wild because smart and well meaning people designed a system that actively prevents people from being honest and getting help. Want to talk to your therapist about your suicidal thoughts, bulimia, or self-harm, nope. Not unless you want to take a mandatory grippy sock vacation away from your support network and get set back in school or lose your job all things famous for improving mental health. Wanna tell your psychologist that you think you might have ADHD because you were at a party, tried something and it made you felt way different than everyone else, haha drug seeker.

zeroonetwothree• 4 years ago

Many people with depression don’t improve on antidepressants so this seems of questionable accuracy.

bitexploder• 4 years ago

They work great for me (adderall and friends). I don’t use them because of the side effects. When I can arrange my work life to be one or two things I like I can focus and work 10 hours productively and it feels easy. Make me manage a lot of trivia and distractions happen and I fall apart. So, I pick hard things and do them and just ignore the rest. It has worked out okay.

wikibob• 4 years ago

WARNING

The above post is utterly false.

This was always known to be false, but was a popular opinion in pop-psychology for a time.

It is untrue.

Stimulant medications DO NOT have this claimed opposite effect on people with ADHD. This is not a view that is supported by science and is not a valid diagnosis method.

pazimzadeh2• 4 years ago

One related I've noticed is that people respond to certain drugs way differently to me. For example, cannabis acts like a stimulant for me (especially the first 1-2 hours) whereas it practically puts some to sleep.

alasdair_4• 4 years ago

Want to talk to your therapist about your suicidal thoughts, bulimia, or self-harm, nope. Not unless you want to take a mandatory grippy sock vacation away from your support network and get set back in school or lose your job all things famous for improving mental health.

It takes a hell of a lot more than this to be involuntarily taken into a psychiatric hospital.

The stuff you are saying is flat out wrong. It's also extremely harmful. I say this as someone who volunteers on a suicide hotline and takes calls like this every night I'm on shift.

No one is going to involuntarily take you to hospital unless you are in really, really imminent danger (as in, you have a loaded gun and insist you will use it in twenty minutes level of danger). Just having suicidal thoughts or even self-harming will not result in your autonomy being taken away.

Please, if you are having harmful thoughts, the best thing you can do is talk to someone. Don't let the nonsense above scare you away - you CAN talk to your therapist about this stuff. It's why they exist.

MistahKoala• 4 years ago

Putting aside other factors for a moment, a rigorous test surely depends on the dose.

Stimulants like lisdexamfetamine can be titrated over a period of several weeks to determine effectiveness and tolerance of the dose, which are unknown until tested - that doesn't seem quick to me and indicates that clinicians can't expect a binary response from a one-off dose.

dang• 4 years ago

We detached this subthread from https://news.ycombinator.com/item?id=33270325.

KineticTroi• 4 years ago

Nothing about solar cycles, or sun position, and other seasonal factors relating to fetal development. An old topic, covered in better detail in a plethora of past research articles. Might be more revealing to read about seasonal differences between children born in south vs north hemispheres.

joemi• 4 years ago

I'm not sure if what you're talking about has anything to do with the article. It sounds like you're just making a flippant comment based on the title of the article (please correct me if I'm wrong). From the article:

Most states have arbitrary cutoffs for kindergarten entry, with children who do not reach a given age by a certain date required to wait a year. In 18 states, children who will turn 5 before Sept. 1 can enter kindergarten in the year that they turn 5; children who will turn 5 after Sept. 1 must wait until the next year. So in states with Sept. 1 cutoffs, in any given class, August-born children will usually be the youngest and September-born children the oldest. These arbitrary cutoffs have important implications for the diagnosis of A.D.H.D.

caddemon• 4 years ago

There are also other reasons birth month could be related to psychiatric disease that sound more pseudoscience-y at first. There's good reason to believe that infection at the wrong time of pregnancy can increase risk of Schizophrenia for example, meaning that the alignment of cold and flu season could affect disease rates by birth month.

I agree the comment was probably just being sarcastic, but I think it's worth noting that there could be a more biological component to an effect like this, doesn't need to be a societal environment/diagnosis rate thing to be plausible.

It's interesting reading about a lot of pseudoscience as you go through scientific training, because obviously you have an immediate negative reaction to it. But I've started to notice that more often than not there is some underlying grain of truth that is taken to an extreme and/or given a ridiculous explanation. This in turn dampens real research on the potentially interesting line of questioning.

riwsky2• 4 years ago

Classic Gemini excuse-making. Clearly these kids' problems are caused by $CELESTIAL_BODY being at $PLACE during $TIME; idk why they keep whining like this!

But also: focus isn't distributed bimodally; ADHD is in some respects a matter of degree, not kind. Accordingly, many ADHD treatments also improve the abilities of people without ADHD—to ends both benign (the "secular literature" of productivity porn, which overlaps with behavioral ADHD management) and less-so (widespread stimulant abuse on college campuses). That leaves us with evaluating impairment to a student's quality of life. Is doing that by comparison to their classmates subjective? No—you can still make objective statements about comparative ability—but the ethical question of "do Gemini deserve a 12-month cognitive disadvantage compared to their grade-level peers?" is harder to answer than the medical "would this kid still be diagnosed if they were relatively older?". The article's argument is weaker for eliding it.

NoToP• 4 years ago

What's the difference between stimulant use with a prescription and stimulant use without? A priori why demonize one as abuse and accept the other as legitimate.

riwsky2• 4 years ago

Honestly, I took it as an axiom so as to steel-man the article's argument; if there were no difference between prescribed and unprescribed use, any dismissal of concerns about overprescription would be trivial.

But if I had to argue for it:

I'd wager that unprescribed usage on college campuses is more likely to fall outside of medical guidelines (e.g. at late hours to pull all nighters, or in higher doses for recreational and euphoriant purposes). Whether or not one demonizes this as unethical, it should be uncontroversial to describe the concomitant increases in e.g. seizure risk, addiction, and other side effects as not-benign.

It also advantages 1) lawbreakers who 2) can afford secondhand stimulants. Yes, this is also evidence towards "ok so don't legally require an rx to purchase these"—but such are the rules of the game students are playing, and the argument from personal freedom is strained when made in a competitive context.

hinkley• 4 years ago

What’s the difference between giving people with poor impulse control unfettered access to stimulants and giving them a set of rules that provide structure?

corobo5• 4 years ago

The dosage probably. Prescription tries to get the lowest dose that effectively treats whereas you would probably buy based on value for money off your pal Gregg who knows the dark web. The dose will also go unchecked and unmonitored for effectiveness.

Stimulation prescriptions come with requirements like blood pressure checks to make sure your heart isn't going to explode too.

fumeux_fume• 4 years ago

If you stopped at the first sentence, it would be a great comment. Not really sure what other points are trying to be made, but you got a chuckle right off the bat.

runlaszlorun• 4 years ago

Classic Gemini excuse-making.

you’re proud of yourself for that aren’t you?

you part of New Nazi Nation or someshit?[1]

~ genx jesus

bound008• 4 years ago

I would highly recommend any readers on here who have ADHD to read "Scattered: How Attention Deficit Disorder Originates" by Dr. Gabor Maté[1]

It provides a compelling argument as to the root cause of ADHD.

[1] https://drgabormate.com/book/scattered-minds/

astrange• 4 years ago

Nice nominative determinism, maté is quite the most caffeinated thing I've had in my life.

elcritch• 4 years ago

I would recommend taking this book or similar ones with a grain of salt. Just going off the summary it claims to "prove" that ADHD isn't inheritable, which goes against lots of well established research showing strong inheritability of ADHD.

Any books that claim to undercover the "root cause" of something as varied and complex likely haven't. Now it might have great insights, but presenting the book this way gives a bit of undertone as "cure ADHD with this one simple trick!".

Guessing about the content of the book, it likely seems to discuss healing emotional regulation by some means. If so I'd agree it's a valuable aspect of treating ADHD, as most ADHD'ers also suffer significant emotional damage. That damage and accompanying maladaptive coping often is far impactful than ADHD itself.

mbrock• 4 years ago

Maté says the inheritable trait is a kind of nervous sensitivity that develops into ADHD in certain early childhood environments especially when the caretakers are stressed, depressed, or otherwise unable to provide the infant with the stable, responsive gaze that they need. I don’t know how true that is, but that’s the idea in “Scattered Minds.”

cja2• 4 years ago

He literally starts the book by saying that he didn't know much about ADHD until four or five years before writing and then he and his three(?) sons were all diagnosed with it and then (or so I gather because I stopped reading then) he comes up with some novel theories contradicting the experts in the field.

There's so much evidence-based material to read from people who have spent decades studying ADHD that it's a shame instead to waste time on Mate. He may be an expert in some things, just not this

rauhallinen• 4 years ago

Agree with other responses. Maté's book, as his other works, resonates intuively - a humanistic shout in this cold and sick world.

Things are however more complex. He gets a lot of publicity, eg with recent Joe Rogan interview clips on the topic being spammed to me by YouTube's rec engines. Mental health issues are something that many people take intellectually lazy stances, to one direction or another, and this is somewhat worrying.

This book is 20 years old. I'd imagine the scientific & clinical understanding of ADHD has progressed since. Opposing views are of course important for progression, but I'd like to understand his thinking in wider context of psychiatry. Would be interesting to see a dissection of his ADHD points, carried out in a rigorous way.

brador• 4 years ago

At age 10 that's a 10% advantage in life experience, growth, and social skills. Huge.

kova12• 4 years ago

Can we ban submissions which are under paywall.. it's kinda bait and switch'y, every time I click on these I can't help feeling I've been rickrolled

bell-cot• 4 years ago

For most HN submissions from paywalled sites, disabling javascript in your browser is a good-enough solution.

taoufix2• 4 years ago

https://web.archive.org/web/20221020095951/https://www.nytim...

chrsig• 4 years ago

Sometimes I wish HN had a rule against posting things about mental health (perhaps with the exception of Ask HN threads).

At the very least, I'm curious what the statistics on references are compared to technical topics. There's always so much misinformation in ADHD threads. It's really exhausting.

bachmeier• 4 years ago

Sometimes I wish HN had a rule against posting things about mental health

Don't stop at mental health; basically any discussion outside of programming is a disaster AFAICT. It doesn't get cleaned up because the participants don't realize how bad it is. I avoid anything close to economics. I only checked the comments here to see if there was a non-paywalled version.

user_78323• 4 years ago

Perhaps, but is it really detrimental to discuss it? HN is decently moderately enough to avoid flame wars, and sure there's a lot of anecdotal talk going about by folks who aren't doctors, but that doesn't mean that patients/the public shouldn't discuss health.

Perhaps a sticky/banner for health topics may be a good idea? Like "This is a health topic, please don't make unverifiable claims and mark your opinions as your own"?

user_78323• 4 years ago

Come to think of it, starting paragraphs/comments with syntax would be a decent solution. Like:

OPINION: I think....

ANECDOTE: When I experienced this...

BigglesB• 4 years ago

As a counter-anecdote, I have an early September birthday, but the 1st Sept cut-off was advisory rather than strictly enforced. So I was a “year ahead” of where I should have been for my exact age up until I was 13. At which point I repeated a year, going from the youngest of my classmates to the oldest.

Exactly the sort of child the article implies would at risk of being over-diagnosed with ADHD as a pre-teen. Except I wasn’t diagnosed until almost 25 years later.

Of course I’m just one data-point, but I’d be curious whether the developmental age differences might potentially _cause_ ADHD development among younger classmates rather than just indicate misdiagnosis.

drogus• 4 years ago

I’m wondering if the opposite might be true as well - underdiagnosing people from different months. I was born in March and in Poland where I grew up school was assigned by birth year. So the oldest kids in a given class were from January, the youngest from December. I have had little problems in primary school and gymnasium without putting much work into it. Then in high school it got harder, but I still passed, again, without almost any work, skipping classes, being late all the time. I started really struggling at an university and later in life and I eventually got diagnosed.

Granted, ADHD disgnosis was rather uncommon in Poland in the 90s, but I can see how a kid doing good early in school could have been not diagnosed.

corobo5• 4 years ago

All this raises the question of whether the disease is being overdiagnosed.

No chance of it not actually being a disease?

Maybe different brain types are as common as blood types. We'll never know while we label anything that doesn't play nicely with commercialism as diseased haha

nrabulinski• 4 years ago

This idea has been proposed multiple times before but, from what I remember (and I’m paraphrasing here) we’re identifying it as a disorder not because it’s a disease per se but because it affects the lives of those people and in general has been deteriorating ever since humans changed their lifestyles from hunters to farmers.

I think this video talked about this concept in more depth https://youtu.be/QUjYy4Ksy1E

dt2m• 4 years ago

Not a disease? That's down to semantics and personal opinion. What isn't opinion is the fact that the symptoms of ADHD have been objectively identified on a global scale, in people from very different cultures and social classes.

I agree that it isn't beneficial to label a very livable condition with the same word that we use for much harsher illnesses, and it doesn't help that it's not a visible condition. But as somebody with ADHD, it really hurts me to keep seeing this argument repeated ad nausea.

Maybe the issue isn't that it is being overdiagnosed, but rather the fact that the only treatment we consider worthwhile is prescribing amphetamines to children.

corobo5• 4 years ago

But as somebody with ADHD, it really hurts me to keep seeing this argument repeated ad nausea.

I've not seen or made this argument before, where does it usually go and/or what is the end result?

I too have ADHD, I'm sorry if my curiosity and thoughts have caused you harm. I'm new to it and want to know what's what.

Do you have any wikis or articles or twitter threads that can get me up to speed on the basics without traumatising people?

oldgradstudent2• 4 years ago

Maybe different brain types are as common as blood types.

What this research shows is that at least a significant part of ADHD diagnosis rates results from bureaucratic reasons, and unrelated to either disease or brain types.

thomastjeffery5• 4 years ago

It isn't a disease, it's a disorder.

We know a lot about ADHD and what causes it. We know its effects and how beneficial it is to treat it, especially with medication.

corobo5• 4 years ago

I was using the article's wording, for what it's worth.

I've also been diagnosed with ADHD myself, but it was relatively recently so I'm not a part of that we that knows everything just yet :)

amf12• 4 years ago

Maybe different brain types are as common as blood types.

Different blood types don't impact people's life differently. Disorders like ADHD do affect the lives of people who have it.

corobo5• 4 years ago

They do if you transfuse the wrong type into them.

It was an example of something biologically common anyway, I didn't compare it to ADHD the way you've read it.

lqet• 4 years ago

I am endlessly fascinated by the effect your birth month may have on you. It begins with trivial things: if you are born in summer, then by the time you are 6 months old and have developed a vague awareness of your world, "going out" means adding uncomfortably many layers of clothing and being tossed into a cold and harsh environment. Whereas if you are born in winter, your first real playtime outside is a warm and wonderful experience, with flowers and butterflies and soft grass.

But the effect on your personality may go beyond this [0]:

The season in which babies are born can have a dramatic effect on their future risk relating to the development of conditions such as neurological disorders, including seasonal affective disorder, bipolar depression, schizophrenia and type I diabetes. Research has shown that the season a baby is born in can have a major effect on whether or not they will become a heavy smoker.
The risk of suicide increases by 17% for people born in the spring–early summer compared with those born in the autumn–early winter

Our daughter sleeps better and longer in winter, because it gets dark early - so her birth month correlates with the amount of sleep she got in certain stages of development during the last years.

In past ages, the birth month also directly influenced how much (and what kind of) food was available in certain stages of development.

This may sound esoteric, but I really think there is some deep truth in attributing personality traits to astrological signs.

[0] https://en.wikipedia.org/wiki/Influence_of_seasonal_birth_in...

Defitio3• 4 years ago

Personality traits are not mentioned in your references wiki article.

There are plenty of counter examples of other people who are born in the same month than me who are totally different.

There is also a huge difference how people handle sickness like the ones mentioned in the wik article.

The origin of those signs are also totally different and are pure fiction

bmitc• 4 years ago

There are statistics for these things. Counter examples just means they’re somewhere else in the distribution.

coldtea• 4 years ago

There are plenty of counter examples of other people who are born in the same month than me who are totally different.

That's irrelevant though. He didn't say it is a law of nature that forces development in the same exact way. Just that it's a factor.

What is the concern is how a statistically significant part of those born at X months are affected, compared to those being born at Y months.

Not whether there are exceptions. Of course there will be. People being the same in both groups might even be the majority. But one group (say "born in spring-summer ) having 17% more of something compared to the other is a big thing, and that's whats considered here - even if the rest 83% are the same on that aspect.

nkrisc• 4 years ago

This may sound esoteric, but I really think there is some deep truth in attributing personality traits to astrological signs.

Then it ought to be provable, no need to guess.

bjourne• 4 years ago

Now ponder the effects of all unhealthy food you will stuff in her and which modern society will make her effectively addicted to! Whatever effect the weather has pales in comparison.

jollyllama• 4 years ago

How could there not be any truth to it?

It's like when people talk about "lunacy" i.e. the moon influencing human behavior. The moon causes the tides and we're 60% water; how could it not have some effect?

ilikecode• 4 years ago

People simply don’t like admitting that they are not fully in control of themselves.

hirvi7410• 4 years ago

"lunacy" i.e. the moon influencing human behavior.

Is that seriously the etymology of that word? If so, that is absolutely fascinating.

LorenPechtel• 4 years ago

The tidal effect of the moon on the human body is tiny compared to the other forces at play.

gowld2• 4 years ago

The tides work because water flows across the surface of the rigid Earth. You have a body that holds your water in, and a far more massive, much closer object than the moon, exerting far, far more gravitational pull on you than the moon.

Also, the moon is approximately the same every day (but higher or lower in the sky). It looks different on different days due to shadows, not gravity.

mFixman• 4 years ago

I honestly think that the best way to fix everything wrong in the world is to reduce class sizes in schools, and age categorisation seems like a good place to start.

If there is such a difference between the academic results of a kid born in July and another one born in August, wouldn't it make sense to double the amount of classes and group the children in age groups of 6 months of length rather than a year of length?

cmrdporcupine• 4 years ago

The Montessori approach actually does the opposite re: age categorization.

Small classes, yes, very.

But classes with multiple age groups together. 3 year age spans is my recollection. Basically "junior elementary" and "senior elementary" and "adolescent" is how I've seen it grouped.

Many ideas going on here, but partially it's younger kids learning from older kids or being able to access "older" material if they can handle it, encouraging mentoring relationships, not living under the illusion that just because two kids are the same age that they are measurable against each other on some skill sets, encouraging individualized learning paths, etc.

lotophage• 4 years ago

There is some overlap here with a recent article in The Atlantic article that makes the case for delaying the start of school for boys:

https://www.theatlantic.com/magazine/archive/2022/10/boys-de...

taoufix2• 4 years ago

https://web.archive.org/web/20221020095951/https://www.nytim...

bayesian_horse• 4 years ago

ADHD is actually underdiagnosed in most countries...

A proper diagnosis is highly correlated both with the probability of certain consequences (violence, drug addiction, low academic performance...) and the likelihood of treatment lessening those consequences.

mklarmann• 4 years ago

Usually there is more than one class that starts at the same location. They already would do a great job by just grouping them all by age...

thomastjeffery5• 4 years ago

The problem here is not ADHD being over diagnosed. The problem is using academic performance in place of actual diagnosis in the first place. It's a good predictor, but we are entirely capable of more. ADHD is the best studied disorder there is.

ADHD has been very significantly plaugued by misinformation and stygma. Misinformation is still baked into the name itself!

But things are getting better. People are learning that ADHD is actually an executive functioning disorder, that you aren't likely to grow out of it as an adult, and that stimulant medication isn't the Boogeyman that the war on drugs has made it out to be.

So it's no wonder that we are seeing increased diagnosis rates! We're seeing an increase of LGBTQ+ identification rates, too. It's pretty obvious why.

This whole article is just fear mongering backed by circular reasoning. Do better, NYT.

hirvi7410• 4 years ago

I was born towards the middle of the year, but I started school at age 5 instead of 6. I really wish my parents started me later. I think I would have had a lot less issues adapting to such a system.

I have ADHD too, and I wasn't diagnosed until my classical guitar professor basically told me to get treated or don't come back, but in a slightly more tactful manner.

The most disappointing part of the process was when I told people outside my family about my diagnosis. I was met with plenty of resounding comments like, "Wait, how did you not know?" or a "Yea, everyone knows you do. I knew within seconds of meeting you." It wasn't the... response I was hoping for, but oh well. =/

I figured once treated life would hop back on track, and I'd be able to apply myself, become who I was destined to be, etc.. But over the years, I have learned that ADHD, while impairing, wasn't what held me back, and still isn't what is holding me back. There is something else, I am still searching for it. (I don't mean something like a clinical disease, but perhaps my personality, past trauma, thought patterns, etc..)

The link between August birthdays and ADHD (2018)

Related Stories