<p>Like all psychiatric disorers, ADD and ADHD are diagnosed using a set of criteria listed in the <a href="http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders" rel="noreferrer">Diagnostic and Statistical Manual of Mental Disorders, or DSM</a></p>

<p>The latest version is the DSM-IV-TR. The DSM-V is due out in 2013 and may change these criteria.</p>

<p>Diagnosis is expected to be done by a licensed professional who is able to assess these criteria.</p>

<p>From <a href="http://www.mental-health-today.com/add/dsm.htm" rel="noreferrer">http://www.mental-health-today.com/add/dsm.htm</a> :</p>

<pre><code>INATTENTION
(need 6 of 9)

- often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
- often has difficulty sustaining attention in tasks or play activities
- often does not seem to listen when spoken to directly
- often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (no if oppositional behavior or doesn’t understand instructions)
- often has difficulty organizing tasks and activities
- often avoids, dislikes, or is reluctant to engage in tasks or activities that require sustained mental effort (such as schoolwork or homework)
- often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
- often easily distracted by extraneous stimuli
- often forgetful in daily activities

HYPERACTIVITY-IMPULSIVITY  
(need 6 of 9)

- often fidgets with hands or feet or squirms in seat
- often leaves seat in classroom or in other situations in which remaining seated is expected
- often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
- often has difficulty playing or engaging in leisure activities quietly
- is often "on the go" or often acts as if "driven by a motor"
- often talks excessively
- often blurts out answers before questions have been completed
- often has difficulty awaiting turn
- often interrupts or intrudes on others (e.g., butts into conversations or games)

REQUIREMENTS

- Present at least 6 months, maladaptive and inconsistent with development level
- Some symptoms that caused impairment were present before age 7
- Some impairment from the symptoms is present in two or more settings (e.g., at school {or work} and at home)
- There must be clear evidence of clinically significant impairment in social, academic or occupational functioning
</code></pre>

CC BY-SA 3.0
2012-11-16T21:15:37.567Z
None of this answers the original question: Do these traits tend to cluster strongly? Is there reason to believe that they share an underlying etiology? etc.
octern
CC BY-SA 3.0
2012-11-16T21:19:56.140Z
The original question is "How well defined is ADD/ADHD?" The bit about traits clustering together is listed as a *potential answer*. There's also nothing in there about etiology.
Jeff
CC BY-SA 3.0
2012-11-17T01:49:19.297Z
You're right, my mistake. I was thinking about the other question in the post, "Are there good reasons for picking out the behaviors associated with ADHD and giving them a name?"
octern
CC BY-SA 3.0
2012-11-17T02:06:40.650Z
you're right though, that this isn't the best answer. it doesn't address how criteria for the DSM are chosen. my understanding is that this processes is subjective and controversial, but maybe someone can provide a more detailed explanation.
Jeff
CC BY-SA 3.0
2012-11-16T00:11:53.383Z
2012-11-16T00:11:53.383Z
Jeff
<p><strong>Why the symptoms were picked out and given a name</strong></p>

<p>Professionals used to believe ADHD was something children grew out of, but not anymore.
ADHD has always been strongly related to school performance. If a child is not focused on school, and seems unwilling or unable to concentrate, everyone tends to think of ADHD as the cause.</p>

<p>This makes me think that ADHD was "discovered" as an explanation to why some kids are not so good at school.
If you look at the symptoms for ADHD, you'll notice that each of them is completely normal behavior, but every one of them reduces performance at school.</p>

<p><strong>Do the symptoms for ADHD cluster?</strong></p>

<p>Yes and no. They cluster in more than 1 cluster.
Studying personality psychology, I have noticed a growing number of completely normal personality traits that remind me alot of ADHD.</p>

<p>A stereotypical boy with ADHD (restless, fidgety, takative, forgetful, unorganized) would easily remind you of the MBTI personality type ESxP.
(ESFP: <a href="http://www.16personalities.com/esfp-personality" rel="noreferrer">http://www.16personalities.com/esfp-personality</a> ESTP: <a href="http://www.16personalities.com/estp-personality" rel="noreferrer">http://www.16personalities.com/estp-personality</a> )</p>

<p>A stereotypical girl with ADHD (silent, daydreaming, inattentive) would remind you of the MBTI personality trait INxP. (INTP: <a href="http://www.16personalities.com/intp-personality" rel="noreferrer">http://www.16personalities.com/intp-personality</a> INFP: <a href="http://www.16personalities.com/infp-personality" rel="noreferrer">http://www.16personalities.com/infp-personality</a> )
Girl's ADHD: <a href="http://www.addvance.com/help/women/daydreamer.html" rel="noreferrer">http://www.addvance.com/help/women/daydreamer.html</a></p>

<p>Also note how the "boy's ADHD" and "girl's ADHD" are pretty different. The only common traits are poor attention and organization at school.</p>

<p>The typical ADHD behavior also matches well with several parts of the Big 5:</p>

<blockquote>
  <p>Substantial effects emerged that were replicated across samples.
  First, the ADHD symptom cluster of inattention-disorganization was
  substantially related to <strong>low Conscientiousness</strong> and, to a lesser
  extent, <strong>Neuroticism</strong>. Second, ADHD symptom clusters of
  hyperactivity-impulsivity and oppositional childhood and adult
  behaviors were associated with <strong>low Agreeableness</strong>.</p>
</blockquote>

<p><a href="http://psych.colorado.edu/~willcutt/pdfs/nigg_2002.pdf" rel="noreferrer">http://psych.colorado.edu/~willcutt/pdfs/nigg_2002.pdf</a></p>

<blockquote>
  <p>Although previous research on personality and ADHD has focused
  primarily on extraversion and neuroticism, the present study found
  that <strong>agreeableness</strong> and <strong>conscientiousness</strong> were stronger predictors.
  This pattern of results is consistent with the clinical literature on
  adults with ADHD.</p>
</blockquote>

<p><a href="http://www.researchgate.net/profile/James_Parker3/publication/222409991_ADHD_symptoms_and_personality_relationships_with_the_five-factor_model/links/02e7e52cad95c0fcfc000000.pdf" rel="noreferrer">http://www.researchgate.net/profile/James_Parker3/publication/222409991_ADHD_symptoms_and_personality_relationships_with_the_five-factor_model/links/02e7e52cad95c0fcfc000000.pdf</a></p>

<p>Conscientiousness is what measures your ability to stay focused (and more), and neuroticism measures your patience (and more). And those are exactly what primarily defines the J/P factor in MBTI - and ADHD.
You're a P? Congratulations, you may have ADHD. You're a J? Nope, no ADHD there.</p>

<p>Additionally, several of the required symptoms for ADHD do not have any fixed requirement for frequency - they are relative.
When each of these symptoms are completely normal at the same time, the whole diagnose becomes relative - Are you too unfocused to function at school, or do you manage to get your homework done despite of poor attention?
Because nobody will diagnose you with ADHD as long as you are able to cope and function with school and everyday life.
A bit of the problem with the ADHD diagnosis is how there are no exact measurements that can tell whether or not an individual is "suffering".</p>

<p>Having a hard time in everyday life is also one of the requirements to have a diagnosis, but this is more relative than all the other symptoms.
Considering how modern societies are increasingly demanding for the individual, and Conscientiousness is -the- strongest predictor for academic success, there is bound to be a growing gap between the most and least successful individuals.
The least successful individuals are those who struggle to stay focused, and some of these seek psychological help for it. "You struggle at school because you have trouble staying focused? Here, take this test. Yes, I can see that you have poor attention. You have ADHD"</p>

<p><strong>To put it short: ADHD symptoms are all about academic capability</strong></p>

CC BY-SA 3.0
2016-11-07T03:26:48.113Z
Not all children with ADHD perform poorly in school.
aparente001
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2016-11-07T10:28:20.323Z
True, but a lot of people (including professionals) still believe so.
Berit Larsen
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2015-05-28T15:40:49.677Z
2015-05-28T15:40:49.677Z
Berit Larsen
<blockquote>
<p>I understand ADHD is a standard term, but I'm still a bit suspicious that it's not a useful one; Psychiatry doesn't seem like the most reliable field</p>
</blockquote>
<p>Okay, I know this is going to sound weird, but I think ADHD is another name for <em>hypofrontality-mediated unfulfilled potential</em></p>
<p><strong>ADHD as &quot;unfulfilled potential&quot;</strong></p>
<p>Although it is characterised by a dysregulation of executive function, if you look at the diagnostic criteria for ADHD, it's all about a functional impairment. Diagnosis is based on the presence of symptoms, but regardless of the combination of symptoms with which someone presents, it's the following criterion in the DSM-V that's necessary:</p>
<blockquote>
<p>There is clear evidence that the symptoms interfere with, or <strong>reduce the quality</strong> of, so­cial, academic, or occupational functioning.</p>
</blockquote>
<p>In other words, one can be performing extremely well academically, have a high IQ, and still have ADHD. This is not to say that individuals with ADHD aren't typically poor-performing, but there's nothing precluding someone from being a high performer and still fulfilling the diagnostic criteria for ADHD:</p>
<blockquote>
<p><strong>Is attention deficit hyperactivity disorder a valid diagnosis in the presence of high IQ? Results from the MGH Longitudinal Family Studies of ADHD (<a href="https://doi.org/10.1111/j.1469-7610.2007.01735.x" rel="nofollow noreferrer">Antshel et al., 2007</a>)</strong>.</p>
<p>Background:  The aim of this study was to assess the validity of diagnosing attention deficit/hyperactivity disorder (ADHD) in high IQ children and to further characterize the clinical features associated with their ADHD.</p>
<p>Methods:  We operationalized giftedness/high IQ as having a full scale IQ ≥120. We identified 92 children with a high IQ who did not have ADHD and 49 children with a high IQ that met diagnostic criteria for ADHD who had participated in the Massachusetts General Hospital Longitudinal Family Studies of ADHD.</p>
<p>Results:  Of our participants with ADHD and a high IQ, the majority (n = 35) met criteria for the Combined subtype. Relative to control participants, children with ADHD and high IQ had a higher prevalence rate of familial ADHD in first‐degree relatives, repeated grades more often, had a poorer performance on the WISC‐III Block Design, had more comorbid psychopathology, and had more functional impairments across a number of domains.</p>
<p><strong>Conclusions:  Children with a high IQ and ADHD showed a pattern of familiality as well as cognitive, psychiatric and behavioral features consistent with the diagnosis of ADHD in children with average IQ. These data suggest that the diagnosis of ADHD is valid among high IQ children.</strong></p>
</blockquote>
<p>I note that you won't find any literature on unfulfilled potential. Instead, if you parse the above diagnostic criterion carefully, you'll see it: what precisely does the DSM-5 criterion of &quot;reduced quality of academic functioning&quot; mean but some inability to fulfill one's potential with regards to schooling?</p>
<p><strong>ADHD as hypofrontality</strong></p>
<p>Regarding hypofrontality, this has to do with the view of biological psychiatry that ADHD is mediated by dopaminergic hypofrontality. There is an attempt to map the symptoms to a particular neural substrate.</p>
<p><a href="https://www.taylorfrancis.com/books/9781420048414" rel="nofollow noreferrer">Fisher &amp; Beckley (1998)</a> is a little old, but characterises the general view:</p>
<blockquote>
<p>That is not the end of the whole story. If the brain messengers
dopamine and norepinephrine have an impact on the frontal area of the
brain, and the hypofrontality creates the higher-level-thinking
disorder of ADD or ADHD, then wouldn't it also affect the other
thinking areas of the brain that use these same neurotransmitters?
<strong>Hypofrontality defines the lack of dopamine and norepinephrine
primarily in the frontal area of the brain.</strong> However, the effect can
also be seen in the parietal area of the brain. This defines the basis
for the anatomical differences between the two subtypes of ADD: ADHD
and ADD without hyperactivity (ADD). <strong>It has been found through both
clinical research and studies of medication that ADD without
hyperactivity is more closely related to the parietal area of the
brain and the neurotransmitter nore­pinephrine, while ADHD is found to
more related to the frontal area or processes and the neurotransmitter
dopamine.</strong></p>
</blockquote>
<p>A more recent paper, which refers to the role of D1 dopamine receptors in hypofrontality. However, it focuses more on the role on noradrenaline via a2-adrenoceptors (both dopamine and noradrenaline are catecholamines):</p>
<blockquote>
<p><strong>Neurobiology of Executive Functions: Catecholamine Influences on Prefrontal Cortical Functions (<a href="https://doi.org/10.1016/j.biopsych.2004.08.019" rel="nofollow noreferrer">Arnsten &amp; Li, 2005</a>)</strong></p>
<p>The prefrontal cortex guides behaviors, thoughts, and feelings using representational knowledge, i.e., working memory. These fundamental cognitive abilities subserve the so-called executive functions: the ability to inhibit inappropriate behaviors and thoughts, regulate our attention, monitor our actions, and plan and organize for the future. Neuropsychological and imaging studies indicate that these prefrontal cortex functions are weaker in patients with attention-deficit/hyperactivity disorder and contribute substantially to attention-deficit/hyperactivity disorder symptomology. Research in animals indicates that the prefrontal cortex is very sensitive to its neurochemical environment and that small changes in catecholamine modulation of prefrontal cortex cells can have profound effects on the ability of the prefrontal cortex to guide behavior. <strong>Optimal levels of norepinephrine acting at postsynaptic α-2A-adrenoceptors and dopamine acting at D1 receptors are essential to prefrontal cortex function.</strong> Blockade of norepinephrine α-2-adrenoceptors in prefrontal cortex markedly impairs prefrontal cortex function and mimics most of the symptoms of attention-deficit/hyperactivity disorder, including impulsivity and locomotor hyperactivity. Conversely, stimulation of α-2-adrenoceptors in prefrontal cortex strengthens prefrontal cortex regulation of behavior and reduces distractibility. Most effective treatments for attention-deficit/hyperactivity disorder facilitate catecholamine transmission and likely have their therapeutic actions by optimizing catecholamine actions in prefrontal cortex.</p>
</blockquote>
<p>My simplistic understanding is that when there is hypofrontality, psychostimulants will improve the signal:noise ratio in the prefrontal cortex, thereby addressing the dysregulation in executive function seen in ADHD.</p>
<p><strong>Cynical answer the question</strong></p>
<p>ADHD is the label given to someone who is impulsive, unmotivated and bad at school and whose symptoms improve when they're given psychostimulants. This isn't a statement about whether or not ADHD does or doesn't exist, it's a statement about how its currently diagnosed and treated, hence my use of the term <em>hypofrontality-mediated unfulfilled potential</em>.</p>
<p><strong>References</strong></p>
<p>Antshel, K. M., Faraone, S. V., Stallone, K., Nave, A., Kaufmann, F. A., Doyle, A., ... &amp; Biederman, J. (2007). Is attention deficit hyperactivity disorder a valid diagnosis in the presence of high IQ? Results from the MGH Longitudinal Family Studies of ADHD. <em>Journal of Child Psychology and Psychiatry</em>, 48(7), 687-694.<br>DOI: <a href="https://doi.org/10.1111/j.1469-7610.2007.01735.x" rel="nofollow noreferrer">10.1111/j.1469-7610.2007.01735.x</a></p>
<p>Arnsten, A. F., &amp; Li, B. M. (2005). Neurobiology of executive functions: catecholamine influences on prefrontal cortical functions. <em>Biological psychiatry</em>, 57(11), 1377-1384.<br>DOI: <a href="https://doi.org/10.1016/j.biopsych.2004.08.019" rel="nofollow noreferrer">10.1016/j.biopsych.2004.08.019</a></p>
<p>Fisher, B. C., &amp; Beckley, R. A. (1998). <em>Attention deficit disorder: Practical coping methods</em>. Boca Raton, FL: CRC Press.</p>

CC BY-SA 4.0
2018-06-12T08:12:47.350Z
Do you have any references to back your claims?
Chris Rogers
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2018-06-12T08:15:42.810Z
yes, give me a moment. is there anything in particular you want references for?
faustus
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2018-06-12T08:34:29.287Z
For a start, how about a scientific paper or two on *dopaminergic hypofrontality*, and the definition and criteria for *hypofrontality-mediated unfulfilled potential*
Chris Rogers
CC BY-SA 4.0
2018-06-12T08:48:30.493Z
I have found https://doi.org/10.1176/ajp.156.6.891 which talks about Hypofrontality in ADHD but not being in the pure neuroscience field, I wonder what would make the hypofrontality dopaminergic?  Are there any papers on that too?
Chris Rogers
CC BY-SA 4.0
2018-06-12T08:50:40.587Z
@ChrisRogers this is the thing: it's dopaminergic because the drugs used to treat ADHD e.g. amphetamine, methylphenidate act on dopamine. there's a circularity in this, and that's the whole problem with ADHD. but yes, i'll find you some references to support my claim.
faustus
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2018-06-04T11:50:41.353Z
2018-06-12T10:08:23.450Z
2020-06-17T09:55:31.633Z
faustus
<p>I understand <a href="http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder" rel="noreferrer">ADHD</a> is a standard term, but I'm still a bit suspicious that it's not a useful one; Psychiatry doesn't seem like the most reliable field.</p>

<p>Are there good reasons for picking out the behaviors associated with ADHD and giving them a name?</p>

<p>Potential answers</p>

<ul>
<li>Behaviors associated with ADHD strongly cluster</li>
<li>Analyzing
questionnaires of attention and focus behaviors with factor analysis
naturally produces an 'ADHD dimension' that explains a lot of
variance (similar methodology to identifying <a href="http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder" rel="noreferrer">Big 5 personality
traits</a>).</li>
<li>ADHD diagnosis is a strong independent predictor of something
interesting: income or grades or some contrived but interesting lab
test (controlling for obvious things like IQ) </li>
<li>Something else along these lines.</li>
</ul>

CC BY-SA 3.0
2016-11-07T03:29:00.677Z
As a parent of a child with ADHD, I would say that in principle, informing the school of the diagnosis should cause certain ways of supporting the student to kick in.  For us, that has not been the case, but my impression is that our school district is especially obtuse.  As my son's therapists says, "Accommodating for ADHD is not rocket science."
aparente001
CC BY-SA 4.0
2018-06-04T09:11:49.027Z
ADD is the term commonly used to describe symptoms of inattention, distractibility, and poor working memory. ADHD is the term used to describe additional symptoms of hyperactivity and impulsivity. Both are included in the medical diagnosis of ADHD. 1980-1989, Attention Deficit Disorder (ADD) 1997, Attention Deficit and Hyperactivity Disorder ADHD
Dr. Elisha Rose Bayer Neal
CC BY-SA 4.0
2022-04-29T06:28:47.537Z
Questions about the robustness of clustering do indeed arise from differential diagnoses to ADHD, including [ADD](https://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder), [SCT/CDD](https://en.wikipedia.org/wiki/Sluggish_cognitive_tempo), and [MD/ED](https://en.wikipedia.org/wiki/Maladaptive_daydreaming).
Arnon Weinberg
CC BY-SA 3.0
2012-11-16T04:50:11.063Z
It's certainly fine to be dubious of such things, and I don't necessarily disagree with you, but it would make your question stronger if you had some sources to back up your initial claims.
Chuck Sherrington
CC BY-SA 3.0
2012-11-16T16:14:28.623Z
Except for my claim that ADHD is a standard term, everything else is based on vague impressions, so I think lack of sources gives my question the right amount of credibility.
John Salvatier
<adhd>
How well defined is ADD/ADHD?
John Salvatier
# How well defined is ADD/ADHD?

(Asked by: username_0 on 2012-11-15)

I understand [ADHD](http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder) is a standard term, but I'm still a bit suspicious that it's not a useful one; Psychiatry doesn't seem like the most reliable field.

Are there good reasons for picking out the behaviors associated with ADHD and giving them a name?

Potential answers

* Behaviors associated with ADHD strongly cluster
* Analyzing
  questionnaires of attention and focus behaviors with factor analysis
  naturally produces an 'ADHD dimension' that explains a lot of
  variance (similar methodology to identifying [Big 5 personality
  traits](http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder)).
* ADHD diagnosis is a strong independent predictor of something
  interesting: income or grades or some contrived but interesting lab
  test (controlling for obvious things like IQ)
* Something else along these lines.

**Tags:** adhd

> **Comments:**
> **username_4**: It's certainly fine to be dubious of such things, and I don't necessarily disagree with you, but it would make your question stronger if you had some sources to back up your initial claims.  
> **username_0**: Except for my claim that ADHD is a standard term, everything else is based on vague impressions, so I think lack of sources gives my question the right amount of credibility.  
> **username_1**: As a parent of a child with ADHD, I would say that in principle, informing the school of the diagnosis should cause certain ways of supporting the student to kick in.  For us, that has not been the case, but my impression is that our school district is especially obtuse.  As my son's therapists says, "Accommodating for ADHD is not rocket science."  
> **username_2**: ADD is the term commonly used to describe symptoms of inattention, distractibility, and poor working memory. ADHD is the term used to describe additional symptoms of hyperactivity and impulsivity. Both are included in the medical diagnosis of ADHD. 1980-1989, Attention Deficit Disorder (ADD) 1997, Attention Deficit and Hyperactivity Disorder ADHD  
> **username_3**: Questions about the robustness of clustering do indeed arise from differential diagnoses to ADHD, including [ADD](https://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder), [SCT/CDD](https://en.wikipedia.org/wiki/Sluggish_cognitive_tempo), and [MD/ED](https://en.wikipedia.org/wiki/Maladaptive_daydreaming).  

---

## 3 answers

### Answer by username_5 on 2012-11-16. Score: 7

Like all psychiatric disorers, ADD and ADHD are diagnosed using a set of criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, or DSM
The latest version is the DSM-IV-TR. The DSM-V is due out in 2013 and may change these criteria.
Diagnosis is expected to be done by a licensed professional who is able to assess these criteria.
From http://www.mental-health-today.com/add/dsm.htm :
INATTENTION
(need 6 of 9)

- often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
- often has difficulty sustaining attention in tasks or play activities
- often does not seem to listen when spoken to directly
- often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (no if oppositional behavior or doesn’t understand instructions)
- often has difficulty organizing tasks and activities
- often avoids, dislikes, or is reluctant to engage in tasks or activities that require sustained mental effort (such as schoolwork or homework)
- often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
- often easily distracted by extraneous stimuli
- often forgetful in daily activities

HYPERACTIVITY-IMPULSIVITY  
(need 6 of 9)

- often fidgets with hands or feet or squirms in seat
- often leaves seat in classroom or in other situations in which remaining seated is expected
- often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
- often has difficulty playing or engaging in leisure activities quietly
- is often "on the go" or often acts as if "driven by a motor"
- often talks excessively
- often blurts out answers before questions have been completed
- often has difficulty awaiting turn
- often interrupts or intrudes on others (e.g., butts into conversations or games)

REQUIREMENTS

- Present at least 6 months, maladaptive and inconsistent with development level
- Some symptoms that caused impairment were present before age 7
- Some impairment from the symptoms is present in two or more settings (e.g., at school {or work} and at home)
- There must be clear evidence of clinically significant impairment in social, academic or occupational functioning

> **Comments:**
> **username_6**: None of this answers the original question: Do these traits tend to cluster strongly? Is there reason to believe that they share an underlying etiology? etc.  
> **username_5**: The original question is "How well defined is ADD/ADHD?" The bit about traits clustering together is listed as a *potential answer*. There's also nothing in there about etiology.  
> **username_6**: You're right, my mistake. I was thinking about the other question in the post, "Are there good reasons for picking out the behaviors associated with ADHD and giving them a name?"  
> **username_5**: you're right though, that this isn't the best answer. it doesn't address how criteria for the DSM are chosen. my understanding is that this processes is subjective and controversial, but maybe someone can provide a more detailed explanation.  

---

### Answer by username_7 on 2015-05-28. Score: 5

**Why the symptoms were picked out and given a name**

Professionals used to believe ADHD was something children grew out of, but not anymore.
ADHD has always been strongly related to school performance. If a child is not focused on school, and seems unwilling or unable to concentrate, everyone tends to think of ADHD as the cause.

This makes me think that ADHD was "discovered" as an explanation to why some kids are not so good at school.
If you look at the symptoms for ADHD, you'll notice that each of them is completely normal behavior, but every one of them reduces performance at school.

**Do the symptoms for ADHD cluster?**

Yes and no. They cluster in more than 1 cluster.
Studying personality psychology, I have noticed a growing number of completely normal personality traits that remind me alot of ADHD.

A stereotypical boy with ADHD (restless, fidgety, takative, forgetful, unorganized) would easily remind you of the MBTI personality type ESxP.
(ESFP: <http://www.16personalities.com/esfp-personality> ESTP: <http://www.16personalities.com/estp-personality> )

A stereotypical girl with ADHD (silent, daydreaming, inattentive) would remind you of the MBTI personality trait INxP. (INTP: <http://www.16personalities.com/intp-personality> INFP: <http://www.16personalities.com/infp-personality> )
Girl's ADHD: <http://www.addvance.com/help/women/daydreamer.html>

Also note how the "boy's ADHD" and "girl's ADHD" are pretty different. The only common traits are poor attention and organization at school.

The typical ADHD behavior also matches well with several parts of the Big 5:

> Substantial effects emerged that were replicated across samples.
> First, the ADHD symptom cluster of inattention-disorganization was
> substantially related to **low Conscientiousness** and, to a lesser
> extent, **Neuroticism**. Second, ADHD symptom clusters of
> hyperactivity-impulsivity and oppositional childhood and adult
> behaviors were associated with **low Agreeableness**.

<http://psych.colorado.edu/~willcutt/pdfs/nigg_2002.pdf>

> Although previous research on personality and ADHD has focused
> primarily on extraversion and neuroticism, the present study found
> that **agreeableness** and **conscientiousness** were stronger predictors.
> This pattern of results is consistent with the clinical literature on
> adults with ADHD.

<http://www.researchgate.net/profile/James_Parker3/publication/222409991_ADHD_symptoms_and_personality_relationships_with_the_five-factor_model/links/02e7e52cad95c0fcfc000000.pdf>

Conscientiousness is what measures your ability to stay focused (and more), and neuroticism measures your patience (and more). And those are exactly what primarily defines the J/P factor in MBTI - and ADHD.
You're a P? Congratulations, you may have ADHD. You're a J? Nope, no ADHD there.

Additionally, several of the required symptoms for ADHD do not have any fixed requirement for frequency - they are relative.
When each of these symptoms are completely normal at the same time, the whole diagnose becomes relative - Are you too unfocused to function at school, or do you manage to get your homework done despite of poor attention?
Because nobody will diagnose you with ADHD as long as you are able to cope and function with school and everyday life.
A bit of the problem with the ADHD diagnosis is how there are no exact measurements that can tell whether or not an individual is "suffering".

Having a hard time in everyday life is also one of the requirements to have a diagnosis, but this is more relative than all the other symptoms.
Considering how modern societies are increasingly demanding for the individual, and Conscientiousness is -the- strongest predictor for academic success, there is bound to be a growing gap between the most and least successful individuals.
The least successful individuals are those who struggle to stay focused, and some of these seek psychological help for it. "You struggle at school because you have trouble staying focused? Here, take this test. Yes, I can see that you have poor attention. You have ADHD"

**To put it short: ADHD symptoms are all about academic capability**

> **Comments:**
> **username_1**: Not all children with ADHD perform poorly in school.  
> **username_7**: True, but a lot of people (including professionals) still believe so.  

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### Answer by username_8 on 2018-06-04. Score: 2

> I understand ADHD is a standard term, but I'm still a bit suspicious that it's not a useful one; Psychiatry doesn't seem like the most reliable field

Okay, I know this is going to sound weird, but I think ADHD is another name for *hypofrontality-mediated unfulfilled potential*

**ADHD as "unfulfilled potential"**

Although it is characterised by a dysregulation of executive function, if you look at the diagnostic criteria for ADHD, it's all about a functional impairment. Diagnosis is based on the presence of symptoms, but regardless of the combination of symptoms with which someone presents, it's the following criterion in the DSM-V that's necessary:

> There is clear evidence that the symptoms interfere with, or **reduce the quality** of, so­cial, academic, or occupational functioning.

In other words, one can be performing extremely well academically, have a high IQ, and still have ADHD. This is not to say that individuals with ADHD aren't typically poor-performing, but there's nothing precluding someone from being a high performer and still fulfilling the diagnostic criteria for ADHD:

> **Is attention deficit hyperactivity disorder a valid diagnosis in the presence of high IQ? Results from the MGH Longitudinal Family Studies of ADHD ([Antshel et al., 2007](https://doi.org/10.1111/j.1469-7610.2007.01735.x))**.
>
> Background:  The aim of this study was to assess the validity of diagnosing attention deficit/hyperactivity disorder (ADHD) in high IQ children and to further characterize the clinical features associated with their ADHD.
>
> Methods:  We operationalized giftedness/high IQ as having a full scale IQ ≥120. We identified 92 children with a high IQ who did not have ADHD and 49 children with a high IQ that met diagnostic criteria for ADHD who had participated in the Massachusetts General Hospital Longitudinal Family Studies of ADHD.
>
> Results:  Of our participants with ADHD and a high IQ, the majority (n = 35) met criteria for the Combined subtype. Relative to control participants, children with ADHD and high IQ had a higher prevalence rate of familial ADHD in first‐degree relatives, repeated grades more often, had a poorer performance on the WISC‐III Block Design, had more comorbid psychopathology, and had more functional impairments across a number of domains.
>
> **Conclusions:  Children with a high IQ and ADHD showed a pattern of familiality as well as cognitive, psychiatric and behavioral features consistent with the diagnosis of ADHD in children with average IQ. These data suggest that the diagnosis of ADHD is valid among high IQ children.**

I note that you won't find any literature on unfulfilled potential. Instead, if you parse the above diagnostic criterion carefully, you'll see it: what precisely does the DSM-5 criterion of "reduced quality of academic functioning" mean but some inability to fulfill one's potential with regards to schooling?

**ADHD as hypofrontality**

Regarding hypofrontality, this has to do with the view of biological psychiatry that ADHD is mediated by dopaminergic hypofrontality. There is an attempt to map the symptoms to a particular neural substrate.

[Fisher & Beckley (1998)](https://www.taylorfrancis.com/books/9781420048414) is a little old, but characterises the general view:

> That is not the end of the whole story. If the brain messengers
> dopamine and norepinephrine have an impact on the frontal area of the
> brain, and the hypofrontality creates the higher-level-thinking
> disorder of ADD or ADHD, then wouldn't it also affect the other
> thinking areas of the brain that use these same neurotransmitters?
> **Hypofrontality defines the lack of dopamine and norepinephrine
> primarily in the frontal area of the brain.** However, the effect can
> also be seen in the parietal area of the brain. This defines the basis
> for the anatomical differences between the two subtypes of ADD: ADHD
> and ADD without hyperactivity (ADD). **It has been found through both
> clinical research and studies of medication that ADD without
> hyperactivity is more closely related to the parietal area of the
> brain and the neurotransmitter nore­pinephrine, while ADHD is found to
> more related to the frontal area or processes and the neurotransmitter
> dopamine.**

A more recent paper, which refers to the role of D1 dopamine receptors in hypofrontality. However, it focuses more on the role on noradrenaline via a2-adrenoceptors (both dopamine and noradrenaline are catecholamines):

> **Neurobiology of Executive Functions: Catecholamine Influences on Prefrontal Cortical Functions ([Arnsten & Li, 2005](https://doi.org/10.1016/j.biopsych.2004.08.019))**
>
> The prefrontal cortex guides behaviors, thoughts, and feelings using representational knowledge, i.e., working memory. These fundamental cognitive abilities subserve the so-called executive functions: the ability to inhibit inappropriate behaviors and thoughts, regulate our attention, monitor our actions, and plan and organize for the future. Neuropsychological and imaging studies indicate that these prefrontal cortex functions are weaker in patients with attention-deficit/hyperactivity disorder and contribute substantially to attention-deficit/hyperactivity disorder symptomology. Research in animals indicates that the prefrontal cortex is very sensitive to its neurochemical environment and that small changes in catecholamine modulation of prefrontal cortex cells can have profound effects on the ability of the prefrontal cortex to guide behavior. **Optimal levels of norepinephrine acting at postsynaptic α-2A-adrenoceptors and dopamine acting at D1 receptors are essential to prefrontal cortex function.** Blockade of norepinephrine α-2-adrenoceptors in prefrontal cortex markedly impairs prefrontal cortex function and mimics most of the symptoms of attention-deficit/hyperactivity disorder, including impulsivity and locomotor hyperactivity. Conversely, stimulation of α-2-adrenoceptors in prefrontal cortex strengthens prefrontal cortex regulation of behavior and reduces distractibility. Most effective treatments for attention-deficit/hyperactivity disorder facilitate catecholamine transmission and likely have their therapeutic actions by optimizing catecholamine actions in prefrontal cortex.

My simplistic understanding is that when there is hypofrontality, psychostimulants will improve the signal:noise ratio in the prefrontal cortex, thereby addressing the dysregulation in executive function seen in ADHD.

**Cynical answer the question**

ADHD is the label given to someone who is impulsive, unmotivated and bad at school and whose symptoms improve when they're given psychostimulants. This isn't a statement about whether or not ADHD does or doesn't exist, it's a statement about how its currently diagnosed and treated, hence my use of the term *hypofrontality-mediated unfulfilled potential*.

**References**

Antshel, K. M., Faraone, S. V., Stallone, K., Nave, A., Kaufmann, F. A., Doyle, A., ... & Biederman, J. (2007). Is attention deficit hyperactivity disorder a valid diagnosis in the presence of high IQ? Results from the MGH Longitudinal Family Studies of ADHD. *Journal of Child Psychology and Psychiatry*, 48(7), 687-694.  
DOI: [10.1111/j.1469-7610.2007.01735.x](https://doi.org/10.1111/j.1469-7610.2007.01735.x)

Arnsten, A. F., & Li, B. M. (2005). Neurobiology of executive functions: catecholamine influences on prefrontal cortical functions. *Biological psychiatry*, 57(11), 1377-1384.  
DOI: [10.1016/j.biopsych.2004.08.019](https://doi.org/10.1016/j.biopsych.2004.08.019)

Fisher, B. C., & Beckley, R. A. (1998). *Attention deficit disorder: Practical coping methods*. Boca Raton, FL: CRC Press.

> **Comments:**
> **username_9**: Do you have any references to back your claims?  
> **username_8**: yes, give me a moment. is there anything in particular you want references for?  
> **username_9**: For a start, how about a scientific paper or two on *dopaminergic hypofrontality*, and the definition and criteria for *hypofrontality-mediated unfulfilled potential*  
> **username_9**: I have found https://doi.org/10.1176/ajp.156.6.891 which talks about Hypofrontality in ADHD but not being in the pure neuroscience field, I wonder what would make the hypofrontality dopaminergic?  Are there any papers on that too?  
> **username_8**: @ChrisRogers this is the thing: it's dopaminergic because the drugs used to treat ADHD e.g. amphetamine, methylphenidate act on dopamine. there's a circularity in this, and that's the whole problem with ADHD. but yes, i'll find you some references to support my claim.  

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