ADHD is at best greatly overdiagnosed, and the business of providing ADHD diagnoses is quite analagous to the opiate pain pill clinic debacle, in which 'physicians' got kickbacks from the industry for providing opiate prescriptions.

With ADHD, it's 'the medication' that is being sold. Often, the doctor's client is actually the amphetamine derivative supplier, and the product being sold (on a commission basis) is the patient.

Amphetamine addiction results in the patient feeling bad when they run out of their powerful stimulant drugs, and the resulting feelings of malaise tend to confirm the patient's belief that they have a neurological disorder (rather than just suffering from the standard set of problems that come with regular amphetamine use).

I hope this viewpoint becomes a bit more accepted. The human brain is so complex and we love to put ideas in little boxes, hence the term ADHD. In X number of decades, there's a very good chance we will all look back and realize how dead wrong we were about ADHD, attention, and our extremely crude methods of "curing" it.

It blows my mind that especially in American society we are so accepting of putting millions of people on amphetamines to solve attention disorders. Anyone who has gone through higher-ed in the past 10 years knows a huge number of students are on these meds, and even if they suffer some of attention disorder, they are likely at a large advantage after adding the drugs. I'd love to see the percentage of med school students on these drugs.

ADHD is a broad spectrum of developmental delay issues that present as different behaviours but can be observed in ECGs. There is no "cure". Anyone who says otherwise has no idea what they're talking about. There are only strategies for minimising the unwanted effects that cause disruption to your life.

The large portion of people taking stimulant ADHD medication to "study" are not by and large getting the same effect as those with ADHD get. For someone with ADHD the medication balances attention dysregulation, that is curbing hyper-focus, and attention "drift" while on a task. It doesn't temporarily turn you into some superhuman memoriser or Ernest Hemingway. It's not some magical potion buff. For those using it to stay awake to cram more low quality hours of memorisation in, they most likely have good memories to begin with, that's how they got there in the first place, it doesn't enhance their abilities.

The only advantage those with ADHD get is that they finally get to play on a level playing field. That's like saying those who wear glasses are at an unfair advantage in a "spot the difference" exam. Give me a break.

So we'll treat a broad spectrum of issues with amphetamines in order to level to playing field... got it.

My point is that we don't really know what this disorder is, or its root causes. An ECG can reveal its presence in the same way an EKG can reveal certain arrhythmia. However, in the case of EKG, you can't truly determine the cause of arrhythmia; is it cardiomyopathy, fibrosis, stenosis, a combination, etc. Now imagine trying to make the same leap of faith with the brain which is infinitely more complex, less studied, and less understood. Follow that up with a draconian treatment such as amphetamine prescription. Yikes

My prediction is that ADHD as a term will either be scrapped or used an umbrella as we learn more about the nuance and complexity of attention disorders. Making broad claims about what ADHD is and how medications can potentially treat it, at this point in time, is totally ridiculous.

Are we really going to pretend that the millions of Americans prescribed these drugs are actually suffering from ADHD to the point that pharmacology is a necessary intervention?

We treat a broad spectrum of issues linked to the developmental delay of the central nervous system and underperformance of the prefrontal cortex with rigorously studied drugs with proven benefits to patients. Just checking, you have no problem with Methylphenidates, just the one that sounds like "meth" but actually isn't? Any powerful drug can be abused. It's up to professionals to prescribe accordingly. I guess this is another case of where the US medical system gives everyone else a bad name (just not those outside the US who have good medical systems and don't suffer from the same issues).

Trying to make the case that ADHD is not well studied is plain wrong. It is incredibly well studied. The assumption that we can't possibly understand it because "it's the brain" is just wrong, there is a huge amount we know about the brain. I don't know what you're getting at with this ECG business but we've been doing EEGs on people to diagnose epilepsy for 60+ years.

ADHD is already understood as a incredibly nuanced and complex set of issues, the fact that so many people continually reduce ADHD to just "attention" or "focus" shows how little is known or understood about it by people who want to draw some tenuous observational links to... what ends... I don't know? Why do you care? A tiny number of people who actually suffer ADHD would agree with anything you are saying, forgetting the just plain false statements and leaving the opinions they were trying to reverse some support for. ADHD is about dysregulation of emotion, impulse and yes, attention but much more than that, it's about how those fundamental differences effect every damn facet of your life in the most pernicious way and require you to spend more effort and energy to keep up, or fit in, or look normal or to remove you and protect you.

I can't talk to the American system (remember there's a whole world with decent healthcare out there) but just because one country has an issue with misdiagnosis and overprescription, doesn't change anything. What's your point. There are also plenty of non pharmacological interventions. Many that I can claim back through my national health care.

You're conflating to many associated but not actually linked issues and it's unsubstantiated rants like these that perpetuate the stigmatisation of those living with ADHD. You're not helping anyone.

Diagnosing people with ADHD can still yield them treatment beyond medication. The existence of the opioid epidemic doesn't negate the very real pains and ailments that led to people getting overprescribed with painkillers, either.

Other treatments would be great, yet between the ages 6-17, of those diagnosed with ADHD, over 2/3 are prescribed meds while less than half receive behavioral treatment.

My point is that unfortunately these medications are still used as primary treatment.

https://www.cdc.gov/ncbddd/adhd/data.html

Edited for context.

Is that accurate? I thought the moral panic over ADD over-diagnosis has been around since the 90s, where the narrative was too many rambunctious boys were being given medication. "The Ritalin Generation." Are you saying this situation really hasn't improved in nearly three decades?

I'm curious about this - what's informing your belief that ADHD is treated only with medication?

When talking to people diagnosed with ADHD, the diagnosis was accompanied by a mix of behavioral therapy, medication, lifestyle changes, and external support from teachers/friends/family.

Drug-seeking behavior is something else altogether, which I agree is a net-negative on both society AND people with ADHD. Regulations around ADHD medication make the medication ironically very difficult to obtain for anyone with an executive function disorder. People without an executive function disorder have no problem jumping through the extra regulatory hoops.

Surely there are other treatments for ADHD beyond the simple pharmaceutical cures, and it would be salutary to diagnose people so they can try those strategies and get the help they need.

There are. Heaps. And you try them all

Talk therapy is incredibly important. People with ADHD can often suffer from rejection dysphoria and depending on how long until they realise, or how self aware they are, they end up internalising a lot of negative opinions and shame about themselves that needs to be unwound. There are a lot of issues around the pain of "never fitting in" or being understood. Some of these are a result of behaviours that aren't the social norm and so they become marginalised. Others are where differences in processing and learning information are labeled as "stupid" at a young age, when the child probably has a similar IQ to their peers.

Neurofeedback can be used with good success to help "rewire" particular issues with emotion dysregulation for instance. It can be expensive and requires a lot of time to train the brain to a different mode of operation.

Coaching, specifically around time-management and task-management. A lot of people with ADHD suffer from time-blindness. Their perception and relationship with time can be.... complicated. Calendars, specifically having a rigid system for what goes on them, regularly reviewing them, keeping them and a large easy to read clock visible at all times etc can really help.

A good water bottle with a straw. No one really knows why but there are a lot of hypotheses. - One thing that never gets mentioned is the relationship between ADHD and food. Generally the nervous system does a pretty terrible job at letting an ADHD person know, when they are hungry, when they are thirsty, when they need the bathroom. Combined with time-blindness, maybe some stress induced hyper-focus because you're falling behind on whatever you need to do, ADHDers will suddenly realise they've missed lunch and binge eat simple food that doesn't require preparation. Preparing a meal would be akin to telling someone with a deadline to just go run a quick marathon first. It'll feel like one or the other, and in some cases, depending on energy levels it will be. - but back to the water bottle. Using the straw means you don't divert your gaze from what you are doing. Your brain doesn't have to judge how full it is and tilt the glass accordingly, if it's big you don't have to get up to refill it. Frictionless hydration.

I think ADHD could be related to overconsumption of sugar.

The question would be: Which one would be the cause and which one is the effect?

I am diagnosed with ADHD and I consume unhealthy amounts of sugar in form of chocolate, gummy bears and ice cream. I wonder if...

A) all that sugar creates a gut microbiome that facilitate ADHD symptoms or if

B) the general impulsiveness and higher-than-usual glucose demand from the brain create the sugar cravings, or if

C) it's some kind of feedback loop and bad habits get reinforced to the point of addiction

Sugar helps fuel a nervous system that is lacking energy from constant stress and overwhelm.

Chocolate will release serotonin but you need to binge quite a lot of it.

It is also greatly under-diagnosed, and long-term learning skills and coping mechanisms are more effective than medication. I started my treatment with low dose meds and that has helped me developed better skills for management.

The only thing I can say for anyone reading this is to know that everyone has symptoms of ADHD from time to time. Clinical diagnosis looks over your entire life history for consistency of symptoms. So keep that in mind.

So I get that people have issues with lazy doctors who pass out pills like candy. But that's not how ADHD is handled. It requires a diagnosis which takes time, then pills are prescribed from a physiatrist at low doses at first.

As someone who was diagnosed with ADHD in my 40s, it was a great relief and surprise at how effective stimulants work. I have struggled my entire life, and have burned myself out multiple times trying to maintain a balance in my life. There's a huge mental burden every day. Trying to remember what you need to do, remember the best strategies to stay on track, spiking anxiety, feelings of guilt and shame, which can spiral into depression.

These sorts of judgement statements, dismissive words from family or friends, and indifference from the public over mental health has kept many people from seeking treatment for a very wide range of issues.

We need more empathy towards the fact that mental health IS health. We need more insurance support for these issues (because it's expensive!). Furthermore, we need more empathy and support towards those that do get addicted to ANYTHING. Addiction is not limited to drugs.

Starting with the assumption that people are drug abusers is damaging, and is entirely faulty.

Maybe that's not how your ADHD was handled. You admit that your diagnosis occurred in your 40's, and it is well known that adult diagnosis is much more rigorous. To add to that, it's important to consider the rigor of young patients and the apparent effect of amphetamines on developing brains.

>Starting with the assumption that people are drug abusers is damaging, and is entirely faulty.

I don't think many people hold this view regarding ADHD-medicated individuals. The scrutiny, at least mine, is aimed at the doctors who readily tell parents that their child has this disorder without much testing, and then scribble a vyvanse script like it's no big deal.

I'm curious what has led you to believe ADHD is over-diagnosed. I can point to a few papers that indicate ADHD is under-diagnosed in certain population slices, like adult women.

I'm also wondering why you believe doctors are writing scripts for ADHD medications willy-nilly, then sending patients on their merry way. In my experience, the opposite is true:

When someone with ADHD moves across state lines in the US, their new general practitioner doctor typically needs confirmation from an in-state psychiatrist (MD) before they'll write a prescription - even if you've been taking the same medication at the same dosage for years prior. GPs sometimes require that the patient be undergoing therapy too, which is a lot to coordinate on top of a cross-state move. Therapists are also licensed at the state level.

This isn't because GPs are trying to be hard-asses, but because there are strict federal regulations on prescribing ADHD medications in the US.

Are these evidence backed observations? Is this evidence general for the world or specific to your locality?

I can tell you where I am it's only just being realised how _under-diagnosed_ it is for those with primarily internal presentation. Those who are diagnosed later in life have often survived due to above average intelligence and internalising debilitating coping mechanisms their entire lives that finally buckle under the strain of large, stressful life events in adulthood (children, divorce, financial stress, change to managerial work etc.)

To the second paragraph: Maybe in the US, and that's unfortunate but a lot of places in the world they are controlled drugs requiring a psychiatric diagnosis, sometimes with an EEG maybe a drug test.

Common stimulants like Adderall, Ritalin, dexamphetamines, work on the ADHD brain differently. Running out at normal prescribed doses in line with your condition won't result in "withdrawal" or malaise as a result of stopping. Any malaise is probably comorbid depression, which is common for those who have been undiagnosed. Often the ADHD is misdiagnosed as depression when the depression is merely the symptom.

I'm not sure what you are trying to get at in your final point but by this stage it's clear you have some deep biases with little to back-up your observations and are perpetuating the views that stigmatise ADHD sufferers.

Is ADHD really tied to switching hobbies and jobs frequently? I suffer from this too, but I always thought ADHD was the inability to focus in the short term. I can have great focus on daily tasks if I’m interested in them, but my problem is I lose the interest so frequently that I can’t seem to make the leap beyond intermediate competency in a hobby or career direction.

ADHD is the inability to regulate attention. There are a couple ways this presents:

1) Hyperfocus for hours at a time, often forgetting about physical needs like food/drink/bathroom.

2) Extreme trouble getting started on a task (inability to overcome inertia) and constant distraction once started.

3) Switching hobbies, jobs, roles, spouses, etc because the initial stimulation of something new is more rewarding than old interests.

ADHD's symptoms are caused by a deficiency in reward dopamine systems. The "craving" for dopamine is stronger in ADHD brains, which is why impulsive/risky behaviors are common in people with ADHD.

Talk to a medical professional if that resonates. Therapy is also helpful, since the behaviors associated with ADHD can lead to built-up shame / self-doubt.

Medication helps (for me, it was like putting on glasses for the first time), but re-modeling behavior and self-image were equally important for me.

The first two sound like ADHD but the third doesn’t at all. That sounds like most people in the world. Everyone complains of the mundane, the same things, day in day out. We don’t hear “I love how nothing has ever changed in my life”.

I’ve yet to hear someone describe ADHD in the third way and this thread is the only time I’ve seen folks ever mention it.

The first to points are the physiological symptoms, and the third described is one of the effects for most people with ADD/ADHD. Unfinished projects and a chaotic worklife that also can result in criminal activities, drug abuse etc. But it can also lead to succesful entrepreneurship and other positive effects in the long haul.

Some aspects of the ADHD experience might sound universal, but the key difference is the impact on your life.

Someone with a more neuro-typical brain might not be thrilled about mundane experiences, but can still tolerate the situation.

In an ADHD brain, mundane experiences over-engage areas of the brain associated with physical/emotional distress (amygdala). ADHD brains are also impacted by abnormal dopamine regulation, which affects the reward cycle for accomplishing mundane things.

Here are some comics to help contextualize: https://twitter.com/adhd_alien/status/1182670794633207813

I think one of the reasons so many people showed up to post about ADHD here is this, from the OP:

> Although, it seems quite trivial, for me this is a huge live hurdle

It's a bit different because it's more like a obsession to find something rewarding.

My school grades as a kid were fine, but I was studying at least 2 different books at same time because after a single paragraph it was already "boring as hell", even being genuinely intrigued by the problem and the possible outcomes. So to study simple math, multiplication for instance, I had a science magazine open beside to constantly remember the outcomes of studying math (understand astrophysics that apparently is cool), at same time I was studying history with a history book and the cover of Red Alert 2 to remember what can happen if don't understand the outcomes of a possible domination by a authoritarian leader.

So 4 fucking things at same time. All of that to just get a C or B- grade.

I was amazed recently to be able to do just few tasks properly done and managing to rest and remember to eat. Few properly done tasks was usually a result of super/hyperfocus where the toll later was extremely high, like eating lots of garbage food to compensate the lack of food during the previous hours, sometimes as high as 20 straight hours.

3) can just be rephrased to mean continuous novelty-seeking or stimulation chasing. The way it was worded in the post does seem a little dramatic.

ADHD makes it more painful to try to focus on boring things, so even if everyone finds work boring after a while it is worse for those with ADHD.

ADHD-PI here! I've changed majors two times these last three years.

Yes.

What you describe in an ADHD context might be called "hyperfocus": It's a period of intense focus which you are able to maintain and enjoy cause it stimulates your brain.

But, critically, you are not able to maintain this hyperfocus for longer periods on a single topic as the stimulus of novelty flattens out and you become bored and understimulated and this quickly leads to procastination or switching to something new.

What it’s the period when it becomes a disease as what you describe is basically how humans generally work?

It’s not a disease. It is the way some people are wired. Just like some people are really boring

That's my hunch as well. In another society, peoeple "with ADHD" would actually be deemed normal and well-adjusted, while drones who want to go to the same job for 40 years would be medicated. It just happens, that in civilized societies, specialization and consistency give huge payoffs, so we medicate people who can't naturally do that.

Well that doesn’t seem to describe a disorder (the word i meant to use)

This pattern alone is absolutely not enough to suspect it's ADHD. Several other factors need to be present.

In general during diagnosis (I can attest to Germany), it must be credibly shown that multiple symptopms have been present both during child as well as adult age.

Typical patterns are several aborted apprenticeships or studies, inability to hold steady employment over several years, problems with romantic relationships or long lasting friendships.

At this point (2022), we know ADHD has a genetic component. The "Hunter versus farmer hypothesis" is the most prevalent anthropological hypothesis (non-medical) about the historical positive/negative selection pressures for ADHD traits. https://en.wikipedia.org/wiki/Hunter_versus_farmer_hypothesi...

The tl;dr is that we think ADHD traits had positive selection pressure for 90% of human history, which is why ADHD is so common. ADHD is actually believed to be dramatically under-diagnosed in certain population slices, like adult women, because the diagnostic criteria was developed based on predominantly male/child subjects.

In the context of scouting for a nomadic hunter-gatherer tribe, ADHD traits seem like a gift.

In the context of modern American society, ADHD traits can lead to strong negative experiences spanning education, career, and relationships. In some contexts (like entrepreneurship), ADHD traits can still be a gift - but I'd hazard a guess that percentage-wise, a larger % of the ADHD population winds up in prison vs. becoming an entrepreneur.

Similar to autism, ADHD is a spectrum neurological disorder. "Disease" is the wrong term to use; "disorder" is the correct medical term. ADHD traits become a disorder they have a negative impact on development (childhood) or negative impact on well-being as an adult.

So you are on stimulants now that seem to help with your long term focus? Is there a concern of tolerance and dependency, like coffee/caffeine, where you'll have to keep upping the dose to get the benefit? Sorry if I'm being nosy but this is rather eye-opening to me and makes me think it might be worth speaking to my doc about this.

I'm recently diagnosed with ADHD-like symptoms and started on a low dose of Focalin about a month ago.

I can say for short-term focus and motivation it's been life-changing.

I would frequently flip-flop between getting sucked into rabbit-holes and having too many things going on at once. I now find that I can focus on tasks much better throughout the work day. My quality of work has improved as I've been able to better focus my time on what matter.

My doc has warned that over time I likely will need dosage increases, but for now it's been a wonderful experience with very few side effects (headaches the first day or two).

I apologize if my response is kind of all over the place. I am somewhat of rush this morning, but I wanted to throw my hat into the ring.

To contrast the other user who replied, I have been on stimulants for 8 years now.

I will say that there is a very notable drop in efficacy. Not enough to justify stopping them all together, but I'd say I get about 50% of the benefit on my best days.

I would consider my current experiences much like that of caffeine. It worked amazingly in the beginning, but now I feel like they are necessary to achieve a baseline sense of normalcy. I could raise the dosage, I suppose, but I do not want to go down that path again because it is just a temporary fix.

Honestly, taking time off stimulants has been more effective than increasing dosages. Most people can stop stimulants with little to no issues, but since I have adapted to them over the years, the withdrawals are pretty fucking uncomfortable and debilitating. Though, according to my medical professional of questionable quality, my experiences are still unusual. Still, I try to take weekends off, and it's been helpful none the less.

Going forward, I am thinking of switching to a non-stimulant, which may be an option for you as well if you are indeed ADHD. Despite how ever effective stimulants may be, I believe I am starting to lose more from them than I am gaining from them. At least where I live, the constant drug-testing and various laws surrounding controlled-substances makes stimulants almost not worth it.

The medications can be life-changing, but in the ADHD community, it's well known that there is a honeymoon phase (it's not uncommon to experience stimulant-induced euphoria), thus the real judge of how effective they are should be determined once that period is over. However, not everyone gets that honeymoon period, but I sure did for a few weeks.

If I must be entirely honest, I think that the medications do help, but I never have thought they helped enough. They make life easier, but not easy, and that is something I think I have really struggled to come to terms with. I went in with expectations of a silver-bullet, but left with a tool. My fair warning would be to be careful what you read about ADHD medications online.

One other point that I feel I should warn others about -- something no one ever told me -- is to not let meds give you enough rope to hang yourself. What I mean is: I built a career and a life while having access to these medications. Recently, there has been a nationwide shortage in my area. Every pharmacy was out of stock -- literally none in my area had anything. Zero. Nada. I was working on a big project at work, and basically had to put the entire thing on hold for three weeks because once I ran out -- I was flat useless. I couldn't believe how much I depended on them to do my work. It caused me a lot of stress and anxiety realizing that I am basically living a variant of the plot of "Flowers for Algernon" and that without these medications, I seriously do not think I could maintain the life I was able to build on them. I am not trying to scare you away, but I feel like it would be dishonest to not include both the good and the bad.

If you have anymore questions, I'd be more than glad to try to answer them.

Does limiting the number of days you take medication (mon-fri and/or doing x weeks on, x weeks off) help in any way? I've always read threads like these and thought, yes that definitely sounds like me, but I have always been hesitant to get dependent on a medication...

As far as I am concerned, we are all dependent on "something." Prior to medications, I was dependent on moderately high consumption of coffee and tea.

Many patients and providers are both afraid of "dependency." However, what seems to escape me is -- isn't that somewhat of the point?

I depend on the medications to help treat a chronic condition. I see it no different than being dependent on eye-glasses for poor vision.

What many are worried about is the potential for addiction. I do not feel addicted to the medications in the slightest. I do not "crave" them or anything like that. I just crave/am addicted to not fucking up my life any further, and losing what I have barely been able to piece together. I do not feel "high" or feel "good" from these medications. If another medication provided similar level of functionality and was not a stimulant, I'd be on it in a heartbeat (I've heard the non-stimulant options are of dubious efficacy in adults... to say the least).

To answer your questions, does taking weekends off or weeks off help? Well, in the beginning -- yes. Taking weekends off for the first few years was highly effective. I noticed a notable increase in efficacy upon resuming my treatment.

However, something changed down the road once I stopped taking weekends off. I started taking weekends off again, but once I resume treatment, it now takes me like a day or two to "get back" to normalcy while on the treatment. However, the mild side-effects seem to be stronger upon resuming (this was always true).

From what I understand, it takes longer than two days to clear the medication from your system (half-life is around 10-12 hours), so weekends might not be enough time off for me.

As for weeks, I have not taken weeks off in probably 6 years, because I have not been at a point in my life where I have been able to do such. This has more to do with my employment than the medication i.e. the longest I have had off work is 5 consecutive work days in 6 years, so that is the main reason (I need a new job).

Though from what I have discusses with others, taking weeks off here and there is far more effective than weekends off. Current research claims there is no tolerance build-up, and the only tolerance that one acquires is to the negative effects, but I call bullshit.

However, I will leave you with this. I have always felt that these medications were a gigantic help -- especially in the beginning. Though when I look back on my life, things really aren't, nor were they truly ever, "better." I did not magically turn from a struggling developer into a FAANG prodigy. I was your below average, struggling dev in a bottom-of-the-barrel job. After all the time, effort, and treatment, I am still in the same situation.

The doctors handed me a rx and I thought that'd I'd be on my merry way towards achieving the things I wanted in life, but I have come to realize over the years that it's not that simple.

I really appreciate your thoughtful and insightful reply—gives me a lot to think about, thank you!

Thank you very much for your perspective. This is useful to know.

I've basically found some methods to cope with my weird attention issues but since my methods are so unusual and essential for me to be focused it makes it difficult to work with others or keep up my own self-motivation.

I was wondering if there was a magic pill to solve some of these problems, but you've cleared up that it's a double-edged sword.

A wise psych once told me, "Find me a perfect pill, and I will show you a pill that does nothing."

Medications very well may alleviate your focus issues too, and you might have entirely different results than I have, but do what you think is right.

I hope my comment did not persuade you not to seek treatment, I just felt it would be dishonest to not share some of the less than favorable aspects.

Would you be willing to share your coping mechanisms? Or is there a way I could reach out and ask?

Sure, though I don't know how helpful it'll be to you or others. I basically had to change my career to get through things long term, but I do have some day-to-day techniques I follow listed down below. Hopefully some of it is useful.

I was a developer for 4 years after college, but I noticed I was struggling way more than my coworkers and friends in terms of just staying on task in a long term project for more than a few weeks at a time. In the short term I was at least as good as most, but after a while things just became impossible to keep focused on. I constantly asked my manager to be given different tasks or parts of the code to work on. This wasn't terrible because I was useful in many different parts of our code base, but eventually there weren't any parts of our project that I was interested in, and I couldn't see myself being interested in any other role where I had to code for the majority of it. I ended up switching into Software Sales Engineering.

Sales Engineering is, for me right now, the perfect role because I still get to think and work on some technical stuff, but no project is longer than 2-3 weeks which is about right for my ability to focus. There is also a huge dopamine hit at the end of a project because there's a clear endpoint. I'm not one of the Sales Engineers who needs to 'close' I just need to build out demo projects for a client until it's deemed a 'technical success'.

Some short term techniques I've learned for my own mind in just being productive (these were a lot more necessary when I was a developer but I still follow these in some way): * Change my physical working location every 2 hours (COVID has sucked for this, but going to coffee shops and libraries helps a lot) * Drink 1-3 cups of coffee in the morning, and 2-3 cups of tea the rest of the day (I've had to experiment with timings and doses a lot) * Keep a hand-written TODO list and keep my eye on it throughout the day -- For very boring topics or in difficult times, literally write down the scheduled time blocks I will spend on specific topics * Also in very difficult times, I TRY not to look at the computer unless it's to work on my required tasks. Internet to me is seriously more addictive than anything I've experienced

And related to this, don't get discouraged if it ISN'T ADHD and medication for it doesn't help.

I thought I had ADHD and was frustrated as to why medication made it worse until I discovered I actually have PTSD + crippling anxiety that meant I avoided stability because I didn't trust it and 'flight'/taking on a new identity is one of my preferred 'fight, flight, freeze, fawn' responses. Basically my body only knows how to exist in chaotic environments.

Actually never crossed my mind it could be a sickness-related. I just thought it as a sort of "too many possibilities saturation" or too quick loss of interest. So I decided to ask like-minded people like you here, at least from the same more or less background. Will make the online test, though...

I would be cautious in self diagnosing. Taking pills and self medication is thrown around quite easily around here. One does indeed need to find their own path without blaming mental health as a first resort. I am now seeking a transition from software development to something else and as such i experiment with concepts and ideas quite frequently. I changed jobs for a while until i settled down for what i liked, now its time to find something else. Nothing mental health related in this.

I would in general recommend a good therapist. (Warning: this may take some trial and error.) They will help you understand your personality and be able to make professional recommendations, including getting officially tested for things. It's a bit dangerous to convince yourself of various maladies via online tests and anecdotes, especially when a lot of things can be addressed psychologically and behaviorally and also because many disorders share similar symptoms.

> Will make the online test, though...

Go see doctors and therapists, different ones, to get different opinions

Not fitting in our crazy modern world doesn't mean you're "sick"

ADHD isn’t a sickness. It’s a thing that an awful lot of people have.

Disorder is the better word, but it's still a condition defined in relation to how it affects your capacity to function in the target society

I have it for reference. Both my children have it.

What is the difference between someone who has it and somebody who doesn’t? Where is the line? There is no biological line because we all have these traits.

It is only a disorder of it interferes with how you interact with modern life/society.

Being human is a condition and for some a disorder. Here, have a drug (anything that triggers dopamine)

Yes, by definition the difference is only in the sense that it affects your life negatively. Of course, negatively will be relative but logically if the individual is okay with it (and the people in their life agree) they will not seek treatment or a diagnosis.

To be more precise the cliché idea that society is insane and the individual is sane is not really helpful because dysfunction relative to the society is the entire defining aspect of what insanity is.

Perhaps that is why adhd diagnosis is on the up because we see so many people suffering in the construct that does not work well for those that have such sensitivities?

I think there is too much information in general and it's affecting us in unpredictable ways!

You’re getting a lot of advice about ADHD and the medications prescribed for it. My advice is to tread cautiously and know the risks, because most doctors won’t tell you (or they’ll just gloss over them).

Amphetamines are addictive and, used as prescribed, you can find yourself with way worse attention and psychological problems. This is especially true if you take them on a daily basis as prescribed. Taken this way, they can lead to chronically depleted adrenals and long term downregulation of your dopamine receptors, which means you’ll feel like shit when you run out of medicine. The road to up-regulating your receptors is long and arduous.

Hopefully you don’t have a problem filling your medicine, as most people who take controlled substances inevitably come across righteous pharmacists who will refuse to fill them (instead, they will tell you they are out of stock).

There are also long term risks such as the development of Parkinson’s disease. Is a little bit of productivity now for your boss worth developing a debilitating disease in retirement? Only you can make that call.

> Taken this way, they can lead to chronically depleted adrenals and long term downregulation of your dopamine receptors, which means you’ll feel like shit when you run out of medicine. The road to up-regulating your receptors is long and arduous.

Do you have references?

> There are also long term risks such as the development of Parkinson’s disease

Do you have references?

1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419581/

2) https://n.neurology.org/content/90/15_Supplement/P6.079

I had this. Changing jobs, freelancing, jumping from project to project, hobby to hobby. Couldn't be at a job for more than a year...until I found a company that actually does work properly.

I had same symptoms as above but for me it was not ADHD but bad employers. Even hobbies are stable now.

Got "low/medium probability". Guess it's not that.

Just as a point of balance: adult onset ADHD, while possible, is quite rare. Many other more common disorders, such as anxiety and depression, will share the same symptoms as ADHD.

Yes most everyone says the symptoms need to be present in childhood as well. But apparently the structure of school and just being a little smart can mask the performance symptoms in childhood. Then once the structure is gone in adulthood and life becomes much harder and more complex, the big symptoms start to show up.

Not to be pedantic, but just because symptoms are masked does not mean they are/were not present. I think the differentiator is whether one had symptoms to mask or not in the first place.

I masked some of my symptoms as a child, was diagnosed as an adult, etc., but the symptoms were always there despite my prior ability to function around them.

I’m not sure about the whole neurological dysfunction story. It sounds a lot like the now debunked chemical imbalance story for depression. So far as I know there’s no ADHD blood or other objective test. I am however sure about stimulant drugs being a shockingly effective productivity booster when properly dosed though. As the comment I’m replying to notes, it’s trivially easy to walk into a psychiatrist’s office and get an ADHD diagnosis and that’s the safest and most legal way to get them. Whether or not long term use is prudent is an entirely different matter of course.

Edit: The above can be read as dismissive and that's not what I intended. Please see my reply further down for more context.

> I’m not sure about the whole neurological dysfunction story.

Are you a medical professional or do you have a scientific source backing up your suspicion?

The point why there is no objective blood test is mainly rooted in the fact that getting a true measurement of a neurotransmitter is prohibitively costly (measurement across intra- and inter-daily blood samples to establish a true baseline). Yet, scientists are doing this and there are genetic and neurotransmitter markers which are abnormal in people classified with ADHD. For further reading with a variety of medical sources I recommend [0].

It's a disorder, and presents with a large variety of expressions or comorbidities, but the symptoms (restlessness, jumping between hobbies) are shared and the consequences both in private as well professional lives are severe.

The inability to focus on single things lead to worse career outcomes and worse relationship outcomes. It is a serious suffering for those affected. Ritalin has a 60 year pharmacological history and has proven to help people. Modern stimulants are even better.

I am hugely grateful for the fact safe access exists and as someone affected badly, [I don't think it's appropriate to make fun of someone seeking access to this medication.] STRIKE that out, GP explained his intended meaning further below.

[0]: https://www.medicalnewstoday.com/articles/325499

> I don't think it's appropriate to make fun of someone seeking access to this medication.

As someone who takes daily medication, I didn't read the GP's comment as making fun. It seemed to just be a statement of belief.

> I am however sure about stimulant drugs being a shockingly effective productivity booster when properly dosed though. As the comment I’m replying to notes, it’s trivially easy to walk into a psychiatrist’s office and get an ADHD diagnosis and that’s the safest and most legal way to get them.

I might well be over sensitive to this topic, so my bad if I overstepped.

Getting the diagnosis and getting medication has been such a huge relief, it's been quite emotional.

The way I read GP's comment is that he's implying that if you have a productivity problem and cannot cut it otherwise, take the easy route, get an ADHD diagnosis (which he believes is not really a chemical imbalance) and cure your bad productivity with stimulants instead of effort.

Labelling someone not trying hard enough or not cutting it 'cause you're not smart enough, or being a loser cause you need to take meds etc. etc. is exactly the kind of stigmatization people with ADHD might face.

Again, my interpretation. I hope I am wrong.

> Modern stimulants are even better.

And if you can't get access to them or cannot take them for one reason or another, then you are basically screwed.

One would think if a disorder had such negative impacts, it would be taken with a little bit more seriousness, but alas, that has not been my experience in the US Healthcare system.

It seems to me that system loves to hand out stimulants, then they look for any and every reason to take one off them. But hey, that is just my experience, and I am overly cynical.

I'm not making fun of anyone. My beliefs on the subject are informed by my own experiences and direct observation of others. I do have some concern about the long term effects of putting people on a close chemical cousin of methamphetamine indefinitely, even though it is, as I said, an excellent productivity booster for those diagnosed with ADHD. Of course it's also an excellent productivity booster for those who aren't diagnosed with ADHD, which is why you see a thriving secondary market at colleges and universities.

After college, I worked in an engineering org at a big tech company you've definitely heard of. A surprisingly large number of developers that I worked with suddenly got ADHD when they realized it was going to take 60+ hour weeks plus on-call to not get stack ranked out and they saw how effective drugs were making those who were using them. I am confident that some persons were just gaming the system. I know this because they explicitly said so. Not everyone tries to be objective in their self-assessment though, so I imagine many of them actually believed they had ADHD and weren't just engaging in a cynical behavior. And I suppose it doesn't really matter: it's an ego-preserving belief that doesn't appear to have any great cost. In fact, technically speaking once they got the diagnosis from a licensed physician they did have ADHD, by definition, regardless of how cynical their motivations may have been. Edit: I also believe some legitimately had ADHD. I assumed that was obvious, but I now feel like I should be explicit.

I have no doubt whatsoever that plenty of people experience one or more symptoms that are associated with ADHD. I've known too many people of whom that is true not to. ADHD is an observational diagnosis. Medical professionals are just speculating at this point when they say it's some kind of neurological disorder rather than just part of the range of physiologically normal brain function. The brain is complicated and it could be any number of things. I have no doubt that the brain can be trained to exhibit ADHD associated characteristics for example. That is after all pretty much the business model of another one of the big tech companies that you've definitely heard of that I've worked for. We euphemistically called it "engagement."

>long term effects of putting people on a close chemical cousin of methamphetamine indefinitely What is your basis for this "concern"? Sure it sounds bad, but there are plenty of chemical compounds with "off by one" differences that have completely different effects.... that's just... chemistry.

Just so you know, (depending on who you read) those with untreated ADHD may live, on average, 10 fewer years than the rest of the population. So if I had to chose between your concerns and 10 better quality years, I know what I'm picking.

> Medical professionals are just speculating at this point when they say it's some kind of neurological disorder rather than just part of the range of physiologically normal brain function.

Where are you getting this from? Any papers? If this is the consensus then I really must not have been paying attention (pun intended)

You seem to have a lot of "observational" experience in a specific setting, but little more knowledge or understanding than the tip of the iceberg "top-5 symptoms". ADHD is an incredibly complex developmental issue. Look at the issues with ADHD and gauging signals from the body, how those affect eating. Look at various issues with sensitivities sensory stimulation. Issues with inhibition and how they permeate behaviours. Reducing ADHD to "focus" is like reducing baseball to throwing a ball around.

Maybe look into some of Dr Russel Barkley's lectures. Some of them are a little dated but mostly accurate. https://www.youtube.com/watch?v=BzhbAK1pdPM&t

> Just so you know, (depending on who you read) those with untreated ADHD may live, on average, 10 fewer years than the rest of the population. So if I had to chose between your concerns and 10 better quality years, I know what I'm picking.

I don't have a problem with that.

> Where are you getting this from? Any papers? If this is the consensus then I really must not have been paying attention (pun intended)

The burden of proof is on them to show that they are not speculating. Some kind of repeatable physiological test would do nicely.

> You seem to have a lot of "observational" experience in a specific setting, but little more knowledge or understanding than the tip of the iceberg "top-5 symptoms". ADHD is an incredibly complex developmental issue. Look at the issues with ADHD and gauging signals from the body, how those affect eating. Look at various issues with sensitivities sensory stimulation. Issues with inhibition and how they permeate behaviours. Reducing ADHD to "focus" is like reducing baseball to throwing a ball around.

I may have confused you by mistakenly saying the brain is "complicated" when I should have said "complex." What I meant was mind-bogglingly unimaginably confusingly tricky and hard to understand. Also, I don't recall reducing ADHD to "focus," where did I do that? I'm quite curious, what are the top-6-through-10 symptoms that I should be made aware of so I can better understand?

> Maybe look into some of Dr Russel Barkley's lectures. Some of them are a little dated but mostly accurate. https://www.youtube.com/watch?v=BzhbAK1pdPM&t

As someone who likes to learn with a bit of an interest in the subject, I'll have a look. Thank you for the reference.

My bad for implying this based on your shorter answer above, thank you for adding this much context.

You are spot on with regards to potential abuse by career optimizers. I've been lectured by my doc during prescription for that as well.

Again, as someone who really feels badly affected by this I am of course not a fan of the abuse.

It's my fault that you got that impression, so I quite appreciate your letting me clarify.

I know there are people who really are suffering and I'm glad that help is available to them. Thanks for reminding me to not lose sight of that very real human element.

ADHD is quite well studied. If you're up for it, there is a 2.5h video that goes into some detail about what it is and how it affects children. I found it quite fascinating and it helped me understand some of my symptoms. (Mine is comorbid with bipolar. Yay.)

https://www.youtube.com/watch?v=YSfCdBBqNXY

Quick questions, apologies if they're too sensitive:

- Regarding your co-morbidity, how did you know/decide to seek ADHD treatment and diagnosis? Was it before or after your bipolar diagnosis?

- Was there any concern about med interactions?

I live with my sister, who's bipolar and we think she MAY have ADHD, hence my curiosity.

Always happy to talk, but I’m not sure how helpful I can be.

I was diagnosed ADD as a child (~6 years old) but I wasn’t correctly diagnosed with bipolar until I was 33 after voluntarily seeking treatment on the recommendation of my primary care doctor.

As far as treating the ADHD, my psychiatrist didn’t bother with a formal diagnosis. She just decided to treat the executive function issues I reported.

Medication is trickier. I can’t use the traditional stimulants (or caffeine) without risking mania and panic attacks.

So I’m taking Wellbrutin (an NDRI) which is both an antidepressant and a stimulant. It helps with ADHD, Anxiety, Depression, and sexual side effects from antipsychotics.

I don’t have any major side effects to report than increase in sexual function and keeping me awake for the next 10~12 hours. (So no afternoon naps to recharge.)

Thanks for the reply! This was helpful. I'm glad that you were able to get the diagnosis and treatment you needed.

And yes, very concerned about giving her any stimulants/mania inducing things. I'm glad to hear that Wellbutrin/NDRIs don't seem to have the same impact on bipolar people as SSRIs do, we'll look into that a bit. (Ironically, I had a terrible Wellbutrin experience. Bodies are weird.)

>So far as I know there’s no ADHD blood or other objective test.

There's a few genes that have been found to be responsible/correlate strongly i believe but I assume genotyping goes a bit far for common diagnosis.

I'm sure it's not the same for everyone that's diagnosed tho and there's a good amount of misdiagnosis too.

> there's a good amount of misdiagnosis too.

Until there is a more objective way to diagnose ADHD, how can one argue who really has the condition or not? It's not like we humans even remotely understand the brain in its entirety.

> It sounds a lot like the now debunked chemical imbalance story for depression.

If you are referring to the recent Joanna Moncrieff cherry picked literature review that had a press moment, then do some checking to see what her peers said in response. Moncrieff has a well established bias against pharmaceuticals and this is confirmation-bias writ large and has damaged the layman's understanding of what's happening.

There are objective tests for ADHD. You can look at how the brain responds under MRI or ECG to show the depressed activity in the prefrontal cortex. It's not required for diagnosis but anyone who tries neurofeedback or checking/confirming dyspraxia maybe as it relates to other nervous system issues.

What most people don't realise is the way stimulants work in the ADHD brain compared to the non ADHD brain are different. Superlatives like "shockingly" really mischaracterize what's happening and perpetuate a dangerous myth. Mostly based on anecdotes of the short-term effects of high-doses on young neurotypical individuals under stress. It's not the same.

Queue hackernews-ists jumping down your throat

when you have a diagnosis, then what? where do you actually go from there?

are there doors that an ADHD diagnosis opens that have a better ROI than, say, graymarket modafinil?

> are there doors that an ADHD diagnosis opens that have a better ROI than, say, graymarket modafinil?

I suppose it depends where you live.

Here is what I can think of off the top of my head:

1. Potential legal protections and academic/workplace accommodations if necessary (US has ADA as an example).

2. Access to potentially more medications (modafinil is not commonly prescribed in the US for ADHD -- even off label)

3. Perhaps less trouble than having to use the Graymarket? Less risk of getting caught? I'm kind of grasping for straws at this moment.

If what you have works, then I guess keep going? Just please be careful. Unregulated areas of markets, healthcare, etc. make me nervous, personally.

Therapy can help. Some people can learn to manage it without needing drugs, or at least without being as dependent on drugs.

It’s a super power once you get hold of it.

How do you get hold of it?

How did I?

I have impulsive ADHD. It’s been a great tool but also got me into a lot of trouble.

I never thought I could change who I am. I am right but I could become aware of what I am an try to engage my bigger brain rather than the impulsive part.

Once I started investing in knowing me better rather than just allowing me to be on a seemingly uncontrollable train I could see how certain behaviors could be toxic to me and others.

And forgiving myself.

This mostly came through the enlightenment of having a son who has it and dealing with that whilst having ADHD. And that has been my greatest challenge and success.

Meta cognition. We talk with him about it in a way which isn’t blame or ‘you can’t do that!’ and while there is still a lot of support he is thriving.

Happy to chat offline too

Were you able to do this without prescription meds?

Yes however I looked into with a psychologist, a lot of research and decided to not.

Was based on looking back on my life with a new understanding and then working via therapy on aspects of being.

Can you be more specific about what you did?

Therapy. Identifying behaviors and which are coping mechanisms and those that add fuel to the fire.

Then becoming my own therapist and taking time to retrospectively view my actions and behaviors.

Taking action on those epiphanies and acts of vulnerable faith.

Example: with my new boss ‘I have ADHD and I can be brilliant and shit. When you feel me being shit just remind me of this email’

The old reaction would be I might get defensive or try and explain things away.

New reaction or treatment is like a new data point to help me retrain my framework.

Don’t take it as I’m a robot but I catch myself more often than I ever did and if I don’t I have a way of addressing it.

Meditation and understanding the principles of what this is trying to achieve.

Did you find any good ways to manage it?