Higher ADHD Predicts Slightly Higher Distress for Population

Higher ADHD Predicts Slightly Higher Distress for Population

Contents

Variables

A
ADHD 384
A
Distress 1349

Categories

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Symptoms 13336
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Emotions 2028

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Medium Confidence
Very Weak Effect Size
Positive Relationship
Population Study
cause image gauge image effect image
Participants reported a 45.1% average increase in Distress following above average ADHD.

Abstract

Distress was generally 34.5% higher than average after 2.25 out of 5 of ADHD per 4 days.

Aggregated data from 2 study participants suggests with a MEDIUM degree of confidence (p=0.0347, 95% CI -0.407 to 0.718) that ADHD has a weakly positive predictive relationship (R=0.156) with Distress.

The highest quartile of Distress measurements were observed following an average 3.11 out of 5 ADHD.

The lowest quartile of Distress measurements were observed following an average 2.38 out of 5 of ADHD.

After an onset delay of 0 seconds, Distress is typically 16% lower than average over the 4 days following around 2.38 out of 5 of ADHD ADHD.

Keywords: ADHD, Distress, N-of-1 trials, real-world evidence, causal inference, observational study

Preliminary: Based on 2 participants. Results may change as more data is collected.

Results

Primary Findings

Analysis of 34 paired observations from 2 participants revealed a substantial improvement in Distress following above-average ADHD exposure.

+34.5%
Change from Baseline
Substantial effect on Distress
0.03
Predictor Impact Score
Insufficient evidence for causal relationship

Supporting Statistics

Low
Confidence
0.156
Correlation (r)
p = 0.158
Significance
z = 0.83
Effect Magnitude
φ = 1.00
Temporality

What This Means

When participants had above-average ADHD:

  • Distress increased by 34.5% on average
  • Temporal analysis supports ADHD as the predictor (not the outcome)

Interpreting the Predictor Impact Score

The Predictor Impact Score (PIS) integrates multiple Bradford Hill causal criteria into a single metric. Use this guide to interpret the score:

PIS Range Interpretation Recommended Action
≥ 0.5 Strong evidence High priority for RCT validation
0.3 - 0.5 Moderate evidence Consider for experimental investigation
0.1 - 0.3 Weak evidence Monitor for additional data
< 0.1 Insufficient evidence Low priority; may be noise

Note: PIS is a prioritization heuristic, not proof of causation. High scores indicate relationships worth investigating, not confirmed causal effects. With only 2 participants, these scores are preliminary and will become more reliable as additional data is collected.

Optimal Daily Values (Precision Dosing)

Based on the observed relationship, we can estimate the predictor values associated with the best and worst outcomes. These values enable personalized dosing recommendations.

⚠️ Preliminary Data: With 2 participants and 34 observations, these optimal values are preliminary estimates. As more data is collected, precision will improve significantly.

3.3 /5
Value Predicting Higher Distress
Average ADHD when Distress exceeded its mean
2.3 /5
Value Predicting Lower Distress
Average ADHD when Distress was below its mean

What This Suggests

Distress tended to be highest when ADHD was around 3.3 /5.

Important: These values reflect correlations, not guaranteed causal effects. Individual responses may vary. Use as a starting point for personal experimentation, not as a definitive prescription. Consult healthcare providers before making treatment decisions.

Population Correlation

ADHD Distribution

Distress Distribution

Statistical Summary

Relationship Statistics

Property Value
Cause Variable Name ADHD
Effect Variable Name Distress
Sinn Predictive Coefficient 0.028187366945579
Confidence Level MEDIUM
Confidence Interval 0.56245
Forward Pearson Predictive Coefficient 0.1555
Critical T Value 1.6905
Average ADHD Over Previous 4 days Before ABOVE Average Distress 3.11 out of 5
Average ADHD Over Previous 4 days Before BELOW Average Distress 2.38 out of 5
Duration of Action 4 days
Effect Size weakly positive
Number of Paired Measurements 34
Optimal Pearson Product 0.22042111009302
P Value 0.034717
Statistical Significance 0.1584
Strength of Relationship 0.56245
Study Type population
Analysis Performed At 2026-01-04
Number of Participants 2

ADHD Info

Property Value
Variable Name ADHD
Aggregation Method MEAN
Analysis Performed At 2021-07-08
Duration of Action 24 hours
Kurtosis 1.7260742885114
Maximum Allowed Value 5 out of 5
Mean 3.4004495575221 out of 5
Median 3.4288088495575 out of 5
Minimum Allowed Value 1 out of 5
Number of Aggregate Predictors 304
Number of Aggregate Outcomes 80
Number of Measurements 456
Number of Measurements (including those generated by tagged, joined, or child variables) 456
Public true
Onset Delay 0 seconds
Standard Deviation 0.32523905940887
Unit 1 to 5 Rating
User Variables 180
UPC 0
Variable Category Symptoms
Variable ID 88099
Variance 0.37223878792283

Distress Info

Property Value
Variable Name Distress
Aggregation Method MEAN
Analysis Performed At 2020-09-17
Duration of Action 24 hours
Kurtosis 2.8522483497534
Maximum Allowed Value 5 out of 5
Mean 2.4777342286981 out of 5
Median 2.4229733332357 out of 5
Minimum Allowed Value 1 out of 5
Number of Aggregate Predictors 1209
Number of Aggregate Outcomes 140
Number of Measurements 33096
Number of Measurements (including those generated by tagged, joined, or child variables) 32968
Public true
Onset Delay 0 seconds
Standard Deviation 0.53719668856315
Unit 1 to 5 Rating
User Variables 1486
UPC 647297398818
Variable Category Emotions
Variable ID 1305
Variance 0.6312526863217

Introduction

Background

ADHD (Symptoms) and Distress (Emotions) are both important factors in understanding human health and well-being. This study investigates the relationship between these two variables using real-world observational data.

Traditional randomized controlled trials (RCTs), while the gold standard for causal inference, are often impractical, expensive, or unethical for studying many health relationships. Aggregated N-of-1 observational studies offer a complementary approach that leverages within-subject comparisons across large populations to identify meaningful patterns.

Research Question

Does ADHD affect Distress?

Additionally, we seek to determine:

  1. What is the direction and magnitude of any effect?
  2. How confident can we be in this relationship based on the available data?
  3. What are the optimal levels of ADHD for maximizing Distress?

Study Objective

The objective of this study is to determine the nature of the relationship (if any) between ADHD and Distress. Additionally, we attempt to determine the ADHD values most likely to produce optimal Distress values.

Study Overview

This is a population-level observational study using aggregated N-of-1 methodology. By aggregating individual N-of-1 experiments, we can identify population-level patterns while accounting for the substantial individual variation that exists in most health relationships. Effect sizes are reported as percent change from baseline, enabling intuitive interpretation and comparison across different measures.

Full Methodology: Framework for Real-World Evidence-Based Pharmacovigilance: Aggregated N-of-1 Trials for Quantifying Treatment Effects

Discussion

Interpretation of Findings

Participants experienced a 34.5% improvement in Distress following above-average ADHD exposure. The Predictor Impact Score (PIS) of 0.03 indicates insufficient evidence for a causal relationship.

Statistical Significance

Using a two-tailed t-test with alpha = 0.05, it was determined that the change in Distress is statistically significant at a 95% confidence interval. The p-value of 0.1584 indicates there is less than a 15.84% probability that this result occurred by chance.

After treatment, a 45.1% increase (0.844 out of 5) from the mean baseline 2.44 out of 5 was observed. The relative standard deviation at baseline was 38.9%. The observed change was 0.83132 times the standard deviation.

A common rule of thumb considers a change greater than twice the baseline standard deviation on two separate pre-post experiments may be considered significant. This occurrence would have only a 5% likelihood of resulting from random fluctuation (a p-value < 0.05).

T-Test Details
Observed t-value: 2.321
Critical t-value: 1.691

Since t = 2.32 > 1.69, we reject the null hypothesis.

Biological Plausibility

A plausible bio-chemical mechanism between predictor and outcome is critical for interpreting observational findings. This is where human judgment excels beyond statistical analysis.

Community feedback on the biological plausibility of this relationship is still being collected. Consider the known mechanisms by which ADHD might influence Distress.

Bradford Hill Criteria Assessment

The Bradford Hill criteria provide a framework for assessing causality in observational studies. Our methodology operationalizes six of the nine criteria through the Predictor Impact Score (PIS):

Criterion How Addressed Metric
Strength Effect size magnitude Percent change from baseline (Δ%), z-score
Consistency Cross-participant replication Number of users (N), number of pairs (n)
Temporality Predictor precedes outcome Temporality factor (φ), onset delay (δ > 0)
Biological Gradient Dose-response relationship Gradient coefficient (φgradient)
Plausibility Biological mechanism assessment Community votes on mechanism plausibility
Specificity Category appropriateness Interest factor (finterest)

Predictor Impact Score (PIS)

The PIS integrates multiple Bradford Hill criteria into a composite metric quantifying how reliably a predictor affects an outcome. Higher scores indicate stronger evidence:

Population-Level PIS:

$$\text{PIS}_{\text{agg}} = |r_{\text{forward}}| \cdot w \cdot \phi_{\text{users}} \cdot \phi_{\text{pairs}} \cdot \phi_{\text{change}} \cdot \phi_{\text{gradient}}$$

Where φ-factors are saturation functions approaching 1 as evidence accumulates:

  • φusers = 1 - e-N/10 (user saturation)
  • φpairs = 1 - e-n/nsig (pair saturation)
  • φchange = 1 - e-Δspread/Δsig (effect spread saturation)
  • w = weighted average of plausibility votes

Temporality Assessment

We assess evidence for correct causal direction using the temporality factor:

$$\phi_{\text{temporal}} = \frac{|r_{\text{forward}}|}{|r_{\text{forward}}| + |r_{\text{reverse}}|}$$

Values approaching 1 indicate the predictor precedes the outcome (supporting causation); values near 0.5 suggest ambiguous directionality; values near 0 suggest reverse causation or confounding by indication.

Limitations

As with any observational study, correlation does not prove causation. Key limitations include:

  • Unmeasured confounders: Variables not tracked may influence results
  • Self-selection bias: Health trackers may differ from the general population
  • Measurement error: Self-reported data may contain recall bias
  • Confounding by indication: Sicker individuals may use more treatments

However, within-subject comparison and temporal precedence analysis partially mitigate these limitations. If the relationship is merely coincidental, as participants independently modify their ADHD values, the observed strength will decline over time. Spurious correlations naturally dissipate as more data is collected.

Future Directions

Future research should examine:

  • Subgroup analyses to identify individual differences in response
  • Potential confounders and mediators of the observed relationship
  • Optimal dosing and timing for ADHD
  • Confirmation through prospective or randomized designs
  • Biological mechanisms underlying the observed effects

Conclusion

📊 Preliminary Findings: With 2 participants, these results are based on limited data. Effect sizes and confidence will improve as more participants contribute data. Consider these findings directional rather than definitive.

Above-average ADHD was associated with a 34.5% improvement in Distress—a substantial effect. The Predictor Impact Score of 0.03 indicates this relationship is requiring additional data before conclusions.

Bottom Line: Based on a PIS of 0.03 and a 34.5% effect size, this relationship currently lacks sufficient evidence. Continue monitoring as more data becomes available. Note: These conclusions may strengthen or change direction as more data is collected.

These findings contribute to our understanding of how ADHD may influence Distress in real-world conditions. While preliminary, these results may inform future research directions. As more participants contribute data, the reliability and precision of these findings will improve substantially.

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Methods

Study Design

This study is based on data donated by 2 participants. Thus, the study design is equivalent to the aggregation of 2 separate n=1 observational natural experiments.

This within-subject design is powerful because it controls for all stable individual characteristics (genetics, baseline health status, socioeconomic factors) that might otherwise confound the relationship between variables.

Data Analysis

Temporal Assumptions

The analysis incorporates temporal assumptions about the relationship between variables:

  • Onset Delay: It was assumed that 0 seconds would pass before a change in ADHD would produce an observable change in Distress.
  • Duration of Action: It was assumed that ADHD could produce an observable change in Distress for as much as 4 days after the stimulus event.

Statistical Methods

For each participant, we calculated the Pearson correlation coefficient between ADHD values and subsequent Distress values. Individual correlations were then aggregated using Fisher's z-transformation to produce a population-level estimate:

Individual Correlation:

$$r_i = \frac{\sum(x_{ij} - \bar{x}_i)(y_{ij} - \bar{y}_i)}{\sqrt{\sum(x_{ij} - \bar{x}_i)^2 \sum(y_{ij} - \bar{y}_i)^2}}$$

Fisher's Z-Transformation:

$$z_i = \frac{1}{2} \ln\left(\frac{1 + r_i}{1 - r_i}\right)$$

Aggregated Correlation:

$$\bar{r} = \tanh(\bar{z}) \quad \text{where} \quad \bar{z} = \frac{1}{N}\sum_{i=1}^{N} z_i$$

Effect Size Calculation

Effect sizes are reported as percent change from baseline. For each participant, we compare the outcome following above-average predictor values to the overall baseline outcome:

$$\Delta\%_{\text{baseline}} = \frac{\bar{O}_{\text{follow-up}} - \bar{O}_{\text{baseline}}}{\bar{O}_{\text{baseline}}} \times 100$$

Effect Magnitude (Z-Score)

To assess effect magnitude relative to natural variability, we calculate the z-score:

$$z = \frac{|\Delta\%_{\text{baseline}}|}{\text{RSD}_{\text{baseline}}}$$

where RSDbaseline is the relative standard deviation of outcome during baseline period

A z-score > 2 indicates statistical significance (p < 0.05), meaning the observed change exceeds typical baseline fluctuation and is unlikely due to random variation.

Statistical Significance

Correlation significance is assessed using a two-tailed t-test:

$$t = \frac{r\sqrt{n-2}}{\sqrt{1-r^2}}$$

We reject the null hypothesis (ρ = 0) at α = 0.05 when |t| exceeds the critical value, providing statistical evidence that the observed relationship is not due to chance.

Data Sources

ADHD data was primarily collected using QuantiModo. QuantiModo allows you to easily track mood, symptoms, or any outcome you want to optimize in a fraction of a second. You can also import your data from over 30 other apps and devices. QuantiModo then analyzes your data to identify which hidden factors are most likely to be influencing your mood or symptoms.

Distress data was primarily collected using QuantiModo. QuantiModo allows you to easily track mood, symptoms, or any outcome you want to optimize in a fraction of a second. You can also import your data from over 30 other apps and devices. QuantiModo then analyzes your data to identify which hidden factors are most likely to be influencing your mood or symptoms.

Data Quality

Data quality measures were applied to ensure reliable results:

  • Minimum Data Requirement: Only participants with sufficient paired observations were included in the analysis.
  • Outlier Handling: Extreme values were winsorized to reduce the influence of measurement errors.
  • Missing Data: Days with missing values were handled using appropriate filling strategies based on the variable type.
  • Test User Exclusion: Test accounts and invalid users were excluded from all analyses.

Principal Investigator

Program & Methods

Mike P. Sinn
Sinn, M. P.

Designed and implemented data collection, aggregation, causal inference pipeline, and automated study generation framework. Developed the Predictor Impact Score methodology operationalizing Bradford Hill criteria for ranking causal relationships in observational data. When he tells people this at parties, they usually say they have to go check on their car.

Individual study outputs are automated, reproducible, and open to external audit. (Which I would seriously recommend.)

Contact

Cite This Study

APA Format
Sinn, M. P. (2026). Causal Analysis: Does ADHD Affect Distress?. The Journal of Citizen Science. https://studies.crowdsourcingcures.org/study/cause-88099-effect-1305-population-study
BibTeX 
@misc{sinn_cause_88099_effect_1305_population_study_2026,
  author = {Sinn, Mike P.},
  title = {Causal Analysis: Does ADHD Affect Distress?},
  year = {2026},
  publisher = {The Journal of Citizen Science},
  url = {https://studies.crowdsourcingcures.org/study/cause-88099-effect-1305-population-study},
  note = {Accessed: January 7, 2026}
}
Chicago/Turabian
Sinn, Mike P. "Causal Analysis: Does ADHD Affect Distress?." The Journal of Citizen Science. Accessed January 7, 2026. https://studies.crowdsourcingcures.org/study/cause-88099-effect-1305-population-study.
Harvard
Sinn, M.P., 2026. Causal Analysis: Does ADHD Affect Distress?. [Aggregated N-of-1 Study] The Journal of Citizen Science. Available at: https://studies.crowdsourcingcures.org/study/cause-88099-effect-1305-population-study [Accessed January 7, 2026].

Study Type: Aggregated N-of-1 Observational Mega-Study
Evidence Level: Level II (Real-World Evidence)
Methodology: Bradford Hill Criteria with Predictor Impact Score (PIS)

References

This framework was originally developed in 2013 based on the Bradford Hill criteria. Subsequent literature has independently validated similar approaches to causal inference from observational data:

  1. Hill, A.B. (1965). The environment and disease: association or causation? Proceedings of the Royal Society of Medicine, 58(5), 295-300. [Bradford Hill criteria]
  2. Lillie, E.O., et al. (2011). The n-of-1 clinical trial: the ultimate strategy for individualizing medicine? Personalized Medicine, 8(2), 161-173. [N-of-1 methodology]
  3. Pearl, J. (2009). Causality: Models, Reasoning, and Inference . Cambridge University Press. [Causal inference]
  4. Hernán, M.A., & Robins, J.M. (2020). Causal Inference: What If . Chapman & Hall/CRC. [Free textbook]
  5. FDA (2018). Framework for FDA's Real-World Evidence Program . U.S. Food and Drug Administration. [Regulatory context]
  6. Duan, N., et al. (2013). Single-patient (n-of-1) trials: a pragmatic clinical decision methodology . Journal of Clinical Epidemiology, 66(8), S21-S28.
  7. Platt, R., et al. (2018). The FDA Sentinel Initiative—an evolving national resource . New England Journal of Medicine, 379(22), 2091-2093.

This information is for research and educational purposes only, not medical advice. Consult a healthcare provider before making health decisions. Terms of Service

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