Detecting a Proxy for Potential Comorbid ADHD in People Reporting Anxiety Symptoms from Social Media Data (2024)

Abstract: We present a novel task that can elucidate the connection between anxiety and ADHD; use Transformers to make progress toward solving a task that is not solvable by keyword-based classifiers; and discuss a method for visualization of our classifier illuminating the connection between anxiety and ADHD presentations. Up to approximately 50% of adults with ADHD may also have an anxiety disorder and approximately 30% of adults with anxiety may also have ADHD. Patients presenting with anxiety may be treated for anxiety without ADHD ever being considered, possibly affecting treatment. We show how data that bears on ADHD that is comorbid with anxiety can be obtained from social media data, and show that Transformers can be used to detect a proxy for possible comorbid ADHD in people with anxiety symptoms. We collected data from anxiety and ADHD online forums (subreddits). We identified posters who first started posting in the Anxiety subreddit and later started posting in the ADHD subreddit as well. We use this subset of the posters as a proxy for people who presented with anxiety symptoms and then became aware that they might have ADHD. We fine-tune a Transformer architecture-based classifier to classify people who started posting in the Anxiety subreddit and then started posting in the ADHD subreddit vs. people who posted in the Anxiety subreddit without later posting in the ADHD subreddit. We show that a Transformer architecture is capable of achieving reasonable results (76% correct for RoBERTa vs. under 60% correct for the best keyword-based model, both with 50% base rate).

## introduction up to 53% of adults with adhd may also have an anxiety disorder (children and with attention-deficit/hyperactivity disorder report, 2018) @xcite and up to 28% of adults who have an anxiety disorder may also have adhd @xcite . however, patients presenting with anxiety or depressive symptoms may be treated for these disorders without adhd ever being considered @xcite . misdiagnosis of adhd is common, as many clinicians are still not aware that adhd is a valid diagnosis in adults @xcite and physicians are more familiar with mood and anxiety disorders @xcite . the danger of misdiagnosed comorbid adhd and anxiety is that only the symptoms for anxiety will be treated and adhd will be left untreated @xcite . social media such as reddit provides publicly available text data of anonymous first-person experiences @xcite . we analyze people talking about their mental health on the forum website reddit. we propose classifying posts from people who only posted in the anxiety subreddit (forum) and never in the adhd subreddit vs people who posted in the anxiety subreddit and will later have started posting in the adhd subreddit. this way, we can distinguish text from users whose posting will show interest/concern with adhd in the future from people whose posting will not do that. posting about adhd is a proxy for being concerned about adhd. showing that this task is possible indicates that there is a systematic difference between the two groups of reddit users. our hope is that analyzing the classifier can elucidate the connection between anxiety and anxiety-comorbid adhd. a limitation is that posting on reddit is a proxy for concern with adhd, and there can be both false positives and false negatives if reddit posting is used as a proxy for identifying patients with adhd. we demonstrate that the task above is not solvable using keyword-based methods such as naive bayes and logistic regression. we then demonstrate that the task is better solved using roberta @xcite , indicating that the connection between anxiety and anxiety-comorbid adhd is more complex than what can be captured with keywords. we report on visualizing the "explanation" for the classifier's prediction. in future work, we plan to use this visualization to gain insight into the connection between anxiety and anxiety-comorbid adhd. transformer models such as roberta have been used to classify mental health disorders from social media text @xcite . however, we are not aware of research published of using transformers to classify comorbid anxiety with adhd. in the rest of the paper, we expand on comorbid adhd and anxiety (section 2.1), and using learned classifiers on mental health-related text (section 2.2). we then discuss our data collection process (section 3) and report on our experiments showing that it is possible to predict which posts in the anxiety subreddit come from people who will never post in the adhd subreddit vs. people who will post in the adhd subreddit (section 5). we discuss the limitations of our work in section 7 and ethical considerations in section 8. ## data collection text data was collected from the anxiety and adhd subreddits on reddit. although reddit posts are not formal clinical diagnoses, reddit data offers advantages such as being immediately and publicly available, including a timeframe to track historical data, and anonymous posts documenting vulnerable first-person experiences @xcite . all posts were scraped from the anxiety and adhd subreddits from the dates february 16, 2020 to nov 28, 2022. ## experiments with explainability one application of our trained classifier is obtaining further insight into the relationship between anxiety disorders and adhd. to enable qualitative analysis, we have experimented with visualizing the reason that the roberta classifier outputs "will post in adhd" or "will not post in adhd" for a given post. we visualize the difference in output caused by masking out each individual word and each individual phrase in the post. aggregate analysis will be available in the future. ## limitations our primary goal is to gain insight into the connection between anxiety and adhd, as well as model @xcite adhd co-morbid with anxiety. we use a particular social media platform (reddit), which is primarily english-speaking and whose audience is known to skew male foot_0 . conclusions about symptoms drawn from reddit therefore are likely biased by language, gender, and culture. we do not have specific demographic information about the anxiety and adhd subreddits, so that conclusion is itself tentative. the classifier we train is not intended as a diagnostic tool and should not be used as such. classification results on text from outside of reddit and outside of the anxiety subreddit would likely not match what we report. ## ethical considerations we use public data, and as such the research is not human-subjects research, as confirmed by our irb. owing to the sensitivity of the topic, we have decided not to include samples from our data in the paper. creating classifiers whose output is mental health conditions is fraught with the danger that such a classifier would be used without consent on users' text. care should be taken that this does not happen. our classifier is not diagnostically useful. ## conclusions we present a novel task: predicting whether internet text that comes from a person discussing their anxiety comes from a person who in the future will also discuss adhd. we demonstrate that this task is not solvable using keyword-based methods, while it progress can be made using roberta. the immediate application of our method is for obtaining qualitative insight into the connection between anxiety and adhd by visualizing the reason that the roberta classifier outputs "will post in adhd" or "will not post in adhd" for a given post.