Might this be ADHD? How do we explore a diagnosis if so?

[Anonymous]

Anonymous wrote:"I have it myself" --

ADHD is the most heritable neurodevelopment disorder. Twin studies suggest 74-88% heritability.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7046577/

So, yes, your daughter probably has ADHD.

ADHD is less commonly diagnosed in girls because, culturally, girls are taught to be rule-followers, so there is less "running around" or physical acting out.

In our family, the "movement" is inside the brain -- constantly thinking about stuff, and talking (interrupting is a problem for all of us - I thought this was normal until I reached the "outside world").

Also, for many people with ADHD, particularly those that are strong, fluent readers, reading can serve as a form of hyper focus and immersion that is really pleasurable, IME, because it stimulates the brain.

The difficulty of doing things that are unpleasant or boring is a key marker of ADHD. ADHD is not a problem of NOT being able to concentrate, it is a problem of NOT being able to direct your concentration in appropriate ways. The "task positive network" in the ADHD brain has more competition from the "Default Mode Network" in the brain and thus we are more easily disrupted from or avoid boring, routine tasks.

+1 on this

[Anonymous]

Anonymous wrote:This sounds like my son, diagnosed with ADHD, but I question whether there is more, especially with the mood disregulation and frustration intolerances.

This is a huge part of ADHD. Many people think it’s little bits running around and not being able to sit still, but the emotional stuff is the biggest part, you just might not be able to see it all the time as it’s often kept internal.

[Anonymous]

Anonymous wrote:"I have it myself" --

ADHD is the most heritable neurodevelopment disorder. Twin studies suggest 74-88% heritability.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7046577/

So, yes, your daughter probably has ADHD.

ADHD is less commonly diagnosed in girls because, culturally, girls are taught to be rule-followers, so there is less "running around" or physical acting out.

In our family, the "movement" is inside the brain -- constantly thinking about stuff, and talking (interrupting is a problem for all of us - I thought this was normal until I reached the "outside world").

Also, for many people with ADHD, particularly those that are strong, fluent readers, reading can serve as a form of hyper focus and immersion that is really pleasurable, IME, because it stimulates the brain.

The difficulty of doing things that are unpleasant or boring is a key marker of ADHD. ADHD is not a problem of NOT being able to concentrate, it is a problem of NOT being able to direct your concentration in appropriate ways. The "task positive network" in the ADHD brain has more competition from the "Default Mode Network" in the brain and thus we are more easily disrupted from or avoid boring, routine tasks.

Yeah, this all really resonates with me and I think probably with my daughter as well... thanks so much.

Did you have any issues with your kid(s) getting diagnosed? Or were there enough criteria already met?

[Anonymous]

This is similar to my DD. We are on the waitlist at children’s for an evaluation just to get an idea of how we can help more. She is great in school, very common for girls.

[Anonymous]

Anonymous wrote:It's dx mainly through parent and teacher questionnaires. Her teacher says it's not bad enough to warrant pursuing a dx, and you're not sure either. I would wait. You can read books like Smart but Scattered and try to implement some of the strategies. I wouldn't pay 4 k and pull her out of school for 2 days for a neuropsych given what you've shared. When we filled out the parent questionnaire, we were like wheres the column for all the d@mn time and his teacher had been complaining about him.

Stimulants are the main medication for ADHD, and they can help a lot but also have non-trival side effects like appetite suppression and trouble sleeping. There are other medications like Strattera and guanfacine.

I disagree. Do not wait. Outcomes are so much better with early diagnosis. A diagnosis doesn't mean you have to put your kids on meds, although meds were extremely helpful for my kid. I'm not sure who concluded she doesn't meet DSM criteria? Disregard the teacher. They have a whole class and if a kid is not disruptive and hence a problem for them, they tend to dismiss the needs. Go get this kid a neuropsychological evaluation.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It's dx mainly through parent and teacher questionnaires. Her teacher says it's not bad enough to warrant pursuing a dx, and you're not sure either. I would wait. You can read books like Smart but Scattered and try to implement some of the strategies. I wouldn't pay 4 k and pull her out of school for 2 days for a neuropsych given what you've shared. When we filled out the parent questionnaire, we were like wheres the column for all the d@mn time and his teacher had been complaining about him.

Stimulants are the main medication for ADHD, and they can help a lot but also have non-trival side effects like appetite suppression and trouble sleeping. There are other medications like Strattera and guanfacine.

I disagree. Do not wait. Outcomes are so much better with early diagnosis. A diagnosis doesn't mean you have to put your kids on meds, although meds were extremely helpful for my kid. I'm not sure who concluded she doesn't meet DSM criteria? Disregard the teacher. They have a whole class and if a kid is not disruptive and hence a problem for them, they tend to dismiss the needs. Go get this kid a neuropsychological evaluation.

Sorry, my point was it will be difficult to get a dx even if you get a neuropsych because the dx is based on impairment in more than one setting (hence teacher and parent questionnaires) and the teacher doesn't seem to think your kid has a problem. We've gone through 3 rounds of neuropsychs over the years, and each time the dx of ADHD was based on parent and teacher Vanderbilt questionnaires, which focus on the DSM criteria for ADHD that don't include emotional dysregulati on as a core symptom. It was absolutely the worst part of DS's ADHD and I think the dx criteria should include it.

That is different from thinking it will be money well spent to pursue a dx when she doesn't technically meet the criteria. You could try to get an appointment now for early next school year and see how she's doing then. Often ADHD becomes more apparent as school demands ramp up. And it would be hard to get in anywhere much before then anyhow.

[Anonymous]

Anonymous wrote:

Anonymous wrote:This sounds like my son, diagnosed with ADHD, but I question whether there is more, especially with the mood disregulation and frustration intolerances.

This is a huge part of ADHD. Many people think it’s little bits running around and not being able to sit still, but the emotional stuff is the biggest part, you just might not be able to see it all the time as it’s often kept internal.

It’s not in the ADHD diagnosis at all. Emotional dysregulation can be caused by many different things and probably fits the DMDD diagnosis the best. Or it can be a personality issue. Or a parenting issue. or a combination.

Instead of fixating on a diagnosis, much better to work with a parenting therapist.

[Anonymous]

My similar child was eventually diagnosed with generalized anxiety disorder. Once we began treating her with that in mind, everything got better. She now is in college and doing well with a couple of accommodations

[Anonymous]

This article in the Washington Post today speaks to OP's question
https://www.washingtonpost.com/health/2026/04/30/adhd-subtype-extreme-brain-scans/ (here is a link to the referenced JAMA study: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2845158 )

Many 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?

A study published in JAMA Psychiatry this year analyzing 1,154 brain scans of children and adolescents offers fresh evidence for reevaluating the medical establishment’s definition of the disorder.

The researchers grouped three forms of ADHD identified in the imaging into familiar — and one less familiar — categories: predominantly inattentive; predominantly hyperactive/impulsive; and a more severe, combined presentation marked by emotional dysregulation or difficulty managing and responding to emotions in a controlled, appropriate way.

The findings are part of a broader shift: Advances in brain imaging are pushing scientists beyond symptom-based labels toward biologically grounded classifications of neurological conditions — an approach already reshaping autism research, where a study published last year identified four distinct subtypes.

[Anonymous]

Anonymous wrote:This article in the Washington Post today speaks to OP's question
https://www.washingtonpost.com/health/2026/04/30/adhd-subtype-extreme-brain-scans/ (here is a link to the referenced JAMA study: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2845158 )

Many 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?

A study published in JAMA Psychiatry this year analyzing 1,154 brain scans of children and adolescents offers fresh evidence for reevaluating the medical establishment’s definition of the disorder.

The researchers grouped three forms of ADHD identified in the imaging into familiar — and one less familiar — categories: predominantly inattentive; predominantly hyperactive/impulsive; and a more severe, combined presentation marked by emotional dysregulation or difficulty managing and responding to emotions in a controlled, appropriate way.

The findings are part of a broader shift: Advances in brain imaging are pushing scientists beyond symptom-based labels toward biologically grounded classifications of neurological conditions — an approach already reshaping autism research, where a study published last year identified four distinct subtypes.

That doesn’t demonstrate that this is a form of ADHD or that emotional dysregulation is always ADHD.

[Anonymous]

Anonymous wrote:

Anonymous wrote:This article in the Washington Post today speaks to OP's question
https://www.washingtonpost.com/health/2026/04/30/adhd-subtype-extreme-brain-scans/ (here is a link to the referenced JAMA study: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2845158 )

Many 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?

A study published in JAMA Psychiatry this year analyzing 1,154 brain scans of children and adolescents offers fresh evidence for reevaluating the medical establishment’s definition of the disorder.

The researchers grouped three forms of ADHD identified in the imaging into familiar — and one less familiar — categories: predominantly inattentive; predominantly hyperactive/impulsive; and a more severe, combined presentation marked by emotional dysregulation or difficulty managing and responding to emotions in a controlled, appropriate way.

The findings are part of a broader shift: Advances in brain imaging are pushing scientists beyond symptom-based labels toward biologically grounded classifications of neurological conditions — an approach already reshaping autism research, where a study published last year identified four distinct subtypes.

That doesn’t demonstrate that this is a form of ADHD or that emotional dysregulation is always ADHD.

Many 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?

But what do they know that you don't lol

[Anonymous]

More from the WaPo article:

F. Xavier Castellanos, a neuroscientist at New York University who has spent decades studying ADHD brain networks, was part of the working group for the DSM-5, the latest diagnostic manual for psychiatric conditions that was first released in 2013 and updated in 2022. At the time, he said, there was pressure to be cautious; the science was not yet strong enough to support major changes to redefine ADHD.

Now, he said, that may be shifting, and for the next version, he said he would be surprised if an emotional dysregulation subtype was not included.

“This idea has been around for maybe 20 years, but it’s becoming more and more creditable. And the science is at a point that it looks like we are up to something real,” Castellanos said.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It sounds like there are effects both at school and at home so I would definitely explore. Start with your pediatrician.

I can't imagine a pediatrician will diagnose if it's not an obvious case meeting all the standard criteria, would they?

The pediatrician would likely refer to someone for a more comprehensive assessment, psychiatrist, psycho-ed or neuropsych.

And the specialist will almost certainly diagnose something, because cash paying customers always leave with diagnoses.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This article in the Washington Post today speaks to OP's question
https://www.washingtonpost.com/health/2026/04/30/adhd-subtype-extreme-brain-scans/ (here is a link to the referenced JAMA study: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2845158 )

Many 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?

A study published in JAMA Psychiatry this year analyzing 1,154 brain scans of children and adolescents offers fresh evidence for reevaluating the medical establishment’s definition of the disorder.

The researchers grouped three forms of ADHD identified in the imaging into familiar — and one less familiar — categories: predominantly inattentive; predominantly hyperactive/impulsive; and a more severe, combined presentation marked by emotional dysregulation or difficulty managing and responding to emotions in a controlled, appropriate way.

The findings are part of a broader shift: Advances in brain imaging are pushing scientists beyond symptom-based labels toward biologically grounded classifications of neurological conditions — an approach already reshaping autism research, where a study published last year identified four distinct subtypes.

That doesn’t demonstrate that this is a form of ADHD or that emotional dysregulation is always ADHD.

Many 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?

But what do they know that you don't lol

And many physicians and researchers also say ADHD is already too broad and overdiagnosed. Not sure what the purpose is of adding yet another broad catch-all.

Anyway the approach is the same regardless - you need a behavioral therapy like PCIT.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It's dx mainly through parent and teacher questionnaires. Her teacher says it's not bad enough to warrant pursuing a dx, and you're not sure either. I would wait. You can read books like Smart but Scattered and try to implement some of the strategies. I wouldn't pay 4 k and pull her out of school for 2 days for a neuropsych given what you've shared. When we filled out the parent questionnaire, we were like wheres the column for all the d@mn time and his teacher had been complaining about him.

Stimulants are the main medication for ADHD, and they can help a lot but also have non-trival side effects like appetite suppression and trouble sleeping. There are other medications like Strattera and guanfacine.

I disagree. Do not wait. Outcomes are so much better with early diagnosis. A diagnosis doesn't mean you have to put your kids on meds, although meds were extremely helpful for my kid. I'm not sure who concluded she doesn't meet DSM criteria? Disregard the teacher. They have a whole class and if a kid is not disruptive and hence a problem for them, they tend to dismiss the needs. Go get this kid a neuropsychological evaluation.

I did (OP here.) I have read the criteria and taken the Vanderbilt and there is just no way I can check "often" to "Leaves seat when remaining seated is expected" or
"Runs about or climbs too much when remaining seated is expected" or
"Has difficulty playing or beginning quiet play activities" or "Is “on the go” or often acts as if “driven by a motor”." (Talks too much is a bit of a stretch too, but it's possible I'm defining it too narrowly. But she is just not that physically hyperactive outside of being very fidgety, and she is too much of a rule-follower to be getting up and running and climbing when she's supposed to be sitting unless it really were a totally uncontrollable impulse. And she enjoys and engages in quiet play and reading activities on a regular basis.)