ADHD is a common condition in adults, estimated to be around 3-5% of the population. It's very frequently comorbid with other behavioral disorders like depression, bipolar disorder, obsessive-compulsive disorder, etc. But even "pure" ADHD can be quite disadvantageous. People with ADHD are much less likely to finish school, have trouble staying employed, more likely to be divorced, have greater health care utilization among other adverse outcomes.
Despite these factors only 20% of ADHD individuals receive treatment which can make a big difference. Medications can be helpful but are not by any means a "cure". Rather specific behavioral therapies are a necessary part of an effective treatment program.
As a physician specializing in behavioral health, I've treated a great number of ADHD adults. It's impressive how much improvement patients could make over a period of months to years as a result of their determined effort. I came to appreciate patients' innate talents that many were eventually able to exploit. It was gratifying to see some become top-tier innovators in their fields including technologies.
Of course people will "identify" unique traits as part of their sense of "self". ADHD individuals may come to regard aspects of their quirky cognitive styles as part of an "identity" but that's not necessarily the same as having ADHD as the biggest component.
Last thing I'll say is that ADHD is considered a developmental disorder. IOW there's no sharp line between having/not having it. The extent it's a problem depends on the context, which is a huge discussion topic in its own right.
I am 30. I got diagnosed with ADHD a few months ago and I started treatment (adderall and lifestyle changes).
Growing up, ADHD was my biggest enemy in life and I didn't even realize it.
Once I began treatment, the change was almost overnight. I know I'm just one data point in a sea of data points, but I really just want to add that I'm on the other end of the parent comment and getting diagnosed, other than my marriage and the birth of my son, was the best thing that's ever happened to me.
Same here, minus the marriage and son. It's sobering to realize how much failure and self-loathing could have been avoided if it had been diagnosed earlier.
> "Growing up, ADHD was my biggest enemy in life and I didn't even realize it."
That corresponds to what many ADHD adults have experienced. Based on what I've observed among ADHD patients, early response to treatment is a reason for optimism. Chances are ongoing treatment will support continued improvement for months if not years. And not just the patient but also the person's family and beyond. Differences in outcomes are decidedly non-trivial.
One interesting idea I've read is that life long treatment might enable long lasting behavioural and even physical changes in the brain that makes functioning easier when unmedicated.
Basically, meds set you on a healthy path that might lessen the effects of the disorder.
I can't speak to the neurology of it, but I could see that being the case. Forming habits & routines + making lifestyle changes are almost certainly easier when medicated for ADHD. If you engrain those changes into yourself long enough, I bet they would stick after you're off medication as well.
I definitely found I could decrease my dose after a few years because I had developed habits while on it that I never could have without. It's not magic, but I'm in a much better place now.
I understand why you're asking. I have often felt that way myself and it's why I put off getting treatment for so long. I was worried I would just end up being some 30 year old tech dude addicted to adderall who didn't actually need it. I want to address those questions in others since getting a diagnosis was so helpful for me. I want to educate around it.
The short answer is that I was diagnosed independently by 2 professionals, I have a family history of ADHD, and I exhibit all of the symptoms of ADHD.
Anecdotally, I know what stimulant abuse looks like. I have seen friends abuse adderall and other stimulants. I react totally different to it than they do.
Since starting: I'm less angry. I'm less annoyed. I have the ability to listen to my spouse talk to me. I'm not jittery or jumpy any more. I am not always singing, tapping, humming, talking over people, talking at yelling volume in normal conversations. I know when to stop talking. I can actually take naps now and go to sleep before my body almost literally shuts down like I used to not be able to.
I'd be happy to give you or anyone else a more in depth walk through how I got here and how I'm sure of what I have, but I understand that's not what you asked for.
> Since starting: I'm less angry. I'm less annoyed. I have the ability to listen to my spouse talk to me. I'm not jittery or jumpy any more.
THIS! Absolutely this.
Bit crazy that these are also the symptoms of someone on withdrawal from amphetamines and other stimulants†, huh?
But wait a sec... we had these before going anywhere near medication?
Could it possibly be we've been living a life of dopamine withdrawal?
† I was going to say "amphetamine addiction" but stopped myself... a significant number of these poor folk are self-medicating to escape the constant agony of their inner turmoil. They just couldn't get what they needed under the supervision of modern medicine, and micro-dose their intake so it delivers the beneficial effects and minimises the side-effect.
Since not all ADHD medicines are dopaminergic, people would have to be short on norepinephrine and… whatever it is Intuniv/Tenex does as well.
I'm not very keen on the "everyone needs a dopamine break" hypothesis because I'm not sure those are actually the symptoms of amphetamine withdrawal. I mean, for me when it crashes it just makes me unable to get off the couch or go home from work because I forget to do it.
I know I'm telling you what you likely already know. But please please please please try to make the appointment. The only reason I was able to was because I created some sense of urgency to do it. Maybe have a friend that you make yourself accountable to? Tell them you owe them money if you don't make an appointment before X date and then more money if you don't go to the appointment?
If you need someone to talk though it with or if you have questions, my email is in my profile.
Thanks, but i did multiple :) It is just that they tend to take a few months of waiting list each time, to hear at the end "yeah you may have it, but i do not do adults".
It is not taking the first appt the problem, it is continuing despite the system spiting in your face.
The scientific consensus of the medical community is very clear [1]. ADHD exists. It is also clear that the individuals who have it do in fact suffer from it.
Unfortunately medical science is not at the point yet where it can, in an individual case, objectively verified with e.g. a brain scan or a blood test.
You should be aware that comments like yours, while surely not your intention, do real damage to the large category of people (more than half; ibid) who have the disorder and are not receiving treatment because they are being gaslit by a society that already minimizes the disorder at every turn.
Thanks for this. You can discuss any disorder with people and they'll take you seriously, but mention ADHD and everybody is quick to point out that it can be cured/you need to eat better/you need to do more exercise/you need to try harder/it's a talent you need to embrace/it's just a ploy to get stims.
I used to be this kind of person, I ignored the fact that I had many ADHD signs, and it's taken me decades to finally figure out what was wrong with me all along was something I thought was bullshit. Getting diagnosed has completely changed my life.
I would assume from the fact they were diagnosed (as they stated) by a professional (hopefully)?
As someone who also fights an internal battle with my diagnosis 24/7, comments like this are not helpful and can even be hurtful.
Would you ask someone with a hearing aid how they could be sure they were deaf? Or someone wheelchair bound how they could be sure they can't just walk if they try hard enough?
The world of work that we have made for ourselves as a society can be as inaccessible as the built environment can be to those who need accommodations to move around it safely.
Yes, I was diagnosed by two professionals independently of each others because I was so unsure of the first diagnosis.
Comments like these are hurtful. I ask myself the question the commenter asked me every single day. I just try to approach them with care and the assumption they are coming from a good place. I know that isn't always the case, but it's the best I can do.
Also, it's wild that I already have a strategy and thoughts about dealing with comments like these. It's only been a few weeks, but it's already happened a handful of times.
Musk and Andreessen's recent comments on the matter angered me. And though I don't think Andreessenn's were necessarily out of the same place of hate's as Elon's were, they were still framed in a damaging way.
> Comments like these are hurtful. I ask myself the question the commenter asked me every single day. I just try to approach them with care and the assumption they are coming from a good place. I know that isn't always the case, but it's the best I can do.
I try to as well, I had to rewrite that comment several times to be bit more generous but had to leave it where it was. It's hard - Ironically it comes from a place of wishing the world would be more generous to you. Beyond regular therapy I don't talk openly about this, both for this reason, and as I had been struggling with, and treated, for depression for over 20 years (which it now turns out is exacerbated or even caused by the untreated ADHD).
I've spent an incredible amount of effort and energy actively hiding this fact and any consequences from employers, teachers and loved ones out of fear of what it would mean for my already difficult to maintain status quo. I've seen what the stigma of mental health can do to ones career and future opportunities (unless of course you are an active and visual advocate, campaigner as well as your normal role).
It's deeply unfortunate that it's so asymmetrical. u/symlinkk has asked a question that in isolation is merely a category error, a lazy intellectual argument regarding burden of proof, subjectivity inherent in the DSM, clinical standards regarding impairment, etc., that can be dispatched in short order. However the emotional effect of a question that implicitly denies the existence of the illness remains long after the intellectual error is corrected.
It's structurally similar to LGBT erasure. We have already gone through life for years believing that there was something wrong with us that we could fix, and therefore was a moral failing and source of shame ("just use a planner" [1]). If in fact it is an immutable characteristic akin to sexuality, then it cannot be a source of shame. One would not ask nowadays whether one was really sure about their sexual orientation. Then again, very few people recreationally take testosterone.
I can only wish you the best regards, and be grateful that we live in the modern day where science (but not the general public yet) has developed an understanding of these things.
To play devil’s advocate, wearing hearing aids would suck because you are at the whim of whatever algorithm on the aid. Furthermore, they are adjusted to your hearing range. This is how they know your hearing is gone. Phones tend to be problematic especially in ambient environments. It isn’t like wearing earbuds more like noise canceling with fairly low pass through frequency. You’d be hard pressed to find people who would prefer this over normal hearing. I assume most people would also prefer to walk. Adderall is the exact opposite. Each pill is worth $20 at any university during cram time. That tells you it is desirable by all.
There is at least some question about whether or not ADHD meds actually have cognitive benefits for non-ADHD users. This study, which is admittedly limited, shows that Adderall doesn’t provide a serious neurocognitive benefit to healthy individuals: https://www.mdpi.com/2226-4787/6/3/58
At the very least, it’s possible that the benefits to healthy individuals are highly subjective.
> "I mean, anyone benefits from Adderall whether you have ADHD or not."
What benefits of Adderall are you referring to?
Drugs like Adderall can have distinct adverse effects, like cardiac arrythmias, increased blood pressure, jitteriness, insomnia, anxiety. And drug misuse/dependence is a major problem with stimulant-class agents.
So for sure it's not true that everyone benefits from Adderall. Widely abused on college campuses, among non-ADHD students it has a small positive effect on academic performance and at higher doses is a distinct negative. OTOH for people with ADHD the right treatment (Adderall or alternative) can be greatly beneficial. (That is, ADHD treatment allows recipients to perform closer to their non-ADHD peers.)
Finding out if a person has ADHD requires evaluation by a qualified behavioral health clinician. Often it's not an easy diagnosis to make for even the best clinicians. Anyway I'd concur that diagnosis and treatment should not be attempted as a DIY project. Collaborating with a trustworthy practitioner is by far the best option.
I think you’re purposely pretending like you don’t know what I’m talking about. Adderall gives you euphoria, focus, and energy whether you have ADHD or not. For people without ADHD it’s kind of like a strong cup of coffee.
> I think you’re purposely pretending like you don’t know what I’m talking about.
No I wasn't. Though I'm aware of the effects you mention in this comment. Adderall or any amphetamine, including methamphetamine acts similarly. But I do think "euphoria" and "focus" are kind of antithetical, so likely not happening at the same time.
However people with ADHD don't experience these things, not euphoria or energy anyway. "Focus" is more like decreased distraction or clarity of thought. With medications ADHD people typically are calmer, more "centered" and more appropriately motivated to get done what they need to.
Ironically the "stimulant" medications aren't stimulating to those with ADHD. IOW they don't feel anything in particular from the medications, it simply allows them to function more fluently. Of course if the dose is way too much, even ADHD folks will have side effects (usually jittery sensations, anxiety, interference with sleep, and other effects).
Naturally I can't recommend using prescription and DEA-controlled drugs without a good medical reason, but of course I'm sure you knew I'd say that. :)
A strong cup of coffee (or anything above the low Vyvanse dose I usually take) actually makes me so jittery I concentrate even less. Though at least if you took too much Adderall IR, at least it'd wear off in 3-4 hours instead of 12.
> Drugs like Adderall can have distinct adverse effects, like cardiac arrythmias, increased blood pressure, jitteriness, insomnia, anxiety.
Because Adderall is (IMHO) suboptimal. Most of the physical effects come from the 25% levoamphetamine, a primarily physical stimulant.
Other ADHD drugs [1] are 100% dextroamphetamine, which exerts most of its effect in the brain, with minimal physical side effects. D-AMP doesn't increase my blood pressure, doesn't increase my RHR, doesn't cause insomnia nor jitters. It feels smoother than a cup of coffee.
1: then there's methylphenidate, which I've never tried and haven't studied as much.
Adderall has been one of the most popular recreational drugs since the 01960s, despite causing multi-organ failure in common recreational doses, which are higher than the therapeutic doses. If it didn't work on neurotypical brains, it wouldn't be popular.
I think you're purposefully misrepresenting what "works" means in this context. ADHD people can think a lot more clearly with it. The effect of stimulants is completely different on a brain like ours compared to a normal person as it helps regulates brain function in a way that ours can't.
For normal people it just gets you euphoric and agitated, we get CALMER cause we live in a state of constant agitation.
Spencer RC, Devilbiss DM, Berridge CW (June 2015). "The Cognition-Enhancing Effects of Psychostimulants Involve Direct Action in the Prefrontal Cortex". Biological Psychiatry. 77 (11): 940–950. doi:10.1016/j.biopsych.2014.09.013. PMC 4377121. PMID 25499957.
Ilieva IP, Hook CJ, Farah MJ (June 2015). "Prescription Stimulants' Effects on Healthy Inhibitory Control, Working Memory, and Episodic Memory: A Meta-analysis". Journal of Cognitive Neuroscience. 27 (6): 1069–1089. doi:10.1162/jocn_a_00776. PMID 25591060. S2CID 15788121.
Malenka RC, Nestler EJ, Hyman SE (2009). "Chapter 13: Higher Cognitive Function and Behavioral Control". In Sydor A, Brown RY (eds.). Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York, USA: McGraw-Hill Medical. pp. 318, 321. ISBN 9780071481274
Bagot KS, Kaminer Y (April 2014). "Efficacy of stimulants for cognitive enhancement in non-attention deficit hyperactivity disorder youth: a systematic review". Addiction. 109 (4): 547–557. doi:10.1111/add.12460. PMC 4471173. PMID 24749160.
Wood S, Sage JR, Shuman T, Anagnostaras SG (January 2014). "Psychostimulants and cognition: a continuum of behavioral and cognitive activation". Pharmacological Reviews. 66 (1): 193–221. doi:10.1124/pr.112.007054. PMC 3880463. PMID 24344115.
Teter CJ, McCabe SE, LaGrange K, Cranford JA, Boyd CJ (October 2006). "Illicit use of specific prescription stimulants among college students: prevalence, motives, and routes of administration". Pharmacotherapy. 26 (10): 1501–1510. doi:10.1592/phco.26.10.1501. PMC 1794223. PMID 16999660.
a quick scan of the papers you linked (top 2 results, I got bored after that) shows that the studies specifically refer to ADHD patients. I'm not sure the links prove the point you're trying to make.
Tangentially related, interesting tidbit from Russel Barkley:
The first of those papers (mostly about a different drug with similar pharmacokinetics) is a review paper mostly about experiments on rats, though it does also include some results on ADHD patients, and the second one is a meta-analysis of 48 experiments, specifically excluding experiments on ADHD patients.
It's not literally false that "the studies specifically refer to ADHD patients", because they do refer to them in order to explain that the results they're reporting are not in ADHD patients—in the first case, primarily; in the second case, at all. But your comment is crafted to create the false implication that their results were limited to ADHD patients. Either that is a knowing lie, or your claim to have scanned the papers is a knowing lie and your false implication is merely reckless disregard for the truth.
— ⁂ —
The first study you said you scanned, Spencer, Devilbiss, and Berridge 2015, is about the effects of amphetamines and methylphenidate in rats and healthy people, and how that relates to their usefulness for treating ADHD:
> A major breakthrough in our understanding of psychostimulant action was the
demonstration in 1980 that the cognition-enhancing and behavioral-calming actions of
psychostimulants are not unique to ADHD, with similar effects seen in healthy human subjects
(11).
> This and subsequent studies unambiguously demonstrate that when used at low and
clinically-relevant doses, psychostimulants improve prefrontal cortex (PFC)-dependent
behavioral/cognitive processes in human subjects with and without ADHD (11-15).
In the summary, it concludes:
> Low-dose psychostimulants are the first-line treatment for ADHD. At clinically-relevant
doses these drugs improve frontostriatal cognitive function in ADHD patients and healthy
individuals.
> The procognitive and behavioral calming actions of psychostimulants are in stark
contrast to the behaviorally-activating and cognition-impairing effects seen with higher doses.
— ⁂ —
The second study, Ilieva, Hook, and Farah 2015, is titled, "Prescription Stimulants' Effects on Healthy Inhibitory Control, ...A Meta-analysis." Here "healthy" means neurotypical, i.e., not "mentally ill," specifically including ADHD diagnoses as "mentally ill" and excluding them from "healthy". They explain, "Research on children, elderly, criminal, or mentally ill patients was excluded," elaborating, "Twelve studies failed to meet the criteria for eligible participants (mice: n = 1; elderly participants: n = 6; children: n = 2; mentally ill participants: n = 2, including one study on ADHD and one study on cocaine abuse; criminal participants: n = 1)."
— ⁂ —
In short, you are telling baldfaced lies about the studies I'm citing, as easily shown by the most cursory analysis (in the second case, the title of the paper), in order to continue posting vile calumnies against my integrity.
I do not think you should post any more on this site.
Perhaps you should...relax. You and the person you're responding to are having a miscommunication. It happens. No one is making any statement about your integrity.
Also, perhaps you should take a better look at the comment tree. My original request for a citation was levied against the commenter speculating that "this was made up to stop it from getting banned entirely like it is in Asia"
So really, maybe go get some fresh air. It's just a discussion on the internet, it's not worth getting worked up over.
> No one is making any statement about your integrity.
That is not correct; in https://news.ycombinator.com/item?id=31231494 luckydata said, "I think you're purposefully misrepresenting...", and in https://news.ycombinator.com/item?id=31241664 they said, "I'm even more convinced now than before that you're in bad faith." Decent people considering commenting on here should not have to worry that they'll be subjected to such character assassination.
(And neither should I.)
Thank you for clarifying your comment. I think the Spencer et al. paper shows that it wasn't made up to stop Adderall from getting banned entirely; rather, it was a belief that was common among researchers in the field until 40 years ago, based on clinical observation. Also, Adderall is not banned entirely in Asia; for example, last I heard, it's legal in Thailand.
It's not completely different or even mostly different. Getting euphoric and agitated happens with doses an order of magnitude higher than therapeutic doses. Low-dose Adderall has been used to help neurotypical people focus for at least a century, though not of course by that name.
Your vicious, baseless attack on my integrity has no place here. Withdraw it immediately.
In https://news.ycombinator.com/item?id=31243297 I caught you outright lying about what the relevant studies said, I suppose in hopes that other people wouldn't read them. Your accusations of bad faith are groundless and have no place here. That kind of conduct does not belong on this site.
It absolutely has, going by people's subjective ratings, different effects on NT people. That's not to say it doesn't work, there are plenty of explanations. We don't really get how neurotransmitters interact, so it's possible these drugs trip some cascade effect which incidentally treats ADD. More likely, there's a good place to be on the tradeoff curve and different symptoms below and above it. Perhaps large enough doses could push through (though I doubt that amphetamines are so well targeted to permit it), but it's fair to say that if I'm at a 0 and Adderall takes me to a 2, and an NT person is a 3 with Adderall taking them to 4, I can get to 2 and they can't. Is that "working differently"? Depends on how you look at it.
It, for many people, works differently. If you look at people talking about their experiences, those with ADD consistently describe different effects than NT people. It's still good, but it has more of an effect on energy than focus, though the two are well correlated. It might be an overshoot/undershoot thing, it might be that different effects are salient, but I can assure you that if Adderall could do as much for a healthy person as it does for me, we'd be living in utopia.
Thank you for having this perspective to help treat your adhd patients, wish there were more like you. I’ve encountered quite a few doctors who admitted they are scared of the DEA and losing their license and make us jump through flaming hoops to adjust dosages of stimulants or force us to navigate a byzantine maze of psychiatry to get to a psychiatrist that will take the liability away for prescribing/adjusting scheduled medications.
This is even with 10+ years of diagnosis.
Do you have any insight into why it is this way? Have physicians always feared the DEA and threat of losing their license in pursuit of helping their patients try different controlled medications? Did the pill mills ruin it for the entire medical industry?
Amphetamine has such an interesting history. Synthesized in 1887, first used in the 1930s, and in 1937 discovered to have a remarkably favorable effect on hyperactive boys. Methylphenidate (Ritalin) came along somewhat later.
85 years later these two drugs are still the mainstay of ADHD treatment. Sure delivery systems have proliferated and drug variants have been available. Stimulant-class medications remain first-line treatments. Amazingly even after nearly a century nothing better has ever been developed, and it certainly hasn't been for lack of trying.
Prior to 1970 there were relatively few restrictions, but widespread abuse lead to legislation establishing the DEA and tightened regulations. Drugs of abuse were sifted into a schedule of classes 1 to 5, where class 2 drugs were legal to prescribe but subject to limits intended to reduce diversion and misuse.
BTW one of the legal schedule 2 drugs is methamphetamine, approved for ADHD. We know it can be misused, leads to severe dependency problems, but used properly is an effective and quite tolerable treatment for ADHD. Indeed I have prescribed it for a number of patients in the past.
With the huge opioid crisis that's emerged in recent years scrutiny by state licensing boards has increased regarding prescribing patterns. This is making many prescribers nervous to the max. While the thrust of regulators has been in regard to opioid drugs other scheduled drugs such as stimulants, benzodiazepines are caught up in it as well.
Primary care docs are affected by the zealous "witchhunt" in regard to prescribing practices. Hospitals, clinic administrators, etc., are equally touchy about docs prescribing scheduled drugs. So prescribers anticipate getting static if they prescribe stimulants however reasonable it may be. Especially true for PCPs who lack specific training in managing ADHD--harder to defend their actions if challenged by admins.
Among psychiatrists (who should know about ADHD) other factors are operating. Some don't like dealing with ADHD patients, notorious for poor follow through, don't show up for appointments, lose prescriptions, don't pay their bills, etc. Also ADHD cases are frequently more complicated than average due to comorbidities, social issues (marriage/family problems, difficulty at job, etc.), potential for substance use disorder.
Patients without ADHD are more likely to be comparatively more straightforward to deal with, so ADHD sufferers aren't accepted as patients.
Yes indeed, "pill mills" have made everyone's life more difficult. But it doesn't mean every doc who prescribes scheduled drugs operates a pill mill. The tendency to throw out babies with their bathwater is fearsome to many doctors.
Here's my advice to colleagues: every patient deserves a thorough diagnostic evaluation. If ADHD is one diagnosis, it should be treated vigorously within appropriate clinical guidelines. If stimulant treatment is indicated start with a low dose, titrate gradually until reaching an effective and tolerable level. Do not neglect behavioral treatments, these are essential. (Book-length description in progress.)
The SECRET to successful treatment and keeping regulators at bay: excellent clinical documentation. I never was "in trouble" over prescribing, I had the records showing rationale for every prescription, so nothing to be afraid of.\
Your story isn't unusual, there's a shortage of qualified, and willing, providers in this domain. Combined with a cultural bias against and misunderstanding of people with ADHD the treatment situation is troublesome. Educating providers and the public is badly needed. If that's done, over time availability of high-quality care for people with ADHD will improve.
Thank you so much for your detailed and response. Your patients are so lucky to have you! You should really speak at conferences, your voice needs to be heard on this topic!
Do you know how a patient would get funneled to someone like you with expertise on this matter?
My experience with GPs is that they do not understand those issues and do not know how to direct to someone who does. It's not like a physical ailment where they know with a fair degree of certainty what the next avenue is.
Yes, it is a problem finding clinicians with interest in and experience with ADHD adults. In larger cities there are usually a handful of people who qualify, sometimes associated with teaching hospitals. Another possibility is asking at a college or university health clinic (even if you don't attend there).
Organizations like CHADD, local or state psychiatric associations have referral lists that can be useful. Likewise some insurers publish lists of clinical specialists. Other folks with ADHD who are in treatment might have a practitioner with room to see a new patient.
Pays to keep trying to find a provider you can work with, it will happen sooner or later and will be well worth all the trouble you went to.
What improvement would an adult with ADD (without H) have without being diagnosed and without having access to a treatment ? I may or may not have ADD but diagnosing adults in my country is extremely uncommon, and anyway the symptoms I have can be indicative of many other mental troubles, so I'm interested in not-medical ways to cope
I have ADD. Not ADHD; I'm almost never hyperactive. I do, however, hyperfocus on anything and everything, to the point that it's caused severe problems to my career, relationships, and personal life. I'm nearly always hyperfocused on something, and I rarely have control over what that is. I'll forget to eat, sleep, talk to people, or really do anything else for several days at a time when it gets bad. Fortunately, over the years I've learned techniques to solve some of the problems, like having somebody to hold me accountable. Even so, it remains my biggest challenge.
However, it's also one of my greatest strengths. When my brain decides to attack a problem, I'm astonishingly productive. Over the last couple of weeks, I've been hyperfocused on implementing a motion control system for a side project. As a result, I've designed a CoreXY platform, designed a control board for it, learned how to use ngspice to tune the power-up circuit, learned how to use Sympy, used it to derive closed-form solutions for jerk-controlled motion, and found a way to implement that solution in which the motion control interrupt takes a grand total of 70 cycles on Cortex M0. And this is just my spare time outside of work, where I had a completely different set of hyperfocii, and similar productivity.
So, I completely agree with the author that if somebody were to offer me a megadollar in exchange for getting rid of my ADD, I'd have to think very hard about that indeed.
ADD is just old terminology. You have ADHD, and you should read up on some updated science cause you got some very weird, very wrong ideas about your own condition.
[...] 15 The clinical presentation of ADHD can be described as primarily inattentive, primarily hyperactive-impulsive, or combined,
depending on the nature of their symptoms (American Psychiat-ric Association, 2013). [...]
I assume ADD is nowadays just a shorthand for the primarily inattentive presentation.
I find this distinction to be confusing and not particularly useful. Brace for armchair science!: Although it may present as primarily inattentive, the hyperactive stuff can sneak through subtly. I think it becomes un-learned a lot of the time by adulthood such that the DSM criteria don't _seem_ to apply as strongly but it can very much still be there. At least for me, I think I have 'learned' to be more 'chill', but I still can't help myself from interrupting people a lot of the time.
I use it that way too cause my non-native english tongue struggles to pronounce the H but saying "I don't have ADHD, I have ADD" is really specifically and factually wrong.
As someone diagnosed with ADHD later in life, a lot of these ADHD superpowers are just the result of taking dopaminergic stimulants. Especially the hyper focus and feeling superior to people staring out the window or failing to heads-down work for several hours straight. Yes you can hyperfocus even without stimulants, but the real superpower is having access to them so you can channel that consistently.
I personally believe everybody should be allowed to take these stimulants if they want to, because many people would benefit from it. The propaganda around stimulants working radically differently on those with ADHD vs those without is just that (I can go on about why I think that in much more detail). Ask anybody you’re close with how taking their friend’s adderall to study worked out. Look into people like Paul Erdos.
Anyway, I think you can definitely argue that there is a lot more nuance to psychiatry than you see in clinical settings (probably many disorders should be broken up into multiple others, others are just symptoms rather than a problem itself, others are not even disorders but just a different way of being). But really all that matters is that psychiatrists can match symptoms to treatments that work. Matching poor/misdirected executive function to medication that “boosts” dopamine and norepinephrine works pretty well, so why worry about the name of the condition?
> As someone diagnosed with ADHD later in life, a lot of these ADHD superpowers are just the result of taking dopaminergic stimulants. Especially the hyper focus and feeling superior to people staring out the window or failing to heads-down work for several hours straight.
This is the complete opposite of my experience. A lot of my life has been dominated by a hyper-focus that feels like it isn't under my control. I would stay awake reading until I can't think anymore with relentless pursuit of something that was entirely non-relevant to critical priorities in my life.
I very recently (past couple of months) started taking stimulants, and one of the biggest differences for me was the feeling of desperation to pursue was greatly relaxed. Not gone, but definitely not as intense.
I think a lot of the problem here is the definition of focus is overloaded. For me, there are (at least) two distinct levels of focus on different time scales. I define short-term focus as stability on task level executive function. Can you tolerate a brief interruption and go back to what you were doing? Or plan ahead for the next task? This ability is absolutely compromised relative to the population norm for me. I have essentially 0 local stability.
On a longer time scale, I think a similar stability notion applies. I frequently get completely engrossed for periods of a few weeks on a topic - beyond healthy levels of interest. But one day, it's just gone - vapid.
Time for some serious hand waving: my mental model of what stimulants do to me decrease the activation threshold for picking something in an executive space. By lowering this plane, it's easier for me to remain more stable as the surface is a lot more clear.
I'm curious to know if what I'm saying sounds like 100% bullshit though - I haven't really talked through this mental model with anybody.
I am responding specifically to some of the paragraphs in the essay where the author mentions working non-stop for hours straight on something in a quiet room, while their peers who were "studying" were spending some of that time chatting or bothered by some distraction.
Without medication, at least for me and I suspect almost all other people, hyperfocus is something that comes and goes at random and is rarely centered on what it should be (even if I do find it interesting, like real analysis coursework). But even regular people hyperfocus when they take adderall.
This part of the author’s account struck me as well. Like, yeah it would be great if I could summon the hyperfocus at the right moment, and sometimes impending deadlines/tests cause that, but more often than not it just doesn’t work that way. And if it does, the last-minute cram session is way more stressful and less effective than actually doing the work over time would have been.
Yes, the author got that A that one time, but what could he have achieved if he had managed to work on it for more than one night? Or put another way: if you are lucky enough to succeed and level-up through the academia/career/whatever ladder enough despite these problems, you’ll eventually get to a point where cramming doesn’t cut it. You’ll be surrounded by people who are just as smart but who can actually focus at the right times on the right things, and then you’ll struggle (speaking from experience).
I can focus for hours straight in a quiet room but:
a) I can't choose what to focus on. So if I need to do something but it's not the latest thing I'm obsessed about, tough luck
b) Deadlines help but if it's not something I'm obsessed about and there's no deadlines, not going to happen
My experience maps the author, I did well in university because becoming super interested in a subject and reading everything about it for a couple of weeks to the detriment of everything else worked well. Well it worked well in France where we had 2 exams a year and all exams were open book, it didn't work that well in the US where tests were more regular and memorising random uninteresting fact was expected (I lost point in a computer graphics class for not being able to give the name of companies that were members of the Opengl architectural board or when the first version was released... Who cares??)
After graduating, I'd say the fact that I get very interested in things and completely focus on them actually helped me in my career. On the other hand, my inability to do paperwork, send invoices on time (been a consultant most of my life), do my taxes etc lost me around 150k so far. So, it's a double edged sword for sure.
You got me curious, so I read your other comments :) And yes, I totally can relate to " I frequently get completely engrossed for periods of a few weeks on a topic - beyond healthy levels of interest. But one day, it's just gone - vapid."
This is coupled with a bit of a shopaholic tendency where I'll buy anything that would be useful for my new topic of interest (I didn't use to do this, but now I have disposable income so there's no more barriers to doing it) and sometimes by the time everything I bought arrives, I'm just no longer interested.
It's been useful for work because occasionally I will have unhealthy amount of interests in something that will be useful for my work. It's just that it's not controllable.
I relate to what you say about stimulants, however one problem I have is that if I'm not very well rested, concerta makes me sleepy. Unfortunately, I have a newborn so sleep is compromised and that means that right now stimulants cannot help.
Yeah I have the same problem with purchasing stuff for projects - having high income makes it a little too justifiable. When it applies to work though it can be very useful.
Thanks for sharing, I really appreciated the last half. Good thoughts generally One downside I think after reading here is that there is some wacko in the first half of the post that I feel compelled to comment on a few things.
Hyperfocus is a symptom of ADHD proper. Stimulants can also make you feel hyperfocused. However, the general reported effects of stimulants are a feeling of "normalcy", not hyperfocus as a result of stimulants. Many people taking stimulants are still symptomatic, albeit managed, meditation long term is generally an excruciatingly (if excruciating) adjunct to stimulants.
Second, Adderall often gives the feeling of superfocus and speed to neurotypical individuals but has been statistically shown to give little gain in practice in terms of certain raw metrics. A very strong dopaminergic placebo, as it were. I'd suspect the reason for it being considered effective is that it keeps you glued on tasks for significantly longer than otherwise . It's not propaganda, it's science, you can look at the studies yourself, it's pretty drastic. However there may be another layer on top of that that that could be propagandizing what is otherwise a valid scientific distinction.
Much agreed in the last half, I've seen a lot of subclinical dissociative like disorders fall into ADHD, or DPDR, when really there is probably a core condition and several other families lumped in. Such is always the curse of dimensionality reduction. A more root-cause preserving descriptive language set that doesn't rely on the anchor of billing codes would open up the scientific fields a lot. Language determines nomenclature, which determines assumed avenues of exploration. A dimension reduced model of mental health along symptomatic axes will almost always destroy symptom and condition "root cause" linkage. Additionally like you noted anxiety and depression are more symptoms of traumatic disorders and less actual disorders in and of themselves. My pet theory is that's one reason why "depression" is so hard to cure, imagine trying to generically cure "fever" instead of making vaccines, etc.
Ramble over! I think (especially later on) we think pretty similarly!
According to the DSM, the way you get identified as having ADHD is by reporting persistent executive function (esp. for inattentive type) and/or impulsivity-hyperactivity problems [0]. Most people grow out of the H-type symptoms as they mature but I is more persistent and suspected to be less diagnosed[1]. What I mean is that anybody who thinks they have executive function problems likely does.
Yeah, hyperfocus is a symptom of ADHD proper. But if you're unmedicated, for most people it's not something you can control - if you could, it wouldn't really be a disorder at all. I was responding specifically to the following paragraph:
"Until I got to college I didn't understand how people could spend hours a day “studying”. When I got there I found out. When my first-year hallmates were “studying” they were looking out the window, playing with their pencils, talking to their roommates, all sorts of stuff that wasn't studying. When I needed to study I would hide somewhere and study. I think the ability to focus on just one thing for a few hours at a time is a great gift that ADD has given me."
That's pretty much exactly what it feels like to take adderall. For me taking stimulants like adderall allows me to force focus even on stuff I don't care much about/even when I don't normally feel like it. And yes, this is exactly the way people without ADHD feel too (as you mention - even if you don't have ADHD, you can still focus on-task for a long time and feel smart as fuck).
What you mention about dopaminergic stimulants only actually benefitting people with ADHD is likely an oversimplification. To meet the DSM criteria (and thus, in most clinical settings, to get diagnosed with ADHD-I) you just need persistent problems focusing. Hence my overall point that anybody that thinks they have trouble focusing should be able to just take adderall. ADHD is a spectrum and not a binary condition anyway. You can meet 4 DSM criteria and remain untreated, or meet 5 DSM criteria and take 60mg of amphetamine every day.
The "propaganda" is that ADHD is this cut-and-dry binary condition where people with ADHD who take dopaminergic stimulants totally don't get high (go on /r/ADHD and read any post about someone taking medicine for the first time), hyperfocus/tunnel-vision (ie "bad hyperfocus"), chatty, irritiable, or have trouble sleeping. And conversely that people without ADHD who take dopaminergic stimulants will only masturbate, stay up late, dance at a club, or take apart their neighbor's lawnmower. When in reality this is mostly set, setting, conditioning, dose, habits, tolerance, dose metering, and expectations.
And as a consequence of this propaganda, mostly because some people benefit a lot from taking dopaminergic stimulants but they also get you high and our society moralizes against that, plenty of people who don't meet the formal requirements for ADHD under the DSM, are subclinical or at the threshold of being clinical, can't afford a $100 copay every 2-4 weeks, or don't have the executive function to seek treatment remain untreated.
I think he's definitely talking about natural hyperfocus - for one thing the author is in his 50s and I don't think you could get ADHD drugs as easily in 1985.
It is hard to control, but it can help you do one thing as long as you're willing to abandon all other parts of your life, like eating/sleeping.
I have ADHD (ADD), and was diagnosed after 30 - though I've greatly suffered from it since my teenage years. Sure, it is a big part of me, always has been, but I don't really make it part of my identity. I can't control it like a superpower, and there are serious consequences if you're not careful.
I've noticed that in the ADHD community, there are some very vocal people that will wear the diagnosis with pride. I mean, good for them - but it is not really anything I can relate to. I treat it pretty much like I treat my gout...take my medication, adjust my lifestyle, and go on with my day.
Exactly. I can point to specific ways in which my (at the time, undiagnosed) ADHD has negatively impacted my life: I never finished my PhD because I couldn’t execute a dissertation. The coping mechanisms that had served me reasonably well during my young adulthood suddenly stopped working during the pandemic. So, I became unable to motivate myself to a deadline, which had generally been a powerful force to motivate my attention and efforts. Based on my raw intellect alone, I should have been able to contribute more substantively than I have (or, frankly, than I will ever be able to do). I feel that loss.
ADHD is a curse, and I will never be able to see it as anything but that. Am I grateful to know why I am the way that I am? Certainly. But I will never be able to get onboard with the “ADHD as superpower” line that some fellow ADHD folks have adopted. Glad they can see it that way, but if someone offered me a way to 100% cure it tomorrow, I’d take it and never look back. Getting medicated has made a difference in my life, to be sure, but I can’t imagine ever seeing this condition as a positive aspect of my identity.
> The coping mechanisms that had served me reasonably well during my young adulthood suddenly stopped working during the pandemic. So, I became unable to motivate myself to a deadline, which had generally been a powerful force to motivate my attention and efforts.
I have experienced the exact same situation (but with work)... always been motivated by well-planned deadlines, but it just... doesn't work anymore?
I'm trying to figure out why. Suspect a combination of WfH, unrelated family issues, dealing with diagnosis and past trauma, a general surge in anxiety across the board resulting in a total burnout of any motivation... just ceasing to care about anything much at all.
High five back to you. No shame in that game. I’m mostly just glad to have learned that my issues weren’t just because I was “lazy” but because my brain just doesn’t work that way. I learned something about myself, even if it cost me a few years to learn it!
And I wish you all the best. When those coping mechanisms run out, they run out hard. My wife is an attorney, and one of her best friends at work clearly has undiagnosed ADHD. We both keep pushing her to talk to someone about it because I know the day is coming when she’s going to hit that wall, and I seriously don’t wish it on anyone. It’s bad. When it happened to me, I had no idea what was going on. I’d always been able to just get things done (albeit in absolute panic mode), and then suddenly I just wasn’t able to. Keep fighting, my friend.
> When those coping mechanisms run out, they run out hard
Oh, don't I know it.
Have switched career paths a few times because of it. About 4-5 years to ride the wave up before the crash.
Thankful for MY partner... because she's an absolute harbour in the storm. All the executive function I lack, and then more to spare. Otherwise I'd probably be homeless, imprisoned or dead.
I wish you all the best on the journey. It’s a hard-as-hell place to be in, but I’m glad you have someone who can balance things out. (I’m fortunate to have the same!) But it’s still a path you have to figure out on your own, and I’m glad you’re in a good place with it now.
Personally I don't like seeing it as a regular illness. Yes it's a complication to how society wants people to function. Work 8 hours a day 5 days a week. Go to school 6 hours a day 5 days a week. Be productive in that time frame. Keep focus on given tasks.
You can take medication to adhere to these artificial expectations on how an individual should function within society. Or you can live in a way that matches your natural behavior and capabilities.
Granted, we sometimes cannot avoid having to function in the expected way so medication is helpful. But seeing it as an illness that one needs to constantly surpress just doesn't sound right to me.
It's part of my personality. I'm not proud of it. But I also certainly don't see it as something that needs to be constantly treated.
I generally agree with you. But on the other hand, my ADHD makes me way less reliable as an employee, a spouse, and a friend. I’m not sure it’s really right for me to expect people to continually bend over backwards to accommodate my disorder. My ADHD is an illness, and I don’t think that’s just because I’m expected to adhere to the norms of a neurotypical society. A world run according to ADHD norms would be an absolute nightmare to live in! I perhaps wish there was a wider and more correct understanding of the disorder (i.e., it doesn’t just affect children, it’s not only an attentional disorder, etc.), but I’m not particularly bothered by other people expecting me to adhere to social norms of timeliness, behavior, and so forth.
You put this quite well. I knew I was ADHD long ago, and just went about my life not wanting to change. And I even found a job which wasn't particularly negativley affected by it. But finally I realized how badly it was affecting my relationships with my spouse and child. I was not a reliable partner or parent. And that is what finally made me want to really understand more and try to control it better.
I have been diagnosed with an anxiety disorder and I feel the same way about it. It's not an illness, it's simply a maladaptation to the kind of world we live in.
Most milder mental disorders are probably like this; it doesn't make any sense from the evolutionary point of view that a significant proportion of the population would have largely genetic trait that is only harmful in all situations. It's just that traits like ADHD and high levels of anxiety probably were helpful - or at least not harmful - in our evolutionary context, but are not anymore.
> It's just that traits like ADHD and high levels of anxiety probably were helpful - or at least not harmful - in our evolutionary context, but are not anymore.
This. In tribal times it was an asset. A few individuals that sleep till noon and stay up all night? Who cares. When the tribe got attacked by others or wild animals they could save 100-150 peoples lives.
it's a disorder when it effects how you function and how happy you are with your life. if you can live a happy life without medication, and neurotransmitter deficiencies, kudos.
some people with physical deficiencies have no issue navigating the world, and some do. same with queer folk. same with people with ADHD. sure there's a societal aspect, but there's also relationship aspects and everything else. we don't live in a vacuum. you can't look at it from the perspective of "if we were hunter-gatherers we would be fine" because that's not the reality of the world.
and fwiw there are plenty of things one can do that are not working 8 hours a day, that are not working during 9-5, that are not focus related. you just choose not to do them, or do not find the proper opportunity.
and that's why medication exists. so people _can_ do normal things and live a normal life. the system isn't great, to be fair, and i wish it were reformed, but until the glorious proletariat uprising, i'd prefer people get the mental health they need to focus on their lives and not some fictitious idea of what may be
> You can take medication to adhere to these artificial expectations on how an individual should function within society. Or you can live in a way that matches your natural behavior and capabilities.
What if the behaviour causes pain to you? What if it's the cause of your anxiety, depression, loneliness, addiction? Because at a certain point, you need to admit that it's not that you need a life that matches your capabilities, but some help.
Would you think the same if someone were short-sighted? Should they live in a way that everything is at arms reach?
If it makes them better than other people at reading things up close, such a person could thrive in an environment that demands that. Of course, they should also be able to wear glasses when the environment demands it.
I agree. My adhd has never made me more able than anyone, but has certainly been a detriment to myself and those around me. The best I can do is not hate myself for what I evidently can’t control, and continue working to lessen the damage it does. I mean, I was diagnosed because it’s a problem. Not because I have super powers.
I think the idea of wearing it as a badge of pride is because that reflex is easier than being more honest and introspective. At the same time it might help soften the pain. If you have a disability, you are a strain on those around you. You shouldn’t be ashamed of it, but you shouldn’t be prideful either. You should be proud when you succeed against the odds and you know it took hard work, but that’s not adhd happening.
For a brief time I entertained that I should be more adhd positive. Ultimately I realized that bias is not helpful at all if it clouds my perception of how it impacts my life or those around me. For some people though, perhaps it helps lessen the burden of the common self-loathing that tends to manifest as sufferers age.
I agree that some people could choose to see the positive aspects of adhd because it's less painful, but it doesn't mean they are deluding themselves. As a startup founder I think adhd worked both for and against me. Hyperfocus, the ability to perceive constant emergencies as fun, mania, etc. Downsides were very real too; dropping out of college because it was too boring, not opening my mail on time, being late with things, being disorganized, etc. Now that I have access to medication, I see it as a net positive.
for me, it's the lateral thinking that really comes in handy. I can catch weird bugs a lot quicker, and my tenancy to yak shave has led to a pretty awesome kit of tools for every occasion.
I've managed to fix a lot of the organizational problems with a multi pronged sleep / exercise / med regimen, too. All in all, I'd call it net positive.
I can see it from that perspective as well. I’m not trying to be cynical either; I don’t doubt that in many cases, with the right support and personal growth it can absolutely be a net positive. Perhaps over time it’ll be a net positive for me as well.
Similar. I don’t understand wearing it with pride. There is no pride in it. It’s not an accomplishment. When people do this, it looks like a pre-emotive cop-out. “I’m saying to everyone I have ADHD so that if something goes wrong, I have something to blame and can also blame you if you are the authority for not giving me a pass”.
I think you're right, over the last couple years i've noticed ADHD as becoming like a hobby mental disorder. Lot's of people claim it as like something to be proud of. If you really have ADHD then you know it's an absolute miserable experience and the right medication can change you're life. I wasn't properly diagnosed until my very early 30s and I bounced around different medicine until i found the right one and dosage for me. The level of mental peace it has afforded me cannot be overstated. Anyone bragging about having ADHD doesn't have it IMO.
I have it, have had it since I was a kid, and it's moderately treatment resistant to boot, so I'm acutely aware of how much it sucks, and I wear it with pride. I don't take pride in my depression and mood disorders.
I think the big distinction, and what TFA is getting at, is ADHD actually is more like a true neurodiverty than a disorder. The dysfunction largely manifests due to the constraints in the modern world. I love making things but I hate "adulting" - bills, paperwork, keeping 9 million small things in order. Were I living in a hunter-gatherer or early agrarian society, things would be different.
I'm able to offset bad prioritization skills by being really good at breadth-first search and having a huge knowledge base from curiosity driven rabbit holes when I should be doing my "real" work. It feels much more balanced than depression, which just sucks the life out of me and reduces all aspects of quality of life across the board.
Why wear it at all? I was diagnosed last year and there are 3 people irl who know about it. Not because I'm ashamed or anything, but because I don't identify myself by it. These are my personal struggles and if something goes wrong, it's on me, not whatever illness I might have.
I also think it's irrelevant that in some perfect (historical) society ADD would be perfectly suited, because I don't live in that society. I live in the modern one and I want to be a productive part of it.
> I bounced around different medicine until i found the right one and dosage for me
How did you know you hit the mark when you found it?
I have been trying for the greater part of a decade, and I think there are only two possible explanations at this point:
1. I am one of the x% of people that medications do not work /as well/ for.
2. I have too high of expectations of the effects of the medications.
Doctors have been no help, and I do not mean that in an arrogant way. But when I ask, "how do I know if the medication and dosage is optimal?" They act like I am asking if P = NP.
Not GP, but I've commented on a few of your comments so far, so will keep going.
I still haven't repaired a few things in my life that still cause me significant stress (happy to go in-depth if you email, see bio), but I really had no idea what the medication would do until I tried it.
For me; it quietened my (extremely vocal) inner critic and therefore lowered my anxiety, and it slowed down the rapid bounce-around of my thoughts, particularly in situations where I wasn't deeply stimulated (eg I outlasted my kid playing ball for the first time ever because I stayed interested and wasn't just counting down the minutes until I could say 'okay that's enough'). And that's it.
But that means I can actually start to do the hard work of building the right habits to put some important bits of my life back on track, particularly when they'd been built wrong and have to be torn down.
I honestly think it’s probably 2. I’m on 36mg of Concerta and .2mg of Clonidine. The combo has helped with my mood regulation, working memory, attention, and (to a much lesser extent) my motivation. But it’s not a cure-all. I feel like it helps me to get to Everest base camp, but I still have to climb the damn mountain. My wife is a litigator, and I am daily made very aware of the differences in our ability to organize and execute tasks. I’ve found that medication will get you to a baseline ability to function, but it’s on you to develop the external structures that can enable actual success/productivity/etc. If you aren’t already familiar with the work of Russell Barkley, I’d highly recommend it. He emphasizes the need to create informational strategies to supplement the medication. The meds are helpful—tremendously so—but they are a starting point.
I think you are right. It's taken me many years and many bouts of trial and error to come to that conclusion.
> I feel like it helps me to get to Everest base camp, but I still have to climb the damn mountain.
I feel like I can climb the mountain most days, but I can't get to the base camp to get started. I've actually considered if there is something else lurking in the shadows like Sleep Apnea or something else? I just know I have an odd issue where no matter when I take the meds, they do not work until around 1:00/2:00 in the afternoon. I have no idea why -- maybe I need to build a base level for them to start working? Doctors think it's highly unusual, but seem to offer little to no advice past that point.
> I’ve found that medication will get you to a baseline ability to function
I will say, it does wonders for my physical hyperactive symptoms, but it does tend to make me talk faster (I've always talked fast to begin with) and I tend to want to talk more/longer. It's nice to not have to pace and bounce around all the time.
Still, I have noticed I tend to feel a bit more impatient in someways -- like I doubt I could sit down and just read a book. I'd still get bored or distracted and feel compelled to do something more stimulating as my mind tends to feel a bit overclocked.
> If you aren’t already familiar with the work of Russell Barkley
I am familiar with him. I do respect the work he has done, but I also have some qualms with him. I feel like he tends to overemphasis the effects of medication, and it feels kind of odd coming from him since according to his Wiki, "He has been a paid consultant, for pharmaceutical companies including Eli Lilly, McNeil, Janssen-Orth, Janssen-Cilag, Novartis, Shire, Takeda pharmaceuticals, and Theravance."
I do appreciate his research and opinions, and I think he means well, but just because he is the leading researcher in the field does not mean he cannot be incorrect about some things.
I am still dialing things in myself, but a few things I have noted so far. On one I was able to notice just over 8 hour after taking it every day a behavior change back to being on my phone and distracted. It meant something was working at least. And I have a few times, though definitely not regularly, where I can just sit there and be in the moment. Not thinking about work, not wanting to google some random thing I am curious about, nothing. Just there without distractions. Its rare, but I am hoping to get to that place more regularly. At least I think that's what I am supposed to be aiming for. Otherwise I am part of that #2 and have too high of expectations as well.
> On one I was able to notice just over 8 hour after taking it every day a behavior change back to being on my phone and distracted.
I still do this even while medicated. Except, it can actually worse because I can focus on distractions longer than I normally would have pre-medication.
Do you not think it affords anything at all, though? I agree that being well medicated is essential, but it's not like it makes it go away; there are for sure still differences in how I think, and when harnessed properly through meds and routine, those differences are a boon.
It's not really a brag, but I'd rather be medicated and keep a routine than lose the things that make me different as a knowledge worker. I'm a more lateral thinker than my peers, and that comes in super handy, for example.
Same, it's been nothing but a liability and to be perfectly frank it makes my daily life way more stressful than it should be.
The biggest part I don't like is the inability to ever really be 'here in the now' e.g. enjoying the moment. All these important life events just fly by me without even reacting to them it seems, and only in hindsight do I start tearing up thinking about what I missed.
ADHD like many different things are a spectrum. You can have a slight disorder or you can have a really really strong one.
I’m saying this to a level where I personally know bloodlines where men suicide is just a thing that “will happen”. Guess what is the last year’s diagnosis on that?
I live in a society where official stats says that 0.0-0.1% of population is affected and such treatment is not needed. From multiple available treatment options (where single one has around 30% efficiency) there are only 2 available. I recently heard a joke that probably full European country has at most 2 ADHD therapists. Sure maybe you’re lucky enough to get diagnosis but then you might not even be able to treat it meds unless you emigrate. That’s why pride is important - it creates advocates. Advocates creates awareness and awareness provides solutions.
As you mentioned your diagnosis there is a chance you’re sensitive to the critique (it’s often coexisting). Keep in mind that your critique is targeting exact same people like you who struggled with it and came out with pride. Don’t take that away from people.
Completely agree. I think it is just part of the general trend for people to try to attach themselves to labels in search of an identity or community - of course some labels are very readily apparent so you are kind of forced by society to identify with the label, but for a mostly invisible condition like ADHD I really don’t get it.
On a lot of ADHD communities it’s just a constant struggle session about how every problem in people’s life is because of ADHD. It’s exhausting and seems maladaptive.
That is why I think my diagnosis was a double-edged sword. It helped give me a lot of answers and closure to past traumas, but with that knowledge I think it has somewhat held me back from things I have wanted to accomplish. I have used it as a reason as to why I couldn't do something, when the reality is that ADHD wasn't what held me back, but damn was it an easy scapegoat.
My diagnosis last year was primarily a way for me to figure out how to deal with it. It gave me a framework to think inside, gave me treatment options (medical and therapeutic) and it gave me hope that my future didn't have to be as disastrous as my past. It was invaluable.
It is quite possible that some of those who "wear the diagnosis with pride" have more pronounced symptoms that are not as well addressed by the medication. In which case, they have no alternative but to wear it. Speaking from personal experience at least.
There are many who believe certain abilities they have are because of adhd rather than skills they have developed despite the disorder or plainly individual traits.
The diagnostic criteria for mental illness is, to simplify, that an aspect of your mind causes significant problems. If it doesn’t, as the author’s attention seems not to, then you probably shouldn’t be diagnosed with the disorder.
Comparing yourself, when you have mild characteristics in common with a diagnosis and then saying it’s not so bad is perhaps not so helpful to those who do struggle with it.
Are you implying that the author did not get a professional diagnosis and is merely comparing himself to people who have ADHD?
When I was diagnosed with ADHD, the disorder did cause me significant problems. Over the years I have managed to do a lot better, where I can now relate to the state the author is in (just the ADHD part, I do not suffer from depression).
What I'm saying that if "it's not so bad" is reasonably true, the various disorder labels don't apply, perhaps they did and do no longer, perhaps they never did. A "cure" for ADHD looks like "it's not so bad any more".
ADD and ADHD have 5 sub-symptoms of varying impairment, with varying degrees of severity.
If you're diagnosed ADD/ADHD you can have a wide variety of direct and secondary side effects for which treatments can improve your success and quality of life, and it's not very kind to dismiss their experiences regardless of what other people are going through.
Since the topic has come up again, I'd like to take the opportunity to thank the people on HN who have commented at length about ADHD in the past. Without it I might not have realized that the thing that's made my life laborious, if not miserable, since I was a teenager wasn't me being « lazy » or my « temper ». I simply happened to have ADHD and never realized it. Without it I might just have lived the rest of my life thinking that I'm just that way and I'll never be able to fullfil my goals because my brain won't let me. That's a sort of despair I don't know many people can emphasize with, at least none whom I'm familiar in my everyday life.
Over the years I had come up with ways to deal with myself, but they're barely sufficient.
The part I hate most today is that if you relate to a video on ADHD/DID/Depression/Schizophrenia/etc, you will be fed the content until you convince yourself you have a “character trait”. That’s a serious problem with long term effects on society.
I’m very sure I sit somewhere on the spectrum and have depressive disorder markers as well. But the last thing I want to do is to promote these traits. I am not proud of them nor hiding them. They do make me unique. But that’s my business, not the world’s.
What worries me is how easy it is to get diagnosed. TikTok for example will also show you ads for a simple single click ADHD diagnosis and medication plan. Almost as if it’s being handed out like candy.
I found tranquility by looking inward for answers, not outward. I go on my “mental health” walks/runs. I even have taught myself to be mindful enough to notice when platforms like TikTok are emotionally manipulating you and I’ll be half crying while coming to a realization that this keeps me addicted. As I separate myself more from tech and to more nature in the world, these “character traits” don’t seem to be so defining anymore. It’s just a personal observation I’ve made as screen time declines.
I blame the medical profession for not better promoting the concept of normal human variability in these traits, too, and educational leadership for not differentiating career oriented education around people's strengths and weaknesses there in secondary school at least.
Contrary to the depiction above it remains as far as I know exceptionally difficult to acquire adhd treating medication; they’re almost all controlled substances, heavily regulated and consumption tightly monitored.
I imagine it depends on where you live, but in the US, it is insane how easy it is to get prescribed. Try to do it yourself, it takes literally a 10-minute phone call and you'll have a script at your local pharmacy -- https://www.donefirst.com/
Really? Where? Surely not in Europe, where the psychiatrist simply asks you a couple survey questions like "Do you have difficulty finishing tasks?", "Do you overanalyze things?" or "Do you frequently interrupt others in conversations?" before giving you a script for Concerta / Medikinet. The entire survey takes 5 minutes and if I was to take it seriously, then my entire family has ADHD including the dog.
One should draw a distinction between bad faith actors and good faith actors. For bad faith actors you are correct, but you could say the same thing about a lot of controlled substances. They (stimulants) are at least as controlled as benzos if not opiates. After all there is no objective test for chronic pain either from what I understand. For good faith actors I think there are perhaps the correct or at best too many burdens already, as given by the large percentage of people who are under-treated.
Everywhere in the EU. It's not like ADHD can be diagnosed with a blood test, so you are asked questions from a standardized survey and you get a script if you answer "yes" enough times.
My script is EU-wide and the survey is standardized, but you're right - I should have specifically contacted a psychiastrist in each of the 27 countries to make sure.
Getting a prescription is only half the battle. In the US, you can't have more than a month supply. Maybe you're lucky and your doctor realizes this so writes you a larger than necessary prescription, but for most vehicles (extended release) it's not an option. Many people horde a backup stash of pills.
This means you have to get your prescription filled within a small window at the end of your previous supply if you want to avoid running out. You also can't have a recurring prescription, but a rare doctor might renew a prescription over the phone. And even then, you have to deal with pharmacies running out last minute, travel impacting your refill schedule, and health insurance coverage for the otherwise ludicrously expensive medication.
A nightmare process that someone with ADHD cannot go through indeed.
> In the US, you can't have more than a month supply
I've met one doctor before who believed it. But after switching to a few other ones (not due to that, but due to circumstances like me moving states or, later on, my doctor doing the same), I dont think that's true.
Every single doctor I had since then was able to write prescriptions for 3 months supply (because they are required to evaluate the patient every 90 days before writing a refill prescription).
Schedule II allows for multiple prescriptions for up to a 90 day supply, but in practice this is 3 prescriptions each for 30 days, and attached to each prescription is a start date.
So you're allowed to have 90 days worth of prescription, but pharmacies aren't supposed to fill more than 30 days at a time. Ultimately this means 12 trips to the pharmacy a year, if you're lucky.
I've heard of that rule before (explained to me in the exact same way you explained by one of my previous doctors), and it definitely worked in a similar way for me in the past too. But for the past few years, my process has been much easier and simpler.
My insurance provider (Premera) has their own mail order pharmacy (called Express Scripts[0]; technically independent, but Premera officially partnered with them), so i dont have to go at all. My doctor writes a prescription, sends it directly to the insurance, opting for the mail pharmacy option checkbox, and I get my meds in the mailbox. They arrive all at once, with a single pill bottle containing 90 days worth of medication.
Just in case it varies by state, that's how it works for me in WA.
To me its pretty unconscionable that you can't opt out of parts of suggestion algorithms.
The only ability to say "no" that you have is to not use the platform, and given how much useful content coalesces into just a few platforms, you're basically saying "no" to getting content in this fashion
> you will be fed the content until you convince yourself you have a “character trait”.
And who would benefit from that change in classification or public opinion? Health care providers, because why would e.g. the NHS or health insurance pay for therapy or medication or anything else that would help you for something that is "just" a character trait?
My girlfriend got diagnosed with ADHD in her 30's, but only because there was a very short-lived and quickly shut down (due to cost) program at the NHS for adult ADHD diagnosis. If she hadn't had that, she would never have been able to get a diagnosis or the relevant medication.
This seems oddly ignorant of the effect ADD/ADHD has on a person's ability to function in modern life at a similar level to other people. It's not something you can introspect away. If I'm not on ritalin, I can introspect all I want, nothing useful is getting done.
Here in the UK, ADHD drugs are controlled substances. They can only be prescribed as by registered psychiatrists as part of ongoing treatment with patient monitoring. There are not enough doctors qualified to do this, and as a result people who need the treatment are facing year-long queues.
Don't get medical advice from TikTok, and don't form an opinion of a mental disorder and its treatment from TikTok either. The "have you tried mental health walk?" thing is as infuriating as cancer patients getting "have you tried essential oils and yoga?"
> Here in the UK, ADHD drugs are controlled substances
They're controlled susbtances in the US too, but there appear to be a whole slew of sites in the US where you can fill out a form and they'll send you a perfectly legit scrip
> There are not enough doctors qualified to do this, and as a result people who need the treatment are facing year-long queues.
For anyone reading this who thinks they might need treatment and is putting it off, note that there are (expensive! ~£1k) private alternatives where you can get assessed and prescribed by a UK psychiatrist over Zoom with appointments as soon as today.
I used them after struggling for a long time trying to get diagnosed via the NHS (“you’re a successful young man! You can’t have ADHD!”) and have recommended them to several people.
It certainly can affect reading. As the other commenter stated, it can affect people in may different ways. It affects my reading differently based on the content. Ask me to read a textbook for a history class and I won't make it more than a few sentences without serious distraction. If I somehow actually "finish" reading a chapter I still won't be able to tell you much if any of the content. But give me a good sci-fi book and I will burn through it in a matter of hours. And good luck getting anything else out of me during that time.
Here’s a perspective (more a response to the DeBoer article than this one) which I find helpful and which I think not enough people acknowledge:
Neurodivergence (view that mental disorders are a form of human variation that should be celebrated), medicalization (view that they are diseases, much like physical diseases), and personal responsibility (view that they are caused by personal choices) are all lenses which need to coexist in order to explain mental illness.
ADHD is probably the cleanest example because all three lenses truly apply. For many people with ADHD, it’s who they are, and there are aspects of it that they wouldn’t want to change. It’s also a condition which often needs medication to be managed properly. Plus, (in my experience with loved ones) it’s impossible for people with ADHD to function unless they are trying to take responsibility for their actions.
For most disorders, you need at least two lenses. You can’t fully understand alcoholism unless you acknowledge that both personal responsibility and a medical condition (“substance use disorder”) play a roll. Ditto anxiety and depression.
> personal responsibility (view that they are caused by personal choices)
I have interpreted and see personal responsibility as the affected person being responsible for managing the issues. Not as the issues being caused by themselves. E.g., it is not your fault you have it, you did not caused it, but you are responsible for learning strategies or taking drugs to manage issue to the possible extend.
I think I might have ADD, but since I'm a straight A student, socially well adjusted and not hyperactive I can not get any healthcare professional to take my problems seriously.
I cannot do things in time. Not even things that should be rewarding and fun. I cannot start tasks until it's too late, or in the rare event I start I cannot focus long enough on them to make a difference. I cannot really explain why. I know I should just do them, but there's some mental block that I cannot overcome. It has always been this way. None of the strategies I've tried ever made a difference. I always have a to-do list of a hundred small and big things I should have done two weeks ago that stresses me out. I also always lose things.
It's not unusual that I end up crying alone due to stress over all the things I should have done and feeling stupid for putting myself in the same spot again.
I manage to get good grades simply due to the expected workload being much less than my capability and being a good test-taker. At the final weeks before an exam the urgency of the situation allows me to absorb whole courses in a single week and get an A on the exam. But had I just worked 2 hours a day during the whole semester instead I could have saved myself all the stress and the depression and been a lot happier. And even though I know this, I will invariably do the same thing next semester.
I've tried getting help and a diagnosis, but the doctors will dismiss me after a single look at my grades. All they see is a student with great grades (and therefore not in need of help) looking to scam them out of some study drugs.
I get by, and manage to never get in any huge trouble despite my shortcomings. The big problem, except my mental health, is how it negatively impacts my relationships. I have a heard time prioritizing my girlfriend when I'm always stressed and always have a hundred things I should do, which is a reoccurring problem in our relationship. And making time for my friends is even harder.
I have cut out most nonessential responsibilities from by life just to reduce the stress a little. But I have no idea how I will manage big responsibilities like having children in the future without burning out.
I have given up any hope of getting a diagnosis. But I'm worried about the future, and I don't know what to do.
There's probably no help to get here, of course. I just wanted to get if off my chest.
Suggest best is to talk to a psychiatrist. If you think it is adhd then see if you can find a specialist and try make a booking. It costs but you'll get help quicker than trying to talk to a GP.
Don't trust a stranger on the internet, but that was me until a few months ago.
Until recently, my life has been a slow descent into an abyss of despair. Then I got diagnosed and since I've started medication, for the first time in my life I am actually proud of myself. Proud of all my talents and place in the world. There actually is hope and excitement for the future.
Here's my suggestion: do everything possible to talk with a psychiatrist. Get diagnosed. It might be something else, but if it's ADHD you'll be happy to learn that treatment is _very_ effective and often life changing. This is not hyperbole.
i was diagnosed when i was 8 or 9, took meds til i was 15 and then not again until recently. i got mostly As and Bs in school, medicated or not. when i wasn't medicated i did get some Cs and no credit at uni when i struggled with courses i didn't put time into.
i graduated with a decent grade point, like a B+ or A-, and i got straight As in my masters degree. i got jobs all over the world and am pretty smart to not have huge issues with work or anything like that. i still have issues socially, doing work, doing work i'm good at, and all that. even if i manage to mostly get good grades.
and i went to a psych and explained my issues, and i got meds for it. just because you get good grades doesn't mean you don't have ADHD, you just found ways to cope. life isn't just getting good grades and you're fine and don't have ADHD, if that were so then a lot of people wouldn't have any issue.
Wow, really nice article that gives practical examples of what ADD/HD looks like. I am not officially diagnosed, but I am 99% sure ADD/HD is something I have coped with my entire life. This has come up only recently with the pandemic forcing my schedule to change, and I started to realize how much the "9-5 routine" was keeping my train on its tracks and hiding any semblance of an attention disorder.
It's really interesting how attention disorders show and hide themselves. Like the author, I had a consistently inconsistent way of losing or forgetting things. I don't tend to be late or forget appointments, but I have a hard time scheduling them in the first place. I have rejection sensitivity dysphoria, which explains why relationships, family included, have ended poorly and needed a long time from which to recover. I did not complete college and had no idea what I was doing the entire time despite breezing through high school. I have many abandoned and unfinished projects around the house. I have been fortunate to receive accommodations at work such as choosing slightly different hours as needed, but now I understand why that was something I needed.
It hits you like a ton of bricks when you realize "I've had ADHD my whole life" because it explains every negative experience you've ever had. Having authoritarian type parents was the cherry on top.
> (W)hen the world has been willing to let me what I can do in the way that I can do it, the results have been pretty good. When the world has insisted that I do things the way everyone else does them, it hasn't always gone so well.
This is such a succinct description of the main issue with attention disorders. I think the author makes a very good argument that it's the stigma, not the disorder, that is causing more problems than anything. I know stigma against disorders like this is why it never came up.
I intend to obtain an official diagnosis and potentially try medications. The thing is, it's incredibly overwhelming to choose because half of you knows you're doing pretty well right now, why change? The other part is wondering what your true potential looks like, and fighting against how much work and experimentation you think that will take.
since adhd is treated with amphetamine which is essentially a performance enhancing drug that boosts your focus/awareness/intensity. it's probably dangerous to think of your medicated self's potential as being truer than your natural self's. seems like a trap.
When I say true potential, you must understand that this is from the perspective that my unmedicated ADHD brain is only about 30% efficient. Throwing a number out there, but I know that it's very hard for me to work efficiently if my environment isn't exactly right. I'm not interested in long term dependence on any drug and speak to true potential in a healthy, clinically medicated way.
I'd really encourage you to read up on how stimulants affect people with ADHD. It is quite the opposite of "performance enhancing" that you're implying here.
the trap in your example would be following the true scotsman fallacy into believing that you need your insulin to survive/thrive - which could be true in the case of diabetes, so not just like.
Considering people with ADHD have a much shorter lifespan, I would disagree. I encourage you to actually look into what medication for those with ADHD looks like before disparaging those who seek treatment.
not intending to disparage anyone living a normal life on an indefinite adderall prescription, more acknowledging the risk of mistaking its effects as unlocking your true potential rather than as relief from suffering, and then inadvertently shortening your life rather than extending it (hence the "trap" comment)
and depression is treated with anti-depressants which change your mood therefore you are not your true self? what a load of bs lol.
people can _choose_ if they want medication, how they feel on it, and what it helps them with. and it helps millions of people have normal productive lives without fear of inadequacy or ruin because of dysfunction or cognitive issues.
it's great if you or others don't believe in medication, but humanity has coped with drugs that affect performance for millennia.
> humanity has coped with drugs that affect performance for millennia
the tendency to treat disorders with (often life-long) amphetamines and ssris is a relatively recent development. obviously it's your choice to ween or risk it (unless you're restrained in a facility) and it's not bullshit to advise caution generally but especially to anyone seeking "true potential" vs "normal life without suffering"
I recently went through the exact same process you're going through. I'd be happy to chat if you have questions or anything. Email in profile if you want.
> But what if the Devil came and offered to cure my depression, and the price was my right arm? That question is easy. I would say “sounds great, but what's the catch?” Depression is not something with upsides and downsides. It is a terrible illness, the blight of my life, the worst thing that has ever happened to me. It is neither an adorable character trait nor an annoyance to be managed with medical treatment. It is a severe chronic illness, one that is often fatal. In a good year it is kept in check by medical treatment but it is always lurking in the background and might reappear any morning. It is the Joker: perhaps today he is locked away in Arkham, but I am not safe, I am never safe, I am always wondering if this is the day he will escape and show up at my door to maim or kill me.
As a constant sufferer who's been dealing with a debilitating case for over a year now, I love the way the author framed depression. It perfectly describes my fear that if I ever get "better", it's only a local maxima, and I will never be freed of this curse. It's laughable to even think, given how I can suffer from day to day, but I'm honestly afraid of finding something that improves my condition, because of the unknown of how depression might still be lurking in the shadows. I still try (often not very hard), but that fear is there nonetheless.
I have ADHD - mostly inattentive. I'm 46. I was diagnosed in my early twenties. I had never heard of ADHD, but a friend who had been diagnosed with it sounded like he had a lot of overlapping issues. I skipped three grades (middle school), but then failed out of university in my final year.
I'm suspicious of how often ADHD is diagnosed, and the subjectivity and lack of detailed mechanistic explanations. More study is required. I have little experience with where the current youth/teen culture is at, regarding diagnoses, and mental illness.
Behaviours that I attribute to ADHD have caused me a lot of suffering, and contributed to me being less reliable than I would like w.r.t deadlines, and personal commitments. On the other hand, I'm funny, and very creative. Like painfully creative. Like it's a goddamn joy/pain to be exploding with ideas and interests all the time. Going down rabbit holes, etc.
My current medication is quite helpful, although I experienced very bad side-effects to the first medications I took 20 years ago. This led me to avoid medication for about a decade and a half, to my detriment. Medication has not been a cure-all, and has come with some physical side-effects that I choose to tolerate. With age, I've developed coping strategies, but it's still a daily (weekly?) struggle. This is where accepting yourself -- flaws and all comes in. That tension between personal-improvement, and personal kindness / acceptance.
I'm reliable enough to get by, but I think perhaps I would have been a super-star. Still trying, I guess?
All that said, I don't know if I would get rid of it. The easy creativity, just-do-it default, and humour are part of who I am and want to be. That said, the detriments have absolutely been real and contributed to my own suffering. Although, with age, I feel as though I've been through the crucible and am basically unstoppable. I just don't know exactly where I'm going. I am so much tougher, mentally, than I was. Suffering is not all bad, as long as it's not catastrophic, or inescapable.
> For me the ADD really is a part of my identity — not my persona, which is what I present to the world, but my innermost self, the way I am actually am. I would be a different person without it. I might be a better person, or a happier or more successful one (I don't know) but I'd definitely be someone different.
There's a lot of modern discourse around "identity". My view is that the only healthy conception of your identity is the things you share with no one else. So ADD is not your identity, nor is your skin color, ethnicity, religion and so on. Rather, your identity is the result of experiences unique to your life and how those experiences shaped you.
Another big issue here is locus of control. I'm reminded of this quote: "I was dissatisfied with my own conduct, and laid the blame for my excesses on irresistible inner forces, as well as a combination of inscrutable external factors, invisibly staged to provoke and upset me."
DeBoer does the classic thing of "Inventing a guy to get mad at." Are there people who think their ADHD has no downsides and give them superpowers? Sure. There's a lot of people on earth and a distribution of opinions. Why not let people commiserate over their suffering and celebrate the quirks they've leveraged into strengths?
But going undiagnosed, it did force me to cope in creative ways.
I'd zone out in class and forget about tests. Only to inhale all the info in the dopamine-induced panic of the night before.
Long, wordy explanations bored me to tears. Which gave me deep sensitivity when explaining things to others.
And to keep myself sane during endless school days, I'd bend over backwards to try and "real-time edit" topics to be more interesting.
Finally, in my senior year of high-school, I read a blog post summarizing the classic ADHD memoir "Driven to Distraction". For the first time ever, I asked my parents to take me to a doctor. I was diagnosed basically on the spot.
The change was immediate. I went from serial coaster to rampant bookworm. Within a month, I tracked up in all my classes. I finished out high school with a bang (though it didn't matter much to college admissions).
There's always been a slight pang wondering what might have been had I read that blog post sooner. I certainly had the scholastic chops to excel, and could've landed at a much "better" school (and maybe even a "better" career).
But then I remember the blessing in disguise my alma mater, Queens College actually was. Few students cared to take advantage of the (surprisingly) excellent faculty, so I had their undivided attention. Also, the relatively lax workload gave me the space to split my time between class and internships.
And then I think about the weird, rewarding professional path those internships led me down. Where I inhale large amounts of information quickly. Find the shortest, sweetest way to explain it. And "real-time edit" the subject to make it as interesting as possible.
These aren't super-powers. These were talents I was forced to discover and lean on to cope with those that I lacked.
I can relate to certain parts of the author's post, but not all of it. I do like that I can focus very intensely and work for hours on end on a single subject, BUT (and it is a big but) it is very hard for me to get there and I have to be vastly interested in the subject. Sometimes I can go weeks, or even months, on a very exciting project (80 hour weeks voluntarily) only to get to some very mundane or boring parts and then go weeks struggling to work at all (and spend weeks trying to shift into a more exciting part to get me revved up again). If it is a subject I hate and don't find interesting at all it is very difficult to get the work done. Overall, I consider ADD in my case way more of a negative than a positive. I'd give it up for free in a heartbeat.
Thanks for sharing! This is incredibly relatable. One of my hallmarks has always been intensity. I rarely half-ass anything, and when I do, it's almost astonishingly mediocre. But normally it rockets between obsession and extreme apathy. Emotional reactions to anything are always 200%.
“ Depression is not something with upsides and downsides.”
Not sure if this is true.
Evolutionary psychologists have explored the improved tunnel vision that accompanies depression as a means for finding one’s way out of harmful situations.
Society-wide it seems many people are living in harmful situations/ways and are able to medicate their way out of the tunnel vision before recognizing the sources of pain.
>> Depression is not something with upsides and downsides.
> Not sure if this is true.
The remarkable film "Melancholia" (Lars von Trier, 2011) was inspired by the director's depression, and one particular upside: that when things get bad, like really bad, the depressive can function better than normal folks because the outside now matches their inside. Kirsten Dunst plays a young woman with utterly crippling depression, I've never seen anything like it in real life or on film, like unable to move or eat. But when the Earth is about to be destroyed, she's sanguine, unlike everyone else.
Not sure if this is true to life, but it makes some sort of sense.
Depression also seems to teach people valuable lessons when they survive it. For example, it leaves some people far more resilient in certain circumstances.
It’s the classic “what doesn’t kill you makes you stronger” adage at work. The sad thing is that it does kill many, and for some, never leaves in order to make room for growth.
As for the tunnel vision, that’s an interesting one because it does let you focus in on a problem exceptionally well and that could be useful. The trouble I’ve found in myself is that I haven’t always had the tools or resources to do something with that attention.
You end up intently focused on a problem, and it just becomes a painful echo chamber instead of an opportunity to address something. I suspect this is largely due to a lack of understanding and teaching. Perhaps too, like you mentioned, we expect medication to function as a solution eventually, relieving ourselves of any duty to investigate internal solutions. Had I known how normal depression is though, how it can present, how it can be managed, I suspect my own experiences could have been a lot better. It’s impossible to be certain.
I definitely disagree about the ups and downs in any case. Struggle defines us and helps us grow. Getting better doesn’t have to be a fun or enjoyable experience.
Im sure there is some truth to depression being adapative, but I wouldn’t trust anything that evo psych has to say. There is just no way to properly validate their arguments. We can barely explain bird beaks let alone the most complex organ we know of.
I don't really trust mental health diagnoses, but I'll admit to being heavily biased by a background in molecular biology, microbiology and biochemistry. Some diseases are clearly and unambiguously diagnosable - say you have drug-resistant TB, we can do a PCR test and detect the exact strain of TB you are suffering from. Even in some other diseases where there is no blood test and the diagnosis is clinical, like Parkinson's, the criteria seem so much clearer than anything I've heard about ADHD / ADD etc. For example:
While I can believe the condition does exist (schizophrenia may be similarly difficult to accurately diagnose, but it surely exists), it really seems to be overdiagnosed in children, and in adults, I imagine amphetamine addiction plays a big role in continued diagnoses. It's rather odd to read articles about it that make no mention of this factor.
The author really does not do a great job, here, at least in saying something sensible as a response to DeBoer's piece. The core premise seems to be that:
> I find it so very irritating that there is no term for my so-called ⸢attention deficit disorder⸣ that does not have the word “disorder” baked into it. I know what a disorder is, and this isn't one.
But the author then argues against a strawman:
> Why does any deviation from the standard have to be a disorder? Why do we medicalize human variation?
It doesn't, and in fact, the diagnostic criteria for ADHD and many other disorders require that the deviation amount to a disorder rather than not interfering with someone's life.
What the author really seems to be criticizing is that he learned and began identifying with the medical term for a disorder ("the ADD really is a part of my identity") and now he'd like a different way to describe his experience.
Fair! But get the cause-and-effect the right way around: we don't need to "stop labeling every difference as a disorder," we need to not adopt diagnostic terms and apply them to ourselves inappropriately. That's a part of what DeBoer is criticizing—that people self-diagnose and then "perform their various personalities."
To be clear, I agree with the author that it would help to have terminology for people who don't feel negatively impacted by their brains being different in a way that we can label, not just for those who do. Maybe the author could get started with that by dropping the "disorder" bit and just identifying himself as someone with an attention deficit.
The "neurodiversity" viewpoint here is that what we call "ADHD" is part of the natural variation in how human brains work, and that it's a category error to think of it as a malfunction to be repaired, but rather as a difference to be accommodated. That accommodation may or may not be via medication and therapy, but that shouldn't necessarily mean that the underlying neurological state is a diseased one.
A good analogy would be height: a person who is several standard deviations from the mean will face challenges in life that require various forms of intervention, but we don't generally think of them as having a _disorder_ unless there's an identifiable biological cause that usually has other effects.
Another good point of comparison is vision. We can accurately measure vision and create medical devices to correct unwanted variation. As someone with myopia, I find it to be only slightly medicalized -- going to get an eye exam doesn't feel much like visiting a doctor, and people don't tend to talk about it as one does a medical condition. I imagine that if we were able to make a similar kind of standardized assessment of whatever neurological basis there is for ADHD, we would consider medication for it more akin to a stepladder or a pair of glasses (or even an antihistamine) than a treatment for a mental illness.
I'm several standard deviations above the mean in height and it absolutely is a disorder. I can point to the exact hormonal pathway that led to it along with a specific biological root cause, but even if I couldn't, I think it would be disordered. I'll die earlier than a shorter person, have joint and bone problems, have cardiac issues, and nightclubs are way less fun when you can see the entire room.
More to the point, I don't think I'd consider it very offensive if someone called my height a disorder, because it's not core to my identity in the same way thinking is. Calling ADHD (or autism, etc.) a disorder feels like telling someone they're personally deficient, because the person is inextricable from the condition. Growing really tall in your teens is something that happens to you; having ADHD your whole life is something that you are. Note that this is true even if their thinking does meet the criteria to be a disorder.
> and people don't tend to talk about it as one does a medical condition
While I basically entirely agree with your comment, my partner (who is an optometrist here in Australia) would often point out to me that myopia is a big risk factor for retinal degeneration and detachment, open angle glaucoma, and cataracts at a young age. So while we definitely shouldn't treat mild myopia (like I, and likely you have) as some horrific medical condition, she also gets a bit frustrated by general practitioners and retail optoms who don't treat a lot of the eye diseases she handles with the gravity some of them actually should bear.
Anyway this is a massive tangent, just was something interesting I wanted to share!
Fascinating. Seems to me that it would be a comorbidity with a common cause though, rather than the myopia being the causative factor?
My (somewhat loosely informed) intuition suggests to me that in the same way that not spending enough time exposing the eye to light outdoors increases the severity of myopia, it would likely be causative in those other degenerations. Use it or lose it!
Not that I know anyone who spent all of their childhood with nose in a book then graduated to a computer, cough... I say this having quite mild myopia, although I wear glasses still, can't stand a blurry world.
So I just asked my partner, and what she explained was myopia is basically caused by/a symptom of axial elongation of the eye, which is also what can cause the bigger diseases I spoke about initially! Ortho-K/myopia control as a kid/young adult can help fix/arrest the continued development of this, though thats now well outside what I understand of the topic haha
You're right, defining a "disorder" is hardly a boolean question. ADHD has been studying extensively and there is substantial evidence for biological origins. For one, heritability very high, reported to be somewhere between 0.75 and .9, only slightly less than traits such as height.
Significant differences in brain neurophysiology are well-documented in ADHD (vs. non-ADHD people), and show genesis of the condition is multi-factorial. Calling ADHD a "disorder" implies the condition has physiological origins but is not attributable to a narrow/distinct range of factors like a condition termed a "disease" (such as viral illness, etc.).
The issue of diagnosis conceptually reflects a state where "malfunction" and "maladjustment" or "maladaptation" coincide. IOW malfunction is relevant when it's maladaptive, that is lacks fitness to a problem-space. In a computer application a bug (malfunction) can lurk undetected as long as the code containing the error is not invoked. But when some refactoring exposes the bad code to invocation, that code is maladaptive and the result is dysfunction of the application.
An example is an ADHD individual with trouble prioritizing who takes longer than peers to complete tasks. Not a problem when deadlines are minimal. But thrust into a role where timely performance is required risks failure, loss of a job, etc. The individual's malfunction is then maladaptive, which could prompt the person to seek help to mitigate malfunction and improve adaptability to realities of employment.
Consequently there's no across the board right or wrong answer to the "correct" way to regard ADHD characteristics. Also I agree with you that "mental illness" is a misleading term that could profitably be expunged from our vocabulary. However were that to happen the conditions that are labeled as such are still very real and will in many cases continue to need treatment regardless of the labels we apply.
> <X> is part of the natural variation in how human brains work, and ... it's a category error to think of it as a malfunction to be repaired
No! No one is saying that everyone at one end of the spectrum has a disorder. It is specifically not a category error because the term "disorder" is not applied based on the variability, but rather based on whether the variation meaningfully disrupts the individual's life.
That's why the only change the author needs to make here is to say he has an attention deficit rather than saying he has a disorder.
But that exact same person in a different time, place, or career, might not be disrupted. I wasn't diagnosed until recently. The compounding of increasing demands at home with my family and at work, partially due to pandemic side effects lead to it. A hunter gatherer might actually gain benefits from it. Its like saying someone who is very tall has a disorder because it makes them a poor horse jockey, or a very short person has a disorder due to the impact on their NBA career.
> But that exact same person in a different time, place, or career, might not be disrupted.
If you are not disrupted, you do not have a disorder. Psychiatric medicine is about you and how you feel about it. If you feel like you can make a life change and have it not impact you, great! Do that.
> A hunter gatherer might actually [...]
That's nice, but it's not what you are and not how your life currently looks. So why do you think it's relevant? I don't understand this reference.
> Its like saying someone who is very tall has a disorder because it makes them a poor horse jockey
It is not, because this is about mental quirks that impact your life to such an extent that you feel you cannot adequately live it.
No. Again: the diagnostic criteria are not this simple, and it's a strawman to argue against something that isn't happening. Diagnosis requires disruption across multiple areas of one's life—not just an inability to be successful at the highest competitive levels in a specific skill.
I would just add that I like to refer to it as "attention dysregulation" rather than 'deficit'... my experience I can focus on one singular task to the exclusion of all other needs and demands (even base biological ones), to point of being in pain and exhaustion and causing myself harm.
Staying up for 40 hours programming... running trails for hours and hours... I have more than enough attention.
That’s a major reason why Dr. Russell Barkley refers to it as Executive Function Disorder. We actually don’t have a problem with attention; we have a problem prioritizing what we attend to. Everyone with ADHD is familiar with the hyperfocus phenomenon. We can pay attention (even sustained, abnormally intense attention) to activities that provide a healthy dopamine payout, but we don’t really control what those activities are. It’s helpful if they happen to be socially useful activities!
Yes! I've been slowly getting into his work on the various executive functions, not just the intellectual/thinking one... emotional regulation is a big thing too!
Honestly, the emotional regulation component is one of the biggest things for me, as anyone who has ridden with me driving could tell you…
But learning to see it as an executive function disorder that really touches on a whole host of other cognitive functions beyond just attention has been a real game-changer for me in terms of conceptualizing the disorder. It makes it more overwhelming on some level, but it also helps to explain many of the struggles I have beyond just paying attention (which, as we know, often isn’t the major problem we face).
(Excuse the google link, its a direct PDF file download annoyingly)
> Be aware that it is common for the experiences
of Aboriginal people (such as seeing spirits or hearing voices
of deceased loved ones) to be misdiagnosed or mislabelled as
mental illness when they are not in fact ill. Fear of misdiagnosis
can be a strong barrier to help-seeking for Aboriginal people.
For these reasons, you should take great care not to simply
assume that the person is developing a mental illness or
suffering a mental health crisis.
That said it can be incredibly hard to medicate someone in psychosis, especially if there's an aspect of paranoia.
And even then, the medications are generally only somewhat effective, which can be a world of improvement, but still leave the person in a state of psychosis.
And that leaves accommodations: in the US, it's hard to get a psychotic disorder like schizophrenia covered by disability insurance. Workplace accommodations are near impossible.
Even medical professionals can present difficulty, if they're not familiar with the implications of being in such a psychotic state.
And anything done to improve the situation can easily be misconstrued and in fact make their mental state worse.
I think the main gripe sits with how we label it and the way we associate with the label. Yes, in a medical context we can use words like retard, but it's not acceptable to use this word in front of a patient because often the medical definition isn't known.
To the same degree disorder may be an acceptable label by a clinician, but we need a different word for regular everyday use - because if I come into work and tell everyone I have a disorder, they're going to make assumptions. And then back into the closet that information goes.
I'd say a lot of people don't share information about their neurodiversity for this very reason. The fact the top comment here argues about the linguistics rather than the content or spirit of the article, tells me we're not ready for that yet. Which is surprising given the readership of this website likely caters to more neuro atypicals than average.
I don't think it's just a linguistic point. The non-stigmatizing alternative is to not label things, and to just speak in conversational language about the ways our minds are diverse.
In particular, I think it's important to recognize that most people do share information about their neurodiversity, and really this is the key point of neurodiversity as a term. When there's no "disorder" framework lurking in the background, people are happy to talk about how they're cranky in the morning or terrible at public speaking or spent the last 30 minutes anxiously editing their 5 line email. It's only when people worry about falling under some particular label that letting others know becomes an issue.
> Yes, in a medical context we can use words like retard
Not applied to intelligence in the USA[2]. Personally I think retard is a fine word, so long as it is not applied to anyone with a low IQ, which most people wouldn’t do. Idiot, imbecile, and moron[1] are also fabulous words, which have lost their technical meaning from last century, because they were repurposed for “vernacular” use. Then again, I like using “special” or “speshul” too, so perhaps I am just bigoted.
The concern, by some, is that eventually new terms will become a new pejorative. " 'Intellectual disabilities' carries less baggage with it at this moment," said Douglas Biklen, dean of the School of Special Education at Syracuse University. "Twenty years from now, it can become the new epithet."
My main grip with having ADHD is why it's so damn hard to do simple things like open the mail or make a phone call, it's almost like needing a secretary to survive. Second gripe is how hard it is to get an appointment to get medication sorted. I've never felt judged or victimized for it, though I have felt personally lacking due to my struggles to get things done.
I wish I could say the same. Were you diagnosed as child or an adult? I was diagnosed as an adult, and the school system I grew up in was rather... unwilling... to accommodate my "personality" differences.
I find ADHD to be an "occasional" disorder. I feel very much like the author much of the time, but honestly I want it to continue to be researched as a disorder, because I want strategies and medications that are better than post-it notes and Adderall (and yes, I've tried lots and no, none of them are better for me than the occasional 5mg of Adderall).
Most of the time, ADD works in my favor. But sometimes, (and NOT always due to "societal expectations") I need my brain to work differently than it does, and for those occasions the meds do wonders. But I truly hate the after-effects, thus I rarely take them.
I have family members with similar issues. If you could could elaborate, what are the common situations when ADD works in your favor, and what are the times when you find you need your brain to work differently?
1. When high levels of energy or reaction are required e.g. sports and games where reaction speed and/or impulsivity is advantageous. I have been told on multiple occasions when I have been in emergency situations with others, that I do not tend to "Freeze up" like many others do.
2. High stress environments -- When it gets down to "Fire and Brimstone" time, I can develop a "hyperfocus" in which I can focus for an exceptionally and unhealthy long amount of time. However, too much of this without recharging, and I burnout. In fact, I think there is a joke that ADHD medical school students all become ER doctors.
3. Environments where divergent and abstract thinking is beneficial over convergent thinking. I often think I can come up with good ideas, but I personally find my mind falling short of being able implement them.
4. Social situations. I know this somewhat ironic, since we tend to have trouble listening and pay attention to conversations, but I seriously have done extremely well in any role dealing with customer service, talking to unfamiliar people, etc.. I imagine a part of this is possible due to my personality, but I have heard anecdotes from other people with ADHD having similar experiences.
hirvi, this is brilliant and so relateable, so thank you. Mine are very similar, but I would add with respect to your points...
1. Yes, but I also have to know that I am the one in charge... otherwise I will not take charge, but I will be ready to be told exactly what to do, and THAT I will do very quickly. [see A below]
2. Also yes, and true for software development too, but it makes the long burn so difficult. Give me a fire to put out! I casually know an ER doctor who is highly regarded, but his personal life is a mess and he's into extreme sports. (And saw my son when he came in with a suspected neck fracture.)
3. Again, yes. Once a solution has been found, I'm done! Implementing it? Naaah... that's the boring stuff.
4. Sort of... I think due to personality and temperament yes, but also upbringing.
Two more points building on those.
Autism and adhd have a high co-morbidity. If someone has social skills to the point where others comment on how good they are; highly unlikely that's you. If the idea that you "intellectualise social interaction" rings a bell, it might be the case.
Sensitivity issues. This is a reason behind my addition to point 1 above. The most mild of corrections comes across as an accusation that one is am totally worthless and useless. A constant running inner critic devaluing every thought and action. My experience is that this is silenced or at least turned down by medicating with stimulants... and it is totally liberating.
Thank you, and I greatly appreciate your comment as well.
1. I can sympathize.
2. I am software engineer that has and currently played various extreme sports, so there is probably a strong correlation lol.
3. I don't have enough bandwidth to implement thing sometimes when the RAM is maxed out and I do not have any Swap Space.
4. Makes sense. My family was predominantly in the medical field and they constantly would have to talk with lonely and/or bored patients all the time. So, you are probably on to something.
> "intellectualise social interaction" rings a bell
I tried to search for what this meant, but I found a few differing ideas that I didn't know which one to attribute to what you meant. Do you mind elaborating?
I do tend to talk fast and talk a lot. It used to get me in a lot of trouble in school growing up because I would basically talk non-stop (wasn't diagnosed or treated during those times). I still talk a lot, but I have grown out of a lot of it.
I have sound sensitivity issues like misphonia and I hate going to concerts despite being a musician at one time due to how painful I find the volume. If I go, I have to wear earplugs or I find it physically painful to be a setting that loud. Same thing with small engine devices like chainsaws and other machinery.
I do not think I have co-morbid Autism, but if I do not, then I probably missed a good chance -- then again, there is probably symptom overlaps between the two.
3. Yes, that too. It becomes burn-out at the worst.
>> "intellectualise social interaction" rings a bell
> I tried to search for what this meant, but I found a few differing ideas that I didn't know which one to attribute to what you meant. Do you mind elaborating?
That was the goal behind me asking... if it did ring a bell; I think you'd know! I pre-plan social interactions, they inevitably never go as planned, then I spend forever ruminating on what I did wrong. Rinse, repeat.
To your concluding paragraph, I think a way to join back up these disparate threads is a reminder that ADHD and autism are both non-binary, spectrum conditions... they're labels slapped on a grab bag of manifested difference->disorder->disability symptoms, hence diagnostic criteria that are: "has to have 5 out of 8 of these factors".
Thanks for your examples, a lot of that really hits home, especially the stimulants. I have been trying to figure out why I can't quite function without caffeine, not in a get a headache and feel sleepy sort of way, but that without it I feel really listless and almost depressed.
I think the underlying tension here comes from the fact that people are currently prescribed drugs for ADHD on the basis that it is a disorder that needs to be treated, and a lot of those people would like to still have access to that medication while also being less stigmatized. The analogy to homosexuality is problematic because in that same analogy Adderall is equivalent to conversion therapy.
No, he isn't: he supposes that "any deviation from the standard" is called a disorder. That's false: we call something a disorder when it disrupts people's lives, not just when there's diversity. "Disorder" only applies when someone is bothered—and addressing the bother isn't "medicalization" any more than cleft palate repair or prescribing eyeglasses.
He seems committed to using the term "disorder" about himself, even though he says he doesn't have one. But it's a problem of his own making: he could stop saying he has ADD and start saying he has an attention deficit.
> the diagnostic criteria for ADHD and many other disorders require that the deviation amount to a disorder rather than not interfering with someone's life.
> interfering with someone's life
The specific phrase used in the DSM-V is: "symptoms interfere with or reduce the quality of social, academic, or occupational functioning".
Schooling started to become compulsory in the USA in the mid-to-late 19th century, and really only became universal in the early 20th century.
By the late 20th century we had decided that children whose normal behavior "interfered with or reduced [...] academic [...] functioning" had a disorder.
We created a system that does not accommodate everyone, then turned around and said that those who are not accommodated are definitionally disordered. The logic is clearly backwards.
I am very close to someone who suffers from this disorder. Their inability to function in terms of personal care, family, social life, occupationally, etc. goes way beyond "normal behaviour in a system that does not accommodate everyone".
Try imagining a literal five-year old in a grown-up body. That's what this person is like when it comes to anything that does not have immediate (< 5 minutes) consequences.
I say this with love, to be clear. They are the most wonderful person. But I could not live with them without support.
Any system that accommodate this type of problem needs an external support structure to offload the burden on many other people. In our society, we call it mental healthcare, and we use diagnoses to help triage.
There are extremes to any condition. By far most people with ADHD manage to survive just fine. That survival could be changed into thriving for a big number of them if only society would get their collective head out of their collective arses and not tilt at the slightest sign of "different."
In a lot of areas, thriving has nothing to do with society's reaction. Leaving kitchen cupboards open and then ramming your head into them isn't something that society blames or stigmatizes someone for, it just hurts. Having a difficult time pursuing one's own goals isn't about how someone fits into society's expected roles—it's about not having the executive and organizational skills to design a path forward and then (remember to) stick with it.
That's a convenient explanation, but it doesn't account for the emotional dysregulation that accompanies ADHD. And it's historically dead wrong: symptom clusters associated with ADHD were described as early as 1798, and were identified in the 1800s outside the school context.
I’ve often thought that I could be diagnosed with ADHD if I wanted, but I don’t feel the need to label myself with a “disorder” and its possible stigma for something that I feel helps me more than it hurts (now that I’ve learned strategies to work with it). Then again, it might have been easier/faster to find my coping strategies if I was diagnosed early. For these reasons, I think it would be helpful to drop the “disorder” bit culturally.
Imagine your skin has a different from your neighbors color. Would it be sensible to consider it a disorder? Even if it may happen that it negatively affects your every day life, and it may be maladaptation in the region where you live but it may be a considerable advantage if you had lived on different latitude.
Or consider a game where different character classes exist e.g., Necromancer (can raise an army with no resource, quickly) and Wizard (requires lots of resources, slow to develop though some units are exceptionally strong). Would it make sense to consider being a Wizard to be a disorder in such a game?
Does someone with congenital heart failure have a disorder?
I'm not suggesting that ADHD is on par with congenital heart failure, but neither are skin color or one's propensity towards wizardry on par with ADHD.
The point is that we shouldn't consider screwdrivers to be demented hammers even If you are a hammer like most in your surroundings.
If a game map is small (there is not much time for development before you are destroyed) and/or resource-poor then being Wizard is certainly a disadvantage compared to Necromancer (it is a "disorder", wizards are "demented" from the Necromancer's point of you).
Except humans are not primitive tools, and the brain is not a piece on a game board.
Perhaps a concept like CPU/GPU binning would be a bit more helpful to consider, but even then, it reduces one’s entire experience into manufacturing terms.
The worst CPUs are thrown in the trash. So are the broken hammers, and eventually the screwdriver misused as a hammer.
You are trying to reduce human mind to one bit: broken/working. Humans have strong general intelligence and therefore are capable of solving many different tasks. There are many different tasks in the world where different characteristics may be useful in addition to pounding nails (though if you are a hammer, it may be hard to imagine) The existence of screwdrivers shouldn't be considered a disorder.
> You are trying to reduce human mind to one bit: broken/working
Not at all! That’s why I mentioned CPU binning, which takes varying results of the manufacturing process, and categorizes each according to what it is capable of. I still think this is an imperfect analogy, but felt closer to the topic than wizards and fairly primitive tools.
> The existence of screwdrivers shouldn't be considered a disorder
I think I’ve lost you here - this analogy is stretched pretty far at this point.
But if the screwdriver is missing it’s handle, and the head of the screwdriver is deformed and unable to make contact with screws, a pretty good case could be made that this screwdriver has some serious problems.
CPU binning assumes just one axis: from 100% working (perfect) then
various degree of broken to 0% (completely broken) which leads to the
wrong attitude of thinking in terms of "disorder" (from perfect
human to completely broken).
My examples tried (unsuccessfully) to show that there can be more
than one axis: whether a tool is considered working/broken can depend
on specific task you are trying to apply it to. Use the right tool for
the job. It is not that the tool by itself is broken, it is the
combination tool+job can be inadequate (but it doesn't mean that the
tool by itself has a disorder):
| tool | job | good fit |
|-------------+--------------+----------|
| hammer | pound nails | yes |
| hammer | drive screws | no |
| screwdriver | pound nails | no |
| screwdriver | drive screws | yes |
There can be broken hammers, screwdrivers too that are not suitable
for any job. There can be situations where you see only nails around
you and you'll be having a hard time if you are a
screwdriver. Screwdriver by itself is not broken.
Obviously, human minds/tasks people do have many many aspects to
them and therefore different types of humans can find a good fit to
their abilities despite the differences. The symptoms of ADHD can
often be considered adaptive to their specific environment (and of
course, they can be crippling too):
"How a gene associated with ADHD may have been adaptive: an example
About one-seventh of a Kenyan tribe, the Ariaal, have the long version
of the DRD4 gene, which is associated with
novelty-seeking. Pastoralists, some Ariaal still lead a nomadic life,
moving from place to place, whereas others now have a more settled way
of living. A study found that men with the novelty-seeking allele who
lived a nomadic life were well nourished and healthy. In contrast,
those with this same allele living a settled life were on average less
well nourished (Reference Eisenberg, Campbell and GrayEisenberg
2008). It seems that having the ‘ADHD-inducing’ variant might well be
a better option when living a less settled kind of life, and that
different genetic variations aid survival or success in some
environments but not others." https://www.cambridge.org/core/journals/bjpsych-advances/art...
(most of the paper is psychobabble but the example stands by itself)
If the authors life is not being impacted by his ADHD then he does not have ADHD. The clinical diagnosis for a mental illness is that it impacts your life in a negative way. His attention deficit does not impact his life in a negative way, therefore it’s not a disorder.
The author frankly does not know what he’s talking about. And, clinically, he does not have ADHD.
I have a mood disorder (NPSLE). I am on permanent disability and I have been hospitalized several times.
Even though I know my disorder comes with a gift, and rather unappreciated gift because I do consider myself neurodivergent, I also know at times I want to die at my own hands. And I also know it makes me unable to work.
I think the threshold for where we think some Neurotype is affecting our life has been lowered dramatically.
Please make your substantive points without crossing into personal attack. That's always important, but especially when the topic is as sensitive and emotional as this. Certainly you're welcome to share your own experience—that's important, and what you've said about it here is important. We just need it to come without swipes and putdowns towards others.
Edit: we've had to ask you before about breaking the HN guidelines (https://news.ycombinator.com/item?id=30570715). If you wouldn't mind reviewing them and sticking to the intended spirit of the site, we'd appreciate it.
The criteria specifies that
"There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning."
I don't see this as being the same thing as ADHD being a NEGATIVE. It's like saying that being short is a disorder because it interferes with picking fruit from tall trees, and being tall is a disorder because it interferes with your ability to be a jockey. While both of these are true, it's ultimately condescending to frame either of these as a "disorder" simply because both aspects negatively interfere with one lives in certain contexts.
The diagnostic criteria does not rule out that one can be an exceptional A+ student which still has their symptoms interfere with school functioning if they're for instance repeatedly sent to the principals office for disrupting classes. Simply the very fact they have an issue that other children typically do not typically have, wipes away all consideration of their positive merits, and justifies a rather insulting label. To me, this is reflective of the typical feeling superior to those who are atypical.
>I think the threshold for where we think some Neurotype is affecting our life has been lowered dramatically.
Undoubtedly, but this doesn't in itself justify not lowering the threshold.
"There's too many kids being diagnosed with ADHD."
Um, just maybe those kids would really like to not be made to feel absolutely worthless in life because they have struggles with their attention that was previously written off as them being naughty or not trying hard enough?
Don't get me started on what a horrendous environment a school can be to someone who might just operate a little bit differently.
Being short can be a disorder. It just so happens that picking fruit from tall trees by itself isn't considered by society to be a very necessary & important activity, while "social, school, or work functioning" is. Adults who remain too short to do things that are considered necessary & important for adults to do would almost certainly have a negative disorder of some kind.
That criteria sentence from the CDC website is overly broad. If you watch more technical talks [1] on ADHD they go into much more detail about what ADHD is exactly and why it affects almost everything very severely (it has a specific impact on executive function, which cuts across a lot of behavior). It's not just a wishy washy way of describing a category of dysfunction.
If the DSM-V definition is overly broad, and the truth behind ADHD is different, is that not fairly alarming?
Currently 9.4% of children are diagnosed with ADHD[1], but we don't diagnose 9.4% of the population as having a disorder on merit of being very tall or very short. In fact, with ADHD, we're also not also counting the opposite of ADHD as a disability, so we're counting a HUGE swathe of the lower end of the spectrum as being disabled. I don't disagree the reason ADHD is considered so serious is cultural, but I find the culture to be incredibly condescending.
For context, Russell A Barkley has been a paid consultant for a large number of pharmaceutical companies. He takes the position that ADHD is akin to a physical handicap and Ritalin is akin to a wheelchair, espousing how incredibly treatable of a disorder ADHD is. I don't agree with him very much because I've found the wheelchair to have a surprising amount of side effects while not being entirely effective. It feels more like a wheelchair I sit in to please others which ruins my own health. I have watched all of Russell Barkley's videos, and took him seriously enough to try everything he advised (Which is a LOT and I had to fight with psychs to try some of it), and it didn't work. Overall, I've mostly found myself to be pretty successful without using any sort of pharmacological treatment, and thus I'm not very attached to the "ADHD as a disorder" narrative and honestly feel like it's mostly done me a disservice.
I also don't really feel it's something I have to accept due to it being scientific fact, as the sheer instability of ADHD diagnostic rates makes me sceptical scientists really have that firm of a grasp on the disorder, the differences in how people react to medication is pretty much completely unexplained by the current scientific theories, and the current scientific theories don't really explain that well why people without ADHD seem to have performance enhancing benefits from the drugs [2]. Which makes me wonder if we're "treating" ADHD, or if we're just letting people with ADHD dope while not allowing others to. To me, I suspect ADHD is an oversimplification of a more complex underlying reality, similar to IBS. I am much more keen on the "ADHD as as social construct" theory than I am on the "ADHD as a medical condition" theory.
Nearly half of US adults (age 20+) are estimated to have refractive errors in their vision [1], which would be a vision disorder. Other estimates I've found are even higher, with more than half of adults needing corrective eyewear. Is that swathe too huge for this demonstrably defective vision to be a disability? Is our society being condescending by inculcating the value of non-defective eyesight?
Not every disorder has a double-sided spectrum of behavior. What's the opposite of Bipolar?
I don't doubt that diagnosis is hard and error-prone, and I don't think any honest scientist claims they have firm explanations for every aspect of ADHD and its treatments. It's an ongoing field of research.
But 70 - 80% of children quickly show improvements in response to stimulant therapy very quickly. That's worth a try for such a debilitating condition that sees a third of its patients drop out of high school and 5 - 10% graduate college at all. ADHD's heritability is insanely high at ~80%. None of your tenuous data-free assertions really changes the good science that has been established. We're not talking about controversial stuff here like SSRIs that barely beats placebo. You're going to have to do more than poke at some gaps to twist ADHD into the wholly different "social construct" theory you have even less actual evidence for.
>But 70 - 80% of children quickly show improvements in response to stimulant therapy very quickly.
They also show improvements if they don't have diagnosed ADHD and take the drugs, as I've already cited. This says more about the drugs than the medical model of ADHD.
>That's worth a try for such a debilitating condition that sees a third of its patients drop out of high school and 5 - 10% graduate college at all.
I just don't see any reason why more and more students wouldn't take simulants so long as they can access them and tolerate them, which ought to push up standards, which ought to increase the pressure to use them. I'm generally supportive of stimulant use, but using drugs to pump grades is pretty much the LEAST compelling reason to take stimulants. I think stimulants are great to, help you cook meals, stay organized, keep your finances in order, things like that. begin with... academics.
I also don't fundamentally see low academic achievement as proving disorder. To me, I think the biggest reason something associated with low academic achievement is considered a disorder, is that the people who write the DSM and ICD are all academics, who see people with ADHD as their lessers.
Studies show that if you don't have ADHD, stimulants don't actually improve your school performance. This has been trialed, it does not beat placebo [1]. The very study you cited [2] shows that at best, there's some evidence it improves performance in rote memory tasks in patients without ADHD, not the complex memory usually needed for academic achievement (the study literature explicitly point this out, this is not just my own speculation). There's a significant difference between how it affects ADHD and non-ADHD patients.
Low academic achievement is a huge handicap in modern society whether you or psychologists like it or not.
And it's not just low academic achievement. Executive function impairment cuts across so many things. Expect huge elevated risks in teenage pregnancies, poverty & debt from financial mismanagement, divorces, inability to hold a job, violent conflict and arrests. Expect an overall life expectancy 13 - 20 years lower than the average.
Go ahead, thumb your nose at societal expectations, it won't change the measurably worse life outcomes experienced by those with ADHD. That's what makes it a disorder.
i don't understand any of the points you are trying to make. it's great you can cope, either you don't have ADHD or you found ways to deal with it, but others are not you. people with ADHD struggle greatly and in a diversity of ways. a lot of people can adapt and integrate in work/social life/school way better on medication, and studies have shown the concentration and focus have increased measured cognitive benefits.
people with ADHD have decreased function of neurotransmitter activity for dopamine and norepinephrine, which is proven. i don't doubt that the future of medication will be more controlled or targeted, as we understand more, but your idea that a lack of understanding means the drugs aren't appropriate, or that ADHD isn't a disorder is basically the same thing as saying "we don't know why people consciousness exists so why bother studying it".
i personally had issues since i was not medicated for quite a number of years, mostly social and behavioural. i never was unintelligent, just had a lot of trouble focusing on tasks, prioritising, and having things in order. the pandemic and work-from-home were very hard for me, and taking stimulants again has literally opened my eyes and removed the fog of inaction. in just a few weeks i've seen huge improvements in my mood, happiness, work effectiveness, and focus, as well as thoughtfulness in conversation.
not everyone responds well to drugs, and people can cope in various ways at varying times, but that doesn't mean we should throw decades of proven methods out the window and cancel the disorder entirely. if we were only hunter-gatherers maybe it wouldn't matter, but we quite literally live in a society that demands an exceeding amount of effort 100% of the time to be successful
I don't want to end the use of stimulant medications. Nor do I want to suggest there are not correlations between certain groups of people and those who benefit from drugs. Nor do I want to deny people have differences in neurotransmitter levels.
My issue is primarily with the jargon of calling such people "disordered". It's just such a crass and unnecessary subjective judgement. I reject the entire framing as an attack on my person and an insult to my face. Just because I can become hyper-smart by taking some drugs doesn't mean I'm disordered.
> The clinical diagnosis for a mental illness is that it impacts your life in a negative way. His attention deficit does not impact his life in a negative way, therefore it’s not a disorder.
In my experience, I noticed most the negative impacts caused by the disorder were actually due to how I was treated by others for the negative impact my disorder caused in their lives (real or perceived).
> The DSM-5 defines a mental disorder as a syndrome that causes significant disturbance in behavior, emotion, and cognition. These disorders are also usually accompanied by significant distress that affects a person's work, school, and social relationships.
I'm not sure there's a contradiction here. Tourette's seems like a clear example of a disorder that both represents an obvious disturbance in behavior and matters primarily because of how others react.
> causes significant disturbance in behavior, emotion, and cognition
According to other people.
What if I think my behavior or emotions are appropriate or justified? The people that are not like me get to tell me how I should be? Seems kind of sick to me. What about the opposite? Are the people that lack disturbances in behavior, emotion, and cognition really that much better off? Regardless, they are definitely accepted easier (assuming they have no other divergent issues causing them to not fit the mold).
To me, it seems like ADHD is basically a diagnosis in which one lacks the proper neurological components of being a good little worker-drone in a capitalistic machine.
Can't focus? Can't sit still for 8 hours straight? Take longer to complete tasks? That's no good. Take these pills, shut up, sit still, and produce! Who cares about the longterm effects of taking amphetamines everyday. It's not /their/ problem, it's /my problem/. I mean, that is all us dairy cows are good for right? And what good is a dairy cow that produces no milk?
So that might be the cynical motivation that some people have to care, but at its core ADHD makes it harder for someone to choose what to focus on, and that's quite objectively a bad feature.
> To me, it seems like ADHD is basically a diagnosis in which one lacks the proper neurological components of being a good little worker-drone in a capitalistic machine.
No, this is dumb. ADHD doesn't affect work exclusively, it affects your entire life equally and prevents you from having fun, starting a family, cleaning your house. Actually, your work is probably the last to go as you spend the most effort on it.
> Who cares about the longterm effects of taking amphetamines everyday.
We know them; they're positive. It's neuroprotective and it reduces the chance of abusing other drugs (like alcohol) quite a lot. At most you want to make sure to get magnesium in your diet to prevent tolerance.
I'll never know, but I have always been of the mentality that everyone has "something." Whether it has a diagnostic label or not. I guess, in a more terse sense -- life ain't easy for anyone.
"life is hard for everyone" for you means that we shouldn't give people mental health? if people have recognised diagnoses they are entirely entitled to treatment. whether it's "i can't sleep enough" to "i'm gay and feel like my relationship with my family has struggled" to "i have a fear of airplanes" to "i can't focus and sit still".
even if there is no true neurotypical brain, the fact is that an overwhelming number (hundreds of millions of people) don't ever question their mental state or life and have no problem doing ANYTHING they want. and then there are people who struggle and ask for help.
it's pretty demeaning to belittle mental conditions as "just something everyone has" tbh
By "something" I meant everyone has /something/ wrong with them to some degree i.e. no one is perfect and there is no such thing as normal. That 'something' could be mental or physical. If a person does not have something wrong at the moment, then time will eventually catch up.
Not to mention there are people that can have conditions to sub-clinical levels. One could technically have some of the criteria of a mental disorder without fully qualifying for a diagnosis. That doesn't mean they live life on easy mode just because they do not carry a diagnosis. Sure, they might have a /easier/ time in life, but I have never been one to think of suffering as some competition amongst others.
I would gladly trade places with if you you honestly think this. I am homeless living with a mood disorder caused by an Autoimmune condition (Neuropsychiatric Lupus) that was misdiagnosed as Schizoaffective Bipolar Disorder for the last 30 years of my life. I cannot work.
So I kind of understand how you came to have this point of view. Since anyone on the internet, and usually some of the most successful people, can put up a blog and complain about their very common phenotype to moan about how losing their gloves amounts to a disorder.
And any short amount of research on nutrition could probably fix their issue but instead they go to pharmaceuticals.
I am sorry to read about your situation and truly hope you are able to be in a better place as soon as possible.
I think being healthy in both mind and body is obviously advantageous compared to the alternatives, but I still don't think that life is easy for said people. Though, I suppose it would have to be looked at on an individual basis and not as a group.
One can be physically and mentally health and still be in abject poverty with no hope or way of getting out. One can also be healthy and on the lower distribution of intelligence. Having low enough intelligence is commonly coupled with certain disorders, but there is still a grey-area where you are still below average intelligence, but above any diagnostic criteria. I would argue that level of intelligence could cause many issues and disorder in one's life, and that their suffering isn't fake because there is no formal pathology to describe it.
Do said people suffer less than those with disorders? Perhaps, but I do not wish to view human suffering as some sort of competition. I think we should strive to help and to support all people when possible.
there are no longterm effects of amphetamine use at therapeutic dosages, that's fake news.
i hate capitalism as much as the next guy (i'm literally a socialist) but i still want to be successful, have healthy relationships, plan events in my life appropriately, and not let people down by inaction, forgetfulness, or social outbursts.
fwiw i'm hugely successful and was even without medication excelling in my field and have contributed to world-changing projects. but i still was frustrated about my utility, my actions in social situations, and the issues i had with executive dysfunction.
i don't fit any mold, and could give less than two shits about "fitting in" in the general sense, but i still want to create good works, build a career, and especially do things like raise a family and enjoy my time with others. and all of those things are domains where ADHD has an effect, and where medication helps.
i've been on-and-off medicated, and there is 100% a utility in it for some.
> there are no longterm effects of amphetamine use at therapeutic dosages, that's fake news.
Sure, I would agree they are not common, but that doesn't mean they do not exist. Not to mention we only know what we know, and we do not know what we do not know.
Other than potential cardiac and vascular issues, albeit rare, researchers are still debating whether the stimulant medications cause an increase in Parkinson's and Parkinson's-like disorders.
> there is 100% a utility in it for some.
Sure, I won't disagree. I still take mine, but it's more of a "it's better than nothing" but I question if the efficacy is as strong as many anecdotes report. Especially after longterm usage. I'll see if I can find the study, but it was some sort of meta-analysis and tracked various children-aged students across a 7 years or so long timespan. Based on the researchers' observations, the medications greatly improved the symptoms of the youth for the first year or so, but around the 7 year mark, the students were back to baseline levels symptoms.
I'm not sharing this to be the 'come all, end all' of the debate of medication intervention. I just remember being told and having read on numerous occasions that, "you gain a tolerance to the feeling of the medication, but not to the therapeutic effects" but I do not believe it. Tolerance is tolerance at least in my experience.
The expression of a disease or disorder is all that really matters. If he went into a doctors office today, instead of say 10 years ago, they would not diagnosed him with ADHD.
Unfortunately, it seems that “affected” is being taken at face value in the parent comment, and the nuances of the presence of the disorder are being ignored.
Yes, many individuals with ADHD can cope without medication and may go on to live good-enough lives that might be the envy of others. However, there may be a lot of potential being left on the table staying untreated.
So to say that someone clearly doesn’t have ADHD because they don’t have a rep of reckless driving tickets because of impulsivity lapses is a bit of a slap in the face for many who still do, but developed compensation strategies to some extent.
"The clinical diagnosis for a mental illness is that it impacts your life in a negative way."
While ADHD has a large part to play in causing mental illness, and is often misdiagnosed as bipolar, BPD, anxiety, etc, ADHD in itself it is not a mental illness, but a disability. I know this is somewhat a semantic debate, but it is important.
"If someone is managing their ADHD it doesn’t mean they don’t have it."
So someone who is managing their ADHD via medication doesn't have it? What about changing their occupation to one where intricate planning is no longer required of them, so they cease to be constantly failing?
Someone can have ADHD and have it impact their life to a much greater or lesser extent based purely on the life situation they are in.
ADHD is the result of physical differences in the brain. You could be managing as well as a neurotypical individual, but that doesn’t mean you’re no longer someone with ADHD.
You are born this way. Such as someone on the ASD spectrum.
The thing is that last D. A mental difference is not necessarily a disorder. That depends on severity and extrinsic factors.
E.g. there are cultures where punctuality is not really a thing. I'm not saying we don't gain many benefits from a culture of punctuality and reliability, or that one would necessarily want to live in one of these cultures. I'm just expanding on the author's point about extrinsic factors. Difference can often be a disorder, but difference is not equal to disorder.
That's like calling a malware infection a damaged hard drive. The way to fix them is at the same conceptual level you learned them from; we don't have offline brain editing tech.
It sure is not handled like one. If that is the case, then I find it odd that most people get treated by psychiatrist and not neurologist. Also, why are fMRI and other neurological scans not used to diagnosis the illness? It seems to be merely symptom based diagnostics coupled with psychological evaluations.
(I am not saying there are not structural neurological differences.)
Do you ever feel like they are just weird manifestations of the accumulations of various stressors in life? Perhaps, there is nothing /neurologically/ different -- at least not to a significant enough degree? What then?
I am not trying to be all woo-woo about this, but we live in a time where technology, and not just recent technology, has propelled us far further than we ready for?
I had trouble sitting still and learning in school, but I was able to fake it enough to learn quickly enough to make it through undiagnosed. However, I still caused various other problems i.e. class clown with good enough grades to not get in trouble. Still, I always found school to be tortuous and stressful (I still would if I had to go back).
However, I like to take a step back when things that bothered me like what I mentioned above start to creep back into my mind -- If I were born 100, 200, ... , 9900, 10000 years ago, how much disorder would I have likely faced? I wouldn't have had trouble focusing in classrooms when there were no classrooms for the below average to average person like myself. How would my life have been? Would I have been 'normal?' If so, then maybe... I'm 'normal,' now?
I cannot speak for mental disorders, but I hope my fellows can find peace. We didn't choose this system, and this system doesn't care about us, but when the sun goes down, the moon comes out. I feel like I have a duty to myself to enjoy life, normal or not, because really... It's not like anything life matters anyway.
First, I really hate when people downvote questions like this. It's just a question? It is inquiry! It should be applauded!
There is no doubt that stress plays a large role. Remember, it is nature AND nurture. I am more sensitive to the nurture aspect because of my genetics, and yes, I know my actual genetics.
I agree that the human condition is not capable of adapting to the quickness of technological changes, and this brings out more peoples genetic sensitivities. Even if you go back to the 1800 with the rise in transportation, It took my family away from an environment they were steeped in for a thousand years. All those genetic adaptations to the environment were suddenly faced with a brand new one.
Being on disability saved my life because it enabled me to live a life closer to my genetics. I was making bank as a network engineer at Cisco but I do not miss the money. For me, much of the neurological damage has been done as seen in brain scans, but I know I am not getting worse and I no longer need to be on medicine 24x7. I do have flare ups, but they are not continuous like they were in the past.
But probably the most important part you have left out is diet. Omega 3 is huge and for ADHD, probably Zinc and B6. But we have a system of sick care, not health care, so these things are never investigated, not even by those who are suffering with these disorders.
> There is no doubt that stress plays a large role. Remember, it is nature AND nurture.
I also should add, that I do not mean just mental stress, but other environmental stressors too. All I am going to say is that I find it odd that in my rural area in the Southeast, USA all of my childhood school friends (7 or so of us) that lived within say... a 3 mile radius of me all have or could meet the criteria for ADHD. Of course, it could be coincidental, but you never know.
> But probably the most important part you have left out is diet.
I could believe this to some degree. I have other health issues (autoimmune) that I think are impacted by diet, but I cannot place my finger on it exactly. Weather e.g. cold, dry air also as strong negative effect compared to more humid and hot summers. Though, I do not think that weather effects ADHD, for me at least.
My issue with supplements are that you have no idea what you are getting or what is in them. The only one I take is vitamin D, and I have taken things like fish oil in the past, but I never noticed any differences. Was the fish oil spoiled? Was it of good quality? Any harmful contaminants in the liquid? I have no idea, and I feel like it's basically just a game of trust, since none of the supplements are regulated in my country.
In my experience, I had an fMRI a year or so ago, and it was cheaper than the psychological evaluations I had to do almost a decade ago, fwiw. But that is just my anecdote. I am sure different health care systems, different counties, etc. impact this significantly.
And it sounds like you’re diagnosing someone based off a blog post.
By the way, don’t tell someone who is disabled and was hospitalized several times with a mood disorder that they’re gatekeeping a disorder. I can assure you, I know more than you do about mental illness, It’s genetics, and its environmental factors.
And how would what you're doing differ from "diagnosing someone based off a blog post"? You've decided they don't have it. Do you have information other than the blog post that allowed you to come to that conclusion?
Because he said he did not have it. Not me. He said he does not suffer from it. If he is not suffering from it why would one consider it to be a disorder?
"By the way, don’t tell someone who is disabled and was hospitalized several times with a mood disorder that they’re gatekeeping a disorder."
Why not?
I'm not saying it's what you're doing here, but it's quite common for sufferers of a particular condition to gatekeep their labels and online communities.
I do it myself!
Typical example: "Everyone is a little bit ADHD." Um, sure... but I can 99% guarantee it is being said in bad faith to discredit actual suffering. GTFO!
Actually, at times it makes me lack empathy and kindness for myself and then I try to die by my own hands.
What you see as a lack of kindness and empathy is a reaction to the disability porn that those of us who are struggling have to endure from the general population.
To add a small snippet of what I've found works against these type symptoms currently I use L-Tyrosine 500mg per day cycled on off every so often. At times I will take breaks every 3 months for a few weeks or so then maybe use Schisandra Berry extract for a week.
I find keeping a super simple excel sheet with a monthly list of work and personal tasks works well with next actions for litterally everything except daily habits/ routines. The act of physically moving complete items from one location to another seems to keep me using it (I use Desktop version with autosave enabled) its not so mobile friendly but it works better for me. Every task system I've tried which is a huge number of them I've got bored with or forgotten to use or micro managed to much, I dislike daily task systems for a number of reasons. This improved my productivity and focus literally about 1000%. I find leaving stuff off the lists causes more persistent interruptions to focus, I beleive due to the zeigarnik effect.
I've found diet works best when Low GI as glucose spikes and crashes really screw things up, will power correlates with glucose levels massively. I don't use any supplements but have done tons in the past they aren't really needed. Diet ratio 50% veggies, 25% protein, 25% carb per plate is a good ratio. Tea, Coffee can be a negative so its good to experiment times without it.
"Many of the downsides of ADD would be less troublesome for everyone, if our world was a little more accepting of difference, a little more willing to accommodate people who were stamped in a slightly different shape that the other cogs in the machine"
I think this is true. We're working and learning in institutions that are incredibly restrictive for people who operate a little bit differently, and it's telling how common ADD is as a colloquialism and not just as a diagnosis.
Foucault used to compare schools to prisons, and joke that the former is the only institution in democratic societies where someone still tells you when you can use the toilet. It's not always so easy to tell with ADD like behavior if the person is pathological or the environment, because you can actually make a pretty decent case for the latter, unlike for some other mental illnesses.
Without playing down the need to help people who do suffer from mental illness, not prematurely pathologizing people and framing them as aberrant is important. In particular with the inflation of ADD diagnoses of young children going hand in hand with a change in culture that seems to have largely robbed children of any opportunity to actually live like kids.
It IS odd that ADD/ADHD is approached this way. There's a sort of weird relativism wherein ADHD can be considered a deviated cognition and not a disorder, but it depends on the environment. Because of the ways of the world, and how modern life goes, it's considered a disorder largely because of the effect it has on integrating with that norm.
If life were different but the ADHD brain wasn't, I think there might be a world where it's not considered a disorder.
I've lived with ADHD-C all my life, and it was something that got me labelled as "lazy" and "unfocused" and even sometimes I was told that I didn't give a shit. People who saw me work 16hr days or work for weeks on end without a day off, these same people called me those things because of how I came across in social situations or in everyday life situations.
I think my tribe of ADHDers sorta see it as part of the formula in how we evaluate our own merit. I'm capable of incredible creativity and ruthless hyperfocus on task when I get spooled up the right way, and so I feel GOOD about myself because I know my true potential. I don't think of myself as some leper weirdo who can't talk right, asks too many questions, turns on a dime. Other people don't really think about that, it's not natural to take that sort of probabilistic view of people, of what they MIGHT be capable of. Stakes are high, and the cost of error correction is high enough usually to motivate a rigid adherence to cautiousness.
I'm not sure how exactly I feel about this article, but I'll say this in conclusion: I've never, ever, ever, even once wanted a different brain than the one I have.
I've wanted to be treated better, and considered more fairly.
I don't know if I have ADHD, but learning more about it, and other forms of neurodiversity, has recontextualized the first 2/3 of my life. I've usually managed to get by pretty well through life's expectations, but I have had struggles along the way that were really confusing. Places where other people seemed to have no trouble meeting expectations, but I would constantly come up short. I also relate to some of the positive aspects or adaptations that folks describe. I haven't prioritized seeking diagnosis or treatment because I've largely figured out how to get by, to my own satisfaction. Although, I know that I could be more dependable to other people if I did.
I have also suffered a couple periods of major depression, which I agree is horrible in a far less ambiguous way. I can actually identify some very positive outcomes of those episodes. Ways in which struggling my ass off to try to be okay pushed me to achieve. But I'd absolutely throw out the good with the bad, if I could. I wouldn't wish depression on my worst enemy.
It can be simultaneously true that ADHD is over-diagnosed (in some cultures), and also that people can benefit from treating what we currently understand as/call ADHD.
It can be simultaneously true that ADHD has no positive consequences for some people, whereas it brings benefits (or is correlated to beneficial traits) in other people.
I am open about my diagnosis of ADD, as are some doctors with ADD who see a doctor for their ADD.
This man, there is nothing wrong with. It is the world around him that's wrong. And apparently it's a clock speed thing, that's an actual scientific conclusion I'm arriving to, and talking with doctors about how to measure with high precision. It's literally, literally, literally the beat of a different drummer, fewer Hertz, and if he did go somewhere with more people like him it would not only be much better, he would both be much more liked and like those around him more (which is reinforcing), people would return him his lost belongings, his defeats would be many fewer, and...I divine his depression would vanish.
I’m pretty sure that I could get an ADD diagnosis. But it’s not something that bothers me.
Mental and behavioral issues are tough because there are many shades of grey. If whatever you are experiencing is causing you pain and you cannot stop it, than it’s a problem.
I think modern society is tough because we tend to have fewer social connections and institutions. It’s easier to get stuck in bad situations or to be isolated than in the past, and I think that makes latent problems more problematic. The good news is that we have professionals who can help, but that bad news is we also have others (schools, etc) who help themselves.
"...There are bigger downsides to ADD, like the weeks when I can't focus on work, or when I get distracted by some awesome new thing and don't do the things I should be doing, or how I lost interest in projects and don't always finish them, blah blah blah. I am not going to complain about any of that, it is just part of being me and I like who I am pretty well. Everyone has problems and mine are less severe than many. ..."
What he is describing is everyone. The last sentence should read "Everyone has these problems just like me."
We are conditioned from a very early age to compare our insides to everyone elses outsides - the personas that they represent - or more accurately that we represent for them. Whether we imagine ourselves better than that persona or inferior in some way - it is all illusion.
Nothing is good or bad but thinking makes it so (where have you heard that before?)
Reading the comments below I feel there is a lot of beating oneself up. I know... I do this all the time. When I recognize that I am doing this I redirect it to accept and love my natural self (very liberating). This is our human nature. We all share in this. We should feel perfectly natural and ok about our nature.
The difficulty is in adapting to the structure of society. We are challenged to find ways to adapt and manage our nature in order to find some measure of accomplishment in that structure. Some adapt readily. Others have to work at it. We all face the same challenge and we all acheive different measures of success. Just make sure that it is your measure of success that you are striving to achieve.
The labels and their definitions are all a product of a feckless mental health industry that needs to create something to justify their existence. The definitions describe observable human nature and the labels categorize them. The negative connotation is a judgement - this is what causes so much stress.
This body of work is dynamic and changing. The American Psychaitric Association Diagnostic Criteria at one time included homosexuality as a mental disease. Can't suffer from Aspergers because technically it is no longer a diagnosis. So consider these examples to help keep it all in perspective.
I also have ADHD and suffered my entire school and university years due to it. I have used every medication there is for it. I recommend everyone to take up meditation. Even 5 minutes a day is good. Im not saying quit your normal medication etc, just meditate for 5 minutes a day, every day. It will make a difference like day and night.
I dare to say that all three examples - depression, adhd and homosexual orientation - have in common, that they lead to questions about identity.
How come that we try to create AI with NNs and billions of funding, but we don't pay the same amount of attention towards understanding the foundations of our own thinking?
this trend of trying to make ADHD into some kind of "superpower" is hogwash and a direct consequence of some deep internalized able-ism of the people that propose that view.
I have ADHD, there's nothing cute or great about it, it really sucks to have this disability, I have lost countless opportunities and had to work 10x as hard to achieve the same as everyone else because of it.
I'm not less valuable as a person because of it of course, but I would gladly return my "gift" if that was possible.
>Having a high IQ, being economically privileged, very good looking,is going to change the impact ADHD has on someone.
In my case it meant staying out of jail, managing to graduate college and getting a career I could thrive in. Still... serious downsides along the way and always a struggle to hold it all together.
Daily 20 hour water (& salt) fasting reduced my desire to jump between tasks. Less scatter-brained too. My thoughts stay on rails longer. Didn't change my diet much; I don't eat many refined foods or carbs other than occasional bread.
Years ago in college I was prescribed Adderall but it didn't make me focus more. It made me compulsively clean my apartment, masturbate, tweak out, and occasionally be extremely paranoid of being attacked while on public transit. I was ready to rip someone's head off. I discourage using this medication.
If you haven't reduced carb intake to a bare minimum I suggest maintaining it first for a month before looking for more help.
Do you think that it might be harmful to discourage the use of a medication for everyone simply because the medication affected you in a way that you didn’t find helpful?
I have severe ADHD and Adderall has played a huge role in allowing me to do things (like building a successful career as a software engineer) that never would have been possible without it.
On the other hand, starting adderall was the best personal decision I have ever made.
I am less angry, less impulsive, more deliberate, more attentive, more kind, and more patient.
Your reaction sounds like the reaction of someone without ADHD. I'm not claiming that's the case. I know everyone has different reactions to medications and you should do what's best for you. That said, starting adderall literally changed my life.
I would consult a physician though instead of eating less bread if you really do feel that you might suffer from a mental disability. Bread might help, but professional insight will certainly help more.
I didn't mean to imply that I only eat bread. Just that it is my main source of the few carbohydrates I eat anymore. They will have to pry chocolate from my cold dead hands.
Sorry, I meant "getting rid of bread". To be honest, I was snarky at you for suggesting dietary changes instead of talking to a professional. It has very "wow thanks, i'm cured" energy. I won't be snarky in the future.
Wow 20 liters a day sounds like you need a lot executive function to make that work. Did you ever suffer from a lack of executive function (if you planned on doing stuff layed everything you need to do for the task, thought about it regularly and the taks just didn't get performed by you 3 times a week or more often)?
Sounds like you may have had too high a dose, or too quickly absorbed of a dose. That's more or less what I feel like in the 30-40mg range, which is about middle of the road for Adderall XR. The problem with XR is for some folks, it isn't extended release at all, it's just two timed dumps of immediate release.
I only consume water, salt, and black coffee for 20 hours of the day.
I found myself reaching for more sweets both natural and artificial when confronted with stressful or difficult tasks as a coping or escape mechanism. This was very distracting. It was the hardest of all to reduce the intake of artificial sweeteners. I used to compulsively chew gum. Gum with aspartame did help me lose 70 pounds when I first started fasting, but I have since sworn it off entirely, as I find the sweets cravings to be a source of distraction themselves. The cravings and irrational dreams of injecting sweets do end after a while. I was very addicted to sweets and was unable to feel full. I think nowadays this is called leptin resistance.
It’s quite possible you don’t have ADHD. They diagnosed me with ADHD and gave me Adderall. It threw me in to manic episode which landed me into the hospital.
I was diagnosed with ADHD at age 13 when my parents were at a loss as to why I could not focus on my schoolwork and homework. They gave me Ritalin at the time, which only made me hostile (their words; I don't recall)
I started adderall a few weeks ago after a vary recent diagnoses at 30 years old. It affected my personality in the sense that my wife claims that I now seem interested in what she has to say, I no longer get angry at the smallest things, I have patience with my son, and I don't get so overwhelmed that I regularly want to curl up in a ball and cry.
Otherwise, I'm the same me. Just functioning and less pissed off or annoyed all the time.
I was diagnosed at 8 years old. Was on Adderall for 10 years. Went off of it as I entered my 20s. Started it again at 31 after doing a rediagnosis, and I've been on it for a year. I now regret not starting it up again in my 20s. I don't think it affects (or would have affected) my personality, but it would have positively influenced my life. In the last year, I've been able to overcome a lot of stuff to get my life "back on track," and I'm finally in a place where I feel happy and productive again.
A lot of the benefits of neuro-diversity are seen at the population level. The bearers of these traits are “taking one for the team” so to speak because they are preserving a genetic trait potentially useful for the future but may be painful in the present. There’s going to be a wide range of suffering though, from manageable ADHD to crippling depression. Society should simply support these people and mitigate near term suffering as much as possible, but calling these things a disorder isn’t wholly inaccurate because they can be reasonably described as problematic for current day life, even if potentially advantageous in future scenarios.
>The bearers of these traits are “taking one for the team” so to speak because they are preserving a genetic trait potentially useful for the future but may be painful in the present
I would rather not “take one for the team” especially if “the team” has to be dragged kicking and screaming into providing any support/“compensation” for the “service” I am providing.
Also “preserving genetic traits that are potentially useful in the future” is way to close to eugenics for my comfort.
I’m not saying they should take one for the team. I’m saying we should treat them as disorders to mitigate the near term disadvantages so they can survive and pass on their genes.
> When I was around seventeen I took a Real Analysis class at Columbia University.
How typical.
> When my first-year hallmates were “studying” they were looking out the window, playing with their pencils, talking to their roommates, all sorts of stuff that wasn't studying. When I needed to study I would hide somewhere and study. I think the ability to focus on just one thing for a few hours at a time is a great gift that ADD has given me.
That's the opposite of executive disfunction. (To be fair, the author does describe other hallmarks of executive disfunction elsewhere.)
A lot of people using "ADD," should know that it doesn't exist anymore. Now it's all diagnosed as ADHD with three sub types: combined (the most common), hyperactive, and inactive. "ADD" aligns with the inactive type. Anyway...
There's a perspective in some ADHD circles (and likely other mental health circles) that the concept of neurodiversity/neurodivergent are not the correct framing for living with ADHD. It follows this idea that when people highlight (or unmask) the parts of ADHD that make them quirky or entertaining to society, they are not revealing the _very negative_ symptoms of ADHD that are extremely debilitating. The proliferation of sound bite videos that portray ADHD in a very positive light on TikTok, ADHD memes, etc. gloss over the dark realities of ADHD. My personal belief is that while it's good to help people understand some of the more lighthearted ADHD symptoms, it's important that we share even the negative aspects. Of course, negative things don't get engagement (as the author states when he gets to mentioning a battle with depression).
TikTok isn't covering things like ADHDers' propensity to lose their jobs due to poor performance, the financial ruin from overspending and money mismanagement, poor physical health and wellbeing, likelihood to have comorbid depression and anxiety, missing out academic/professional opportunities, fewer if any meaningful relationships because of social disorder symptoms attributed to ADHD. You rarely, if ever, see social media ADHDers talk about how ADHD affects something like dental health because of the "out of sight, out of mind" effects and the inability to form healthy hygiene habits because there are no immediate consequences (the "now or not now" mental modes). How getting a restful night's sleep is a rare delight because of ADHD's ability to delay sleep. You'll never hear them talk about how ADHD people have a significantly shorter life expectancy than the general population--some studies calculating it by as much as 20 years.
These are all very negative, debilitating pieces of ADHD that get glossed over by modern social media movements of the quirky/neurodivergent ADHD crowd. Even this author doesn't really dive into the dirty pieces.
This is a long one, but all of that said: I have ADHD. I was diagnosed at 8 years old. Finally, got on stimulants for the first time as an adult and my life's trajectory turned around in a just few months. I still struggle with all the negative things that come with ADHD. But I believe that ADHD is both a blessing and a curse; that I can personally celebrate the parts that make me quirky and bring me joy and also be aware of the negative effects it has on me and on my ability to function in modern society. I do see it as a disability, but not as a hindrance. The more I learn to accommodate it for myself the better off I'm going to be long-term.
I don't ask anyone to change, but if you have a problem I should be under no obligation to help you. I may help you but I'm not obliged to pander to your needs.
Despite these factors only 20% of ADHD individuals receive treatment which can make a big difference. Medications can be helpful but are not by any means a "cure". Rather specific behavioral therapies are a necessary part of an effective treatment program.
As a physician specializing in behavioral health, I've treated a great number of ADHD adults. It's impressive how much improvement patients could make over a period of months to years as a result of their determined effort. I came to appreciate patients' innate talents that many were eventually able to exploit. It was gratifying to see some become top-tier innovators in their fields including technologies.
Of course people will "identify" unique traits as part of their sense of "self". ADHD individuals may come to regard aspects of their quirky cognitive styles as part of an "identity" but that's not necessarily the same as having ADHD as the biggest component.
Last thing I'll say is that ADHD is considered a developmental disorder. IOW there's no sharp line between having/not having it. The extent it's a problem depends on the context, which is a huge discussion topic in its own right.