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

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=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 )
[quote]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.[/quote][/quote]

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

[quote][b]Many physicians and researchers have argued for years that emotional dysregulation is not peripheral to ADHD but a central, overlooked part of the condition.[/b] 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?[/quote]

But what do they know that you don't lol[/quote]

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. [/quote]

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.
[quote]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.[/quote][/quote]

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. [/quote]

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.[/quote]

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