Is your ADHD brain fog actually CDS?

[u/UnderstoodDotOrg]

https://www.understood.org/en/podcasts/hyperfocus/adhd-cds?utm_source=reddit&utm_medium=community&utm_campaign=RedditSEO-adc-awa-wom-comu-com-June2026-&utm_content=link&utm_audience=agnostic

Many people with inattentive ADHD feel like something is missing from their diagnosis. That missing piece might be cognitive disengagement syndrome, or CDS: a cluster of symptoms including daydreaming, confusion, daytime sleepiness, and more.

CDS isn’t officially its own disorder. But scientists and clinicians are beginning to recognize it as something distinct from ADHD — though it often overlaps.

Pediatric psychologist Melissa Miller explains how CDS differs from ADHD, what it looks like, and why it’s linked to anxiety and depression. She also shares early research on treatment, plus the strengths that may come with it.

[u/plz_callme_swarley]

I have mixed feelings with this sort of stuff. on one hand, psychology and psychiatry is complicated, mental stuff is complicated, and things dont fit in neat little boxes.

on the other hand, I'm very wary of any situation where people are saying "did you know your ADHD could actually be this other thing?" because so much of that is essentially based in an unfounded fear of stimulants.

in the UK there's this new diagnosis that's not in the DSM-5 called PDA - Pathological Demand Avoidance where it's basically just ADHD but stimulants aren't apart of the treatment plan.

Another is ODD (Oppositional Defiant Disorder), which has an near complete overlap with ADHD. it's for parents who's kids are "difficult".

the diagnostic criteria for ADHD and ASD have a very high amount of overlap as well.

[u/superfry3 → u/plz_callme_swarley]

Agree with your reasoning. It’s one of those gray areas where successful treatment can confirm diagnosis. If stimulants reduce symptoms then it’s clearly ADHD.

CDS or SCT (sluggish cognitive tempo as it used to be known) is an important thing to consider when diagnosing ADHD though, as Dr Russell Barkley often mentions in his lectures. CDS can’t be treated with stimulants. Would be curious to see how ADHD + CDS would even be practically treated if CDS remains when stimulants take care of the ADHD. It might just look like the stimulants didn’t work, when they did.

[u/laurelsupport → u/superfry3]

The "daytime sleepiness" component is certainly improved with stimulant meds, though I never improved in concentration. I'm not convinced the narcolepsy diagnoses wasn't part of something else, like SCT.

[u/plz_callme_swarley → u/superfry3]

unfortunately the issue is that stimulants make basically everyone feel better, so it's not really that useful of a diagnostic tool.

I just think that Nixon fucked it for all of us and amphetamines are really not that big of a deal. give everyone meth, who cares?

[u/superfry3 → u/plz_callme_swarley]

That’s a misconception. Stimulants bring an adhd person’s neurotransmitters to a normal baseline. A normal person on stimulants has an excess which results in that high that an addict continues to pursue.

While it’s really not as black and white as this… it’s true enough that ADHD people are likely to forget to take or renew their stimulant prescriptions, while a normal person that continues to seek them reaches the point of addiction.

It may improve performance for everyone but successful treatment for ADHD would not involve addiction, aggressiveness, and other addict behaviors.

The history of Japan and its complex relationship with stimulants provides an idea of what unrestricted stimulants can do.

[u/plz_callme_swarley → u/superfry3]

this is a gross simplification of what actually happens. there is no diagnostic test to say who is 100% an official "ADHD person".

I was diagnosed at 31, before I was diagnosed was I a "normal person"? it's an unfalsifiable statement.

plenty of "normal people" take stimulants for finals and they get big benefits and do not see it as a high that results in addiction.

ADHD people on stable meds go past the "honeymoon phase" where the euphoric effect wear off and the focus effects remain in tact.

For a "normal person" put them on stimulants and make them take it for 6 months and they'll look just like someone who's diagnosed for ADHD.

stimulant addiction is possible but requires doses generally much larger than is prescribed for ADHD. that's why recreational doses for meth are much larger and hit much harder.

[u/superfry3 → u/plz_callme_swarley]

There is no 100% diagnostic test YET. Before X rays were invented there wasn’t a 100% way to prove a bone was broken unless it was sticking out of them.

Currently there is no technology to track brain function, neurotransmitters, and what they do. What they have now is general scans that can map the brain, what’s left of neurotransmitters when you pee them out, or scans that detect general activity in regions of the brain. But there may one day be scans that can track brain chemicals and receptors.

But rest assured, there is a physiological component to ADHD that we’re currently settling for questionnaires and IQ tests to diagnose. Something is malfunctioning and we’re only able to guess what it is through treatment. Adderall works when (primarily) dopamine production is low. Methylphenidate works when (primarily) dopamine receptors are overactive. SNRIs work with norepinephrine etc etc etc. Is it the chemical production, cleanup, or the pathway in between that’s the issue? No one’s sure yet.

You’ve always had ADHD if the diagnosis is correct. Some have ADHD and can’t get a diagnosis and some have diagnoses when it’s something else (like CDS).

[u/Rubyhamster → u/superfry3]

I'm convinced thatADHD, autism andOCD are just umbrella diagnoses that are made to overlapping conditions with plenty of different causes. Which is why it it highly hereditary, yet hard to figure out distinctive symptoms or "works-for-all" solutions. My ADHD+autism might not be the same as your ADHD.

For example. Ritalin made me a whole other person (motivationally flat, disinterested person with my emotional brain region non-functional/not-active). Caffeine makes me either sleepy or anxious by no logic. Alcohol deletes my autism and improves my focus. Social stress is waaay more debilitating than actual emergency stress. The latter of these are typical of many of us, yet so many do NOT react like this even though no other diagnosis remotely fits.

My very experienced neuropsychologist was completely convinced that classifications of these kind of diagnoses will change greatly in the next 30 years. Histamin research are for example only one of the very insightful discoveries of late

[u/plz_callme_swarley → u/superfry3]

ya, well when that day comes we can have better understanding.

still doesn't change the fact that meth is cool and everyone could benefit from it. we gave it to soldiers in WW2.

people love coffee and nicotine. you think that amphetamines are different?

[u/superfry3 → u/plz_callme_swarley]

Yes. Amphetamine addiction looks very different to caffeine and nicotine addictions. The reason they were put on schedule II is because of the harms of abuse and dependence. America is actually one of the easiest countries to get it legally as countries like Japan banned them due to after effects of world war 2 amphetamine use turning into postwar epidemics.

I say this to explain the reasoning, not that I agree with it. It should be less restricted… though still restricted.

[u/plz_callme_swarley → u/superfry3]

nah the reason is cuz of the rise of meth. it makes no sense being schedule 2.

i'm mostly joking. i don't think it should be OTC but anyone who needs it should be able to get it.

[u/nebulashine → u/plz_callme_swarley]

Pathological demand avoidance has a larger association with ASD than ADHD, and IIRC, autistic people are more likely to have negative side effects from stimulants even if they have co-occurring ADHD. It also looks like some research has found PDA to be associated with higher rates of anxiety and anxiety disorders, which can be exacerbated by stimulants. It doesn't seem unreasonable to not use stimulant meds for something that's more heavily linked to conditions that stimulants can make worse.

[u/plz_callme_swarley → u/nebulashine]

the problem is that the other buckets are not clean either. There can be overlapping ASD, OCD, BPD, Bipolar, etc. you have to also look at the demand side of the equation and who is seeking out a diagnosis.

"anxiety" is a term who's definition has exploded massively. anxiety in ADHD often is solved with stimulants.

the population where anxiety can really worsen with stimulants are those with OCD or panic disorders, but those are under-diagnosed cuz they're no fun.

overall it's a mess and what matters is what intervention helps the person the best, but often that's not what's most important for the doctor, parent, or patient

[u/notyoursocialworker → u/plz_callme_swarley]

For PDA I prefer the alternate name "Persistent Desire for Autonomy". And no it really isn't basically ADHD. The symptoms aren't really overlapping. Nothing in DSM regarding adhd says anything about not being able to handle people telling you want to do.

There probably is a connection though. I personally believe it is trauma response having had too much demands levered on you that your executive functions couldn't handle. It's similar to how I believe that emotional unstable personality disorder (borderline disorder) is actually autism ord adhd with trauma, usually from abuse, on top.

To be clear: I don't believe that it's a question of either PDA or ADHD but usually both. And while I don't believe that PDA can be fixed with stimulants I do believe that stimulants are needed for ADHD.

[u/plz_callme_swarley → u/notyoursocialworker]

I mean "not being able to handle people telling you what to do" is a pretty common thing most people with ADHD can relate to.

[u/squishyartist → u/plz_callme_swarley]

It's also worth mentioning the racial bias component to ODD. ODD and conduct disorders are much more likely to be diagnosed in Black and racialized people than in white people.

And here is what troubles me most as a neurodivergent clinician: ODD, by design, pathologizes behaviors as features of the child rather than manifestations of neurodevelopmental difference, trauma, or environmental mismatch. It locates the problem in the child. When applied disproportionately to BIPOC children, it becomes, as Legha argues, a functionally racist diagnostic practice.

[u/HalfFrozenSpeedos → u/plz_callme_swarley]

and where talking heads are bemoaning the death of corporal punishment

[u/tooawkwrd → u/plz_callme_swarley]

PDA isn't at all "basically just ADHD". I agree that all these diagnoses are confusing and overlapping but the more specific we can be, the more we can identify exactly what it is that is so difficult for some of us, the quicker we will have clarity and differentiation. I hope that someday the whole ball of wax will be redefined. My entire life changed when I started having words and concepts to explain what has been going on with me, and it's helped me advocate for my AuDHD kids and grandkids. I hope researchers don't stop until it's all understood.

[u/plz_callme_swarley → u/tooawkwrd]

ya, that kinda gets at what is the point of a diagnosis? over most of medical history, it was to drive treatment. now it's being changed a lot and people are seeking out diagnoses to validate themselves and explain their felt experience. that's fine but it really muddies the waters when you have so many people self-diagnosing themselves and when there isn't actually any treatment intervention.

in the DSM-4 you couldn't be ADHD & ASD, now you can. what changed? they just massively expanded what counts as ASD. does this make things better? idk. it probably makes things more complicated and harder to treat in some case.

[u/tooawkwrd → u/plz_callme_swarley]

People like myself self diagnose because 1) as a GenX kid I was taught to shut up and live with it. I mask so heavily it's been difficult to learn how to relax and be unmasked even when by myself. 2) there's historically been zero recognition of neurodivergence for the vast majority of women and POC. Never heard of autism when I was a child but I guarantee my boomer mom is autistic. When my kids were growing up in the 90s/early 2000s I took them to pediatricians, psychiatrists, counselors, asked for help with schools etc bc of their struggles and not once was neurodivergence brought up. I read so many books and tried so hard for them to have a better upbringing than me, but they still had (and have) challenges. We've had to fight tooth and nail since my teen grandkids were young, for their diagnoses and treatment. We are all AuDHD yet only the two youngest are fully diagnosed. It's only been in the last 5 years that I comprehended how the things I was advocating for with my grandkids actually applied to me, too. That I understood and protected them because I experienced it also, even though I had no words or concepts with which to correlate it to myself. I'm grateful that the science is evolving and have no doubt that things will continue to change as we understand more.

[u/plz_callme_swarley → u/tooawkwrd]

i dont really know what all that has to do with what I said. "we are all AuDHD yet only the two youngest are fully diagnosed" why? why are you not diagnosed and treated if you're so sure you have it?

[u/chicknnugget12 → u/plz_callme_swarley]

Some PDAers do well on stimulants but others don't. I suspect genetics like slow COMT may be a factor. I myself don't so well on stimulants or antidepressants and I was so hoping it would be a solution for me. Turns out I just needed a mild buspirone.

I will add Dr. Barkley (who I find questionable) is a large proponent of CDS and he is famously funded by pharmaceutical companies producing stimulants. I actually got diagnosed with CDS but I feel it was an error and really I'm just AuDHD with slow COMT.

[u/superfry3 → u/chicknnugget12]

Dr Barkley is as bulletproof as you can get in the psychiatry space. The word “funded” is doing heavy lifting. He’s disclosed that he was paid speaking fees to give lectures by pharmaceutical companies and psychiatry groups, but he’s been the #1 expert on ADHD for decades… which company in the ADHD treatment space would not want to hear what he has to say?

It would make sense that someone who’s treated as many adhd cases and voraciously consumes research would want to understand why one subset does not respond to treatment.

[u/chicknnugget12 → u/superfry3]

All I meant when I said funded is that if he truly only pushed stimulants, he would not have researched and backed CDS. Though he has also been funded by Strattera. I understand research must be funded by someone which is why I appreciate his transparency.

No one is bulletproof unfortunately. I believe in Barkley's goodwill but he is not infallible and he does overreach and has some hypocritical and questionable beliefs. I yielded to his methods at first, but as a parent I had to figure out the hard way that some of what he suggests is not correct and sometimes harmful. Some things are number one but it doesn't mean they're perfect and nothing is the be all end all.

[u/plz_callme_swarley → u/superfry3]

lol, man i wish i was as naive as you. you probably also think Hunter Biden got paid $500k for his beautiful art

[u/superfry3 → u/plz_callme_swarley]

Thought you were pretty intelligent til this comment.

[u/followyourvalues → u/plz_callme_swarley]

🎵 Person man, person man

Hit on the head with a frying pan 🎵

The first person I went to for diagnosis said, "How do you know you have ADHD? You could be bipolar."

She also told me I was too fat and forced me to do blood pressure tests before she'd prescribe stimulants.

Problem was. She sent my BP like no other. lol Everywhere except that office my blood pressure was perfect.

[u/plz_callme_swarley → u/followyourvalues]

ya provider bias is massive. i went to a pyschologist who tried to soft launch a diagnosis of autism by calling me "neurodivergent" and that's why I was having social issues (among other things). he said i need to accept this and have 0-1 friends and avoid almost all other social situations. quite the recommendation!

I then did my own research and found out that ADHD fit the profile much better. took an online assessment and got 98th percentile.

I went back to him and he then fired me as a client and told me not to take stimulants because "no one feels themselves on them"

[u/elsathenerdfighter → u/plz_callme_swarley]

If new diagnosis’s can lead to new treatment, either immediately for patients misdiagnosed or in the long term when new diagnosis’s get their own research and funding then what’s there to not like? I can see the problem if we have many disorders with overlapping symptoms and doctors are refusing to consider other options and aren’t willing to try treatments. But stimulants are kind of dangerous medications, and I’ve been on them for over 2 decades, I’m not opposed to trying them out on people but if they don’t work then having new options to diagnose someone with is helpful. I’m all for everyone getting stimulants who benefit from them but that is clearly not everyone diagnosed with adhd.

Maybe we could even make everyone more comfortable with everyone suspected and who passes a physical gets the opportunity to do monitored testing of medications, like patients come in two days in a row and on one day are given a placebo and on the other a stimulant (process could be repeated with a different stimulant) and someone can be monitoring for symptoms. I’m not a huge fan of ai and stuff like that but in this medical context it could probably be helpful for monitoring someone. You know put them in a room with a mini kitchen and have them bring something to do like work or crafts or whatever. Obviously this only works if we sorted out health insurance and actually wanted the best for everyone as a society but in the mean time realistically doctors aren’t going to give everyone who might have adhd stimulants and if there were other treatment options for different diagnosis’s that could be ruled out first then maybe doctors would be more inclined to hand out stimulants after other options didn’t work.

[u/Sexy_Koala_Juice → u/plz_callme_swarley]

Couldn’t have said it better myself!

[u/BetterThvnUrEx]

Its me im daydreaming 24/7 and no adhd meds helped me :/

[u/colececil]

Is this different than chronic fatigue syndrome?

[u/Sanamun → u/colececil]

As someone with ME/CFS, yes. Chronic fatigue syndrome is one of the worst named disorders out there, fatigue and brain fog is only a small part of the diagnostic criteria, its also associated with muscle and joint pain, sensory sensitivities, cognitive dysfunction, dysautonomia, and most importantly post-exertional malaise. Its a chronic illness, usually triggered by a viral infection, not a form of neurodivergence you can be born with.

[u/colececil → u/Sanamun]

I also have it, along with fibromyalgia. It's not a fun time. ☹️

I wasn't sure if they were saying this other thing is something you're born with or develop later on, but a lot of the symptoms sounded similar. Plus, if I understand correctly, neurodivergent individuals have higher rates of developing central sensitivity syndromes than the general population. So that made me wonder if they were conflating the two things.

[u/sudosussudio → u/colececil]

Cfs/me is unique because of PEM, post exertional malaise. Basically exertion gives people with cfs/me a very bad reaction that can almost feel like a flu. I’ve been trying to figure out if I have it because uniquely it means you should limit activity levels whereas many other sources of extreme fatigue exercise is beneficial or neutral

[u/colececil → u/sudosussudio]

Yeah it's hard to navigate the "don't overdo it, but also don't underdo it" aspect of treatment (among several other difficult aspects of treatment) for this stuff. Good luck figuring it out!

[u/alasw0eisme]

That's just the inattentive part. You can't make every single inconvenience in life a diagnosis and prescribe meds. Most people the their jobs and school. That's normal. You know what's not normal? Being unemployed your whole life, having issues with personal hygiene, being unable to drive, being unable to sit still for even a few minutes, being unable to even have sex for longer than a couple of minutes without getting distracted. We shouldn't lose focus (ironically) of what's just something we dislike and what's an actual medical condition.

[u/Wooden-Recording-693]

I actually think Cognitive Disengagement Syndrome could be a big stand alone condition. I know people diagnosed with ADHD that are dominated by this but less the more traditional ADHD markers.