Recently, I wrote a post about the four neural sub-types of depression. That classification was based on resting stage fMRI comparing depressive patients with controls; I hope someone does similar studies for other psychiatric conditions.
The current post is an attempt to delineate what may come out in such a study if done for ADHD. I will be focusing on ADHD as it manifests in children, adolescents as well as adults.
I will be mostly relying on factor analytical studies of ADHD that have typically revealed 3 to 4 underlying factors.
ADHD has typically been diagnosed by looking at symptoms from inattentive or hyperactive-impulsive domains. You can find the DSM-5 criteria here. And its sub-types are combined presentation, predominantly inattentive presentation and predominantly hyperactive-impulsive presentation.
As per some studies, a majority (as much as 90 %) of ADHD subjects have inattentive symptoms while a few have hyperactive-impulsive symptoms. This is analogous to the depression findings that predominately depressive patients have a core pathology marked by low mood ; and subtypes marked by say anergia, anhedonia and anxiety.
However, factor analytical studies have presented a more nuanced picture. As per this study [pdf] there are four underlying factors of ADHD.
- Inattentive/ cognitive problems
- Impulsivity/ emotional lability
- Problems with self-concept
The first there factors are well established and quite apparent. To impulsivity description I may just add sensation-seeking too. The problems with self concept is something like low self-confidence/ self esteem, possibly due to continued underachievement and problems at school/ work. I would like to add another dimension to this fourth problems with self concept factor – that of disruptive/ defiant behavior possibly due to self-concept issues.
And I am sure in future, in future, when brain basis and neutral subtypes are more easily available for ADHD, we will find these four subtypes.
Before we leave, its important to note that ADHD lies on a continuum and its a matter of degree than a matter of kind .
Also, ADHD confers benefits too like enhanced creativity and some work has shown that creativity can be mistaken for ADHD in kids.
The above four sub-types may then be classified by their positive poles too:
- Daydreaming/broadened attention
- High energy and enthusiasm
- risk-taking and emotional sensitivity
- independent and idiosyncratic
All the above are also traits associated with the creative person. ADHD & creativity are indeed very closely related and its time we stopped seeing differences like ADHD in purely pathological terms.