There is nothing more ADHD than chasing rabbit down holes when you stumble across novel ideas and data.
I recently watched Dr. Duncan Astle's YouTube presentation, 'Transdiagnostic Mapping in Neurodevelopmental Disorders,' which explores how brain networks are modeled through a computational framework.
But what tweaked my interest and further exploration in ChatGPT was the notion that during our developmental period the process of improving efficiency and integration of our networks involves the creation of neuronal hubs. The effectiveness of these neuronal hubs may influence the risk of later cognitive and learning difficulties.
What could this suggest about the role of early diagnosis and intervention in ADHD, and, more importantly, what does this suggest for late diagnosed ADHD. Given that these hubs may become somewhat 'hardwired,' does this mean neuroplasticity is still possible for an adult diagnosed with ADHD well after the developmental phase? Does this mean that past a certain point we are doomed to not have control over our ADHD, or will psychosocial interventions still be possible?
So I not only got ChatGPT to summarise the transcript with a specific focus on ADHD, but I also posed a challenge for it to confirm or negate my line of thinking, or more to the point:
...whether I am correct in assuming that the author suggests that post developmental phase certain critical hubs are "hardwired" that are then not accessible to neuroplasticity, or at least difficult to rewire? And whether, in an ADHD context, this suggests that late diagnosis with no early intervention makes neurodivergence certain rather than treatable?...
Now bare with me, but my short-form partial prompt has enough history for GPT to understand my direction of thought.
So onto the summary:
Summary of the Transdiagnostic Analysis
Transdiagnostic Approach:
The analysis suggests that traditional diagnostic categories (like ADHD, dyslexia, etc.) do not map well onto the actual cognitive profiles of children. Instead, children with the same diagnosis (e.g., ADHD) can have very different cognitive profiles, while children with different diagnoses can share similar cognitive patterns. This indicates that the current diagnostic system might not adequately capture the underlying neurocognitive diversity.
Neuroplasticity and Developmental Hubs:
The research does imply that certain critical hubs or networks in the brain become "hardwired" to some extent after a certain developmental phase. However, it does not state that these are entirely inaccessible to neuroplasticity. Rather, the hubs appear to be less flexible, suggesting that the capacity for significant neural reorganization or rewiring is reduced after these hubs are established.
In the context of ADHD or other neurodevelopmental disorders, this could mean that if there is no early intervention, the brain might develop along a more fixed path that could be harder to modify later in life.
Implications for ADHD and Late Diagnosis:
If we interpret the findings in the context of ADHD, it does suggest that neurodivergent development becomes more pronounced or "certain" when there is no early intervention, given that critical neural networks might become more rigid over time.
However, the analysis also highlights that cognitive profiles are diverse, even within the same diagnostic category, suggesting that ADHD is not a uniform condition and that different children may have different pathways to their symptoms and difficulties.
Evaluation of Your Assumptions
Your assumption is partially correct: the analysis does suggest that certain neural networks become less flexible or harder to reorganize after they are established. However, it does not necessarily imply that neuroplasticity is entirely unavailable or that neurodivergence is entirely "fixed" post-developmentally.
Neuroplasticity, while reduced, is still present, and interventions might still be effective, though perhaps less so than if they had been applied earlier.
Alternative Theory for ADHD
An alternative theory for ADHD suggested by the presented text would be that ADHD is not the result of a single cause or a fixed pathway but rather emerges from a variety of neurodevelopmental trajectories.
These trajectories are influenced by multiple factors, including genetics, environment, and individual differences in brain development. The brain's organisational principles, particularly how it forms and maintains critical hubs or networks, play a significant role in cognitive function and development.
Therefore, ADHD might reflect a range of neurodevelopmental profiles rather than a single, homogeneous condition. Interventions could be tailored not just to ADHD symptoms broadly but to the specific cognitive profiles of individuals.
Discussion
The last bit was interesting only in ChatGPT had taken the liberty of adding an alternative theory based on the theory, and what it says here is not entirely new.
We know that "having ADHD" does not mean we all experience the same outcomes, as our own experiences, responses and interactions with the environment around us shapes who we are. I mean, this is probably where we can agree with the ADHD deniers, we are all shaped by our own experiences, this is just being human. However, when ADHD is a factor, it becomes a critical variable in shaping outcomes.
But what this does mean for those working with people with ADHD is that recognising late adult diagnosis does introduce some significant challenges that have to be considered.
Psychoeducation on its own is not enough, but rather targeted skills development AND adaptability to individual profiles is critical, while recognising that "hub realignment" is a process rather than an overnight fix. Readjusting our brain's organisational principles requires self-compassion and patience.
While early intervention offers a better path forward for young ADHDers, there is a generation of late diagnosed ADHDers that have to look at their challenges differently than what the system prescribes. When I tell clients that learning about your ADHD is all about unlearning your past strategies and replacing them with useful ones l guess I wasn't too far off the mark.
My challenge to Psychiatrists and Psychologists alike, much of your education relates to ADHD through the lens of children because 90% of available long term studies we limited to <18 years.
If you believe you understand or appreciate the challenges that adults late diagnosed with ADHD face, you probably don't. Listen to your patients when they get frustrated with solutions nots working for them, understand their experiences as unique and be guided by their own stories rather than assume their history.
If you'd like to learn more about why we need you to hear us more, I'm always open for a chat.
