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

[Anonymous]

Op I’m confused. you say she has no ADHD symptoms and list symptoms commonly associated with autism but you think are ADHD?

[Anonymous]

Anonymous wrote:

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.

Actually I think they are trying to identify how these conditions show up biologically. The study referenced is based on brain scans.

The idea isn't to diagnose everyone with any emotional regulation issues with ADHD. It's to recognize that challenges with emotional regulation can be part of the ADHD in a subset of kids.

This brain-first approach provides biological validation of identified subtypes through completely data-driven clustering. Although DSM classifications exclusively rely on consensus-derived symptoms, our neuroimaging-derived clusters converged with clinical phenotypes without using any clinical features. This convergence provides compelling evidence that these presentations reflect genuine neurobiological entities, biologically validating these long-observed clinical distinctions.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Actually I think they are trying to identify how these conditions show up biologically. The study referenced is based on brain scans.

The idea isn't to diagnose everyone with any emotional regulation issues with ADHD. It's to recognize that challenges with emotional regulation can be part of the ADHD in a subset of kids.

This brain-first approach provides biological validation of identified subtypes through completely data-driven clustering. Although DSM classifications exclusively rely on consensus-derived symptoms, our neuroimaging-derived clusters converged with clinical phenotypes without using any clinical features. This convergence provides compelling evidence that these presentations reflect genuine neurobiological entities, biologically validating these long-observed clinical distinctions.

But there’s no reason to believe the MRI findings are a “newly identified subset of ADHD.” It could have been people wrongly diagnosed with ADHD or the differences could be due to something else. This is important because just throwing Ritalin at everyone isn’t likely the answer.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Actually I think they are trying to identify how these conditions show up biologically. The study referenced is based on brain scans.

The idea isn't to diagnose everyone with any emotional regulation issues with ADHD. It's to recognize that challenges with emotional regulation can be part of the ADHD in a subset of kids.

This brain-first approach provides biological validation of identified subtypes through completely data-driven clustering. Although DSM classifications exclusively rely on consensus-derived symptoms, our neuroimaging-derived clusters converged with clinical phenotypes without using any clinical features. This convergence provides compelling evidence that these presentations reflect genuine neurobiological entities, biologically validating these long-observed clinical distinctions.

But there’s no reason to believe the MRI findings are a “newly identified subset of ADHD.” It could have been people wrongly diagnosed with ADHD or the differences could be due to something else. This is important because just throwing Ritalin at everyone isn’t likely the answer.

it sounds like you feel really strongly that emotional regulation shouldn't be considered part of ADHD. It also appears that many experts who have been studying ADHD for decades have seen sufficient scientific evidence that it can be a core feature of ADHD in a subset of kids. In this particular study they were looking at kids diagnosed based on the current criteria. The kids in the "new" category weren't kids that just had emotional dysregulation - they also had the highest scores in inattention and hyperactivity.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Actually I think they are trying to identify how these conditions show up biologically. The study referenced is based on brain scans.

The idea isn't to diagnose everyone with any emotional regulation issues with ADHD. It's to recognize that challenges with emotional regulation can be part of the ADHD in a subset of kids.

This brain-first approach provides biological validation of identified subtypes through completely data-driven clustering. Although DSM classifications exclusively rely on consensus-derived symptoms, our neuroimaging-derived clusters converged with clinical phenotypes without using any clinical features. This convergence provides compelling evidence that these presentations reflect genuine neurobiological entities, biologically validating these long-observed clinical distinctions.

But there’s no reason to believe the MRI findings are a “newly identified subset of ADHD.” It could have been people wrongly diagnosed with ADHD or the differences could be due to something else. This is important because just throwing Ritalin at everyone isn’t likely the answer.

it sounds like you feel really strongly that emotional regulation shouldn't be considered part of ADHD. It also appears that many experts who have been studying ADHD for decades have seen sufficient scientific evidence that it can be a core feature of ADHD in a subset of kids. In this particular study they were looking at kids diagnosed based on the current criteria. The kids in the "new" category weren't kids that just had emotional dysregulation - they also had the highest scores in inattention and hyperactivity.

Correct; I do not think the incredibly broad category of “emotional regulation” should be added to the already broad category of “ADHD.”

[Anonymous]

Anonymous wrote:Op I’m confused. you say she has no ADHD symptoms and list symptoms commonly associated with autism but you think are ADHD?

Where did you get that from? She has plenty of ADHD symptoms, just not 6 of them in a single category.

And I would be absolutely shocked if she is autistic-- she's very sensitive to non-verbal cues, has lots of friends, doesn't really stim or have intense special interests, really no tell-tale signs except being on the sensory-sensitive side of things but it's not extreme and that's certainly not something exclusive to autism.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Op I’m confused. you say she has no ADHD symptoms and list symptoms commonly associated with autism but you think are ADHD?

Where did you get that from? She has plenty of ADHD symptoms, just not 6 of them in a single category.

And I would be absolutely shocked if she is autistic-- she's very sensitive to non-verbal cues, has lots of friends, doesn't really stim or have intense special interests, really no tell-tale signs except being on the sensory-sensitive side of things but it's not extreme and that's certainly not something exclusive to autism.

Everything you listed that you “read about” being associated with ADHD but isn’t actually part of the DSM criteria dor ADHD is actually part of the DSM criteria for autism. Sensory sensitivity, rigidity (her insistence on justice, low frustration tolerance), literalness in communication style(mad when she doesn’t get a joke).

This is just to say stop trying to diagnose your kid based on blogs or what you read on Reddit or whatever. take her to an actual doctor.

I also wonder why you seem offended by the observation that she fits autism criteria better.

[Anonymous]

My son is like this. The teacher rated him with 6 hypersctive. At home I find more impulsivity than hyperactivity, but still not 6 of either. He has the low frustration tolerance as well. We went to the pediatrician and no diagnosis was made. He said to see how it goes next year with a different teacher.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Op I’m confused. you say she has no ADHD symptoms and list symptoms commonly associated with autism but you think are ADHD?

Where did you get that from? She has plenty of ADHD symptoms, just not 6 of them in a single category.

And I would be absolutely shocked if she is autistic-- she's very sensitive to non-verbal cues, has lots of friends, doesn't really stim or have intense special interests, really no tell-tale signs except being on the sensory-sensitive side of things but it's not extreme and that's certainly not something exclusive to autism.

Everything you listed that you “read about” being associated with ADHD but isn’t actually part of the DSM criteria dor ADHD is actually part of the DSM criteria for autism. Sensory sensitivity, rigidity (her insistence on justice, low frustration tolerance), literalness in communication style(mad when she doesn’t get a joke).

This is just to say stop trying to diagnose your kid based on blogs or what you read on Reddit or whatever. take her to an actual doctor.

I also wonder why you seem offended by the observation that she fits autism criteria better.

I'm not offended at the idea of her being autistic, I just don't think it fits her very well-- her only characteristics that might point in that direction are things that are also common in ADHD, as well as not uncommon in the general population even if she doesn't have ADHD. She's socially skilled and perceptive, and doesn't have a literal communication style at all (you may have misread-- she doesn't struggle with understanding jokes, it's that she's disappointed and frustrated when we don't think her jokes are as hysterically funny as she hoped we would, which she picks up on based on the subtleties of our tone of voice and facial expressions even if we laugh and say the right things and do find it kinda funny)... I don't think she comes anywhere close to meeting even one of the social/communication criteria for autism, let alone all three.

But yes, I'd very much like to have an expert involved in assessing her rather than drawing these conclusions on my own. I just need help figuring out where we could go that's actually the right fit for this particular situation.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Op I’m confused. you say she has no ADHD symptoms and list symptoms commonly associated with autism but you think are ADHD?

Where did you get that from? She has plenty of ADHD symptoms, just not 6 of them in a single category.

And I would be absolutely shocked if she is autistic-- she's very sensitive to non-verbal cues, has lots of friends, doesn't really stim or have intense special interests, really no tell-tale signs except being on the sensory-sensitive side of things but it's not extreme and that's certainly not something exclusive to autism.

Everything you listed that you “read about” being associated with ADHD but isn’t actually part of the DSM criteria dor ADHD is actually part of the DSM criteria for autism. Sensory sensitivity, rigidity (her insistence on justice, low frustration tolerance), literalness in communication style(mad when she doesn’t get a joke).

This is just to say stop trying to diagnose your kid based on blogs or what you read on Reddit or whatever. take her to an actual doctor.

I also wonder why you seem offended by the observation that she fits autism criteria better.

I'm not offended at the idea of her being autistic, I just don't think it fits her very well-- her only characteristics that might point in that direction are things that are also common in ADHD, as well as not uncommon in the general population even if she doesn't have ADHD. She's socially skilled and perceptive, and doesn't have a literal communication style at all (you may have misread-- she doesn't struggle with understanding jokes, it's that she's disappointed and frustrated when we don't think her jokes are as hysterically funny as she hoped we would, which she picks up on based on the subtleties of our tone of voice and facial expressions even if we laugh and say the right things and do find it kinda funny)... I don't think she comes anywhere close to meeting even one of the social/communication criteria for autism, let alone all three.

But yes, I'd very much like to have an expert involved in assessing her rather than drawing these conclusions on my own. I just need help figuring out where we could go that's actually the right fit for this particular situation.

Again the things you list as ADHD are not actually in the DSM under autism. the things you list are more similar to autism. You listed several restrictive-repetitive behaviors and especially sensory issues which are almost paradigmatic for autism. I’m not saying she has autism - in fact it sounds like you are overly concerned - but to the extent you are listing a set of subclinical symptoms, it is more like autism than ADHD. (FWIW kids with autism can have friends and be perceptive about feelings especially when they are taught to observe them.)

Unless you are leaving a lot out it doesn’t seem like you kid really has big issues so suggest you just work on addressing the challenges she has. She can learn appropriate reactions to disappoint without a dx.

[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.

See, and this is why parents ask here, because it's no small feat to get a neuropsych given the time, cost, or wait for providers that take insurance, and you might not even end up with a diagnosis that gives you a path forward.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Op I’m confused. you say she has no ADHD symptoms and list symptoms commonly associated with autism but you think are ADHD?

Where did you get that from? She has plenty of ADHD symptoms, just not 6 of them in a single category.

And I would be absolutely shocked if she is autistic-- she's very sensitive to non-verbal cues, has lots of friends, doesn't really stim or have intense special interests, really no tell-tale signs except being on the sensory-sensitive side of things but it's not extreme and that's certainly not something exclusive to autism.

Everything you listed that you “read about” being associated with ADHD but isn’t actually part of the DSM criteria dor ADHD is actually part of the DSM criteria for autism. Sensory sensitivity, rigidity (her insistence on justice, low frustration tolerance), literalness in communication style(mad when she doesn’t get a joke).

This is just to say stop trying to diagnose your kid based on blogs or what you read on Reddit or whatever. take her to an actual doctor.

I also wonder why you seem offended by the observation that she fits autism criteria better.

I'm not offended at the idea of her being autistic, I just don't think it fits her very well-- her only characteristics that might point in that direction are things that are also common in ADHD, as well as not uncommon in the general population even if she doesn't have ADHD. She's socially skilled and perceptive, and doesn't have a literal communication style at all (you may have misread-- she doesn't struggle with understanding jokes, it's that she's disappointed and frustrated when we don't think her jokes are as hysterically funny as she hoped we would, which she picks up on based on the subtleties of our tone of voice and facial expressions even if we laugh and say the right things and do find it kinda funny)... I don't think she comes anywhere close to meeting even one of the social/communication criteria for autism, let alone all three.

But yes, I'd very much like to have an expert involved in assessing her rather than drawing these conclusions on my own. I just need help figuring out where we could go that's actually the right fit for this particular situation.

Again the things you list as ADHD are not actually in the DSM under autism. the things you list are more similar to autism. You listed several restrictive-repetitive behaviors and especially sensory issues which are almost paradigmatic for autism. I’m not saying she has autism - in fact it sounds like you are overly concerned - but to the extent you are listing a set of subclinical symptoms, it is more like autism than ADHD. (FWIW kids with autism can have friends and be perceptive about feelings especially when they are taught to observe them.)

Unless you are leaving a lot out it doesn’t seem like you kid really has big issues so suggest you just work on addressing the challenges she has. She can learn appropriate reactions to disappoint without a dx.

Thanks for your input but I don't think further conversation between the two of us on this is helpful, PP. I do not think you are paying close enough attention to what I am writing, or maybe it is that I am not communicating it clearly enough, but regardless, you appear to have an impression of what my daughter is like that is inaccurate (along with perhaps being unaware of the research on the frequency of sensory and emotional regulation issues among people with ADHD) and I don't think it makes sense for us to continue going in circles. I appreciate the time you spent on this, though!