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Re:Adult ADHD Is the Wild West of Psychiatry by lolinder on Saturday January 20, 2024 @11:00PM (#39075402)
One of the best things we can do for people with ADHD is to adjust our expectations of people in general (adults and children).

ADHD wasn't identified as a disorder until recently because it wasn't a disorder until recently. For most of human history, the traits associated with ADHD would have been at worst a wash and in many cases advantageous to have in small numbers within a community. The adults that I know with ADHD are disproportionately likely to be the movers and shakers in their worlds—they work well under pressure and make things happen. You don't want everyone to be that way, but having a portion of the population that can't sit still has huge advantages.

That only changed when we moved into the 20th century and started expecting 100% of the population to be okay with sitting quietly in a chair for 6 hours a day for 12 years of their lives and then, if they had any kind of ambition, to do more sitting in chairs working a white collar job until retirement.

The people with ADHD aren't a problem, the unnatural world we've created is the problem, and we risk losing an important part of the larger organism that is civilization if we force these people to conform.

Re:Adult ADHD Is the Wild West of Psychiatry by atlas_hugged on Saturday January 20, 2024 @11:34PM (#39075604)
I swear, every ADHD post on hacker news, someone comes in here with this uninformed nonsense.

For those of you afflicted with this curse, lookup Dr Russell Barkley’s videos on YouTube. He’s retired now, but was a great ADHD researcher. Really helped me understand what was going on.

Re:Adult ADHD Is the Wild West of Psychiatry by romeros on Sunday January 21, 2024 @12:35AM (#39075898)
Dr. Russell Barkley's brother who had ADHD ended up becoming homeless and dying. He is biased and has a negative outlook on ADD. He talks in a very authoritarian manner.

You should look up other prominent ADHD experts like Ed Hallowell who have a more positive take.

Richard Feynman famously wrote "Science is the Belief in the Ignorance of the Experts". He meant, and explained that "science - a.k.a. research - is in the making, belongs to the (unknown, yet to be discovered) future, while expertise is based on the past, with in-built obsolescence".

Re:Adult ADHD Is the Wild West of Psychiatry by flir on Sunday January 21, 2024 @05:31AM (#39077272)
I'm ADHD and I don't buy that "would have made great cavemen, natural movers and shakers" rubbish for a minute. Dude above who was worried he wouldn't have electricity when his g/f came over because he just couldn't handle paying the bill on time? Much closer to the mark. When I got together with my now-wife, she sorted out a water bill I'd been paying on my old place for months because I hadn't gotten around to telling them I'd moved.

My psychiatrist recommended Gabor Maté for what it's worth, but I prefer a really reductionist "it's all about dopamine" model. It might be simplistic, but it has the advantage of being concrete.

Re:Adult ADHD Is the Wild West of Psychiatry by lolinder on Sunday January 21, 2024 @10:33AM (#39079331)
> I'm ADHD and I don't buy that "would have made great cavemen, natural movers and shakers" rubbish for a minute. Dude above who was worried he wouldn't have electricity when his g/f came over because he just couldn't handle paying the bill on time? Much closer to the mark. When I got together with my now-wife, she sorted out a water bill I'd been paying on my old place for months because I hadn't gotten around to telling them I'd moved.

As a preface, just so you don't think I don't understand what you're talking about—my dad struggled to hold down a job for most of my childhood and finally got diagnosed with ADHD and started medication after he turned 50. I'm intimately familiar with the impairments that ADHD can cause and the real harm that is possible.

That, said, what you're describing is exactly the kind of modern overhead that I'm talking about—the modern world imposes a million little things to keep track of that ultimately shouldn't be required, which leaves us chronically falling behind on menial tasks. That leads to anxiety and depression that makes things even worse.

In the present reality, medication may be an appropriate patch to quickly restore sanity to people who need it, but I'm unconvinced that we should treat medicating a full 5% of the population for ADHD as a reasonable end goal. There are huge social movements for making accommodations for a portion of the population much smaller than that. There's no reason we can't make substantial changes to accommodate ADHD, especially given that said accommodations would really benefit everyone.

Re:Adult ADHD Is the Wild West of Psychiatry by flir on Sunday January 21, 2024 @11:20AM (#39079836)
I get it, because I was diagnosed very late. The sense of opportunities missed is a killer, I feel for him. It's only lucking into a skillset like ours and a wonderful mother, and then wife that let me pull off a reasonable facsimile of adulting for as long as I did - and it was more like "basic functioning" than "thriving".

I've got no problem with the OXO Good Grips argument ("accommodations help everyone"). The only thing I'll take issue with is laying the blame at the feet of the modern world, because I know I'd be just as much of a flake if I lived in a village of 75 people and grew turnips for a living.

Re:Adult ADHD Is the Wild West of Psychiatry by mnk47 on Sunday January 21, 2024 @05:42AM (#39077324)
His views, biased as they may be, match the scientific consensus and are backed up by decades of research. Many of his Youtube videos are just him going over studies and meta analyses, and explaining the findings in layman's terms. I have read Russell Barkley's book, "Taking Charge of Adult ADHD" where he encourages you to not just trust his words but try to keep up with latest research and discuss things with a professional. I have recently started reading "Driven to Distraction" by the expert you mention, Ed Hallowell, and the content is very similar to Barkley's, it doesn't sound like their views on the disorder are different.

In fact, here's a quote from Chapter 1 of Hallowell's book:

>In the decades since that time, research has ballooned. Probably the most up-to-date and definitive account of the history and current state of the field is to be found in a book written by one of the great researchers in the area, Russell Barkley; currently in its third edition, his book is entitled, simply, Attention Deficit Hyperactivity Disorder

Maybe their tone is slightly different, but their descriptions of what ADHD is (not a society problem) and the solution they offer (lifestyle changes and medication) are pretty much the same.

Re:Adult ADHD Is the Wild West of Psychiatry by romeros on Sunday January 21, 2024 @11:34AM (#39079951)
>> His views, biased as they may be, match the scientific consensus and are backed up by decades of research.

This is the problem. Just because he is an expert doesn't mean ALL of his views are correct. For instance Dr. Russell Barkley believed earlier in his career that having sugar in the diet will make ADHD symptoms worse. Years later after much more research he found out that he was wrong and that people with ADHD should sip in a bit of sugared water to focus better.

This is the problem with building a cult around a personality. Science is basically built off of hypothesis. Some of which will be proven wrong by much further research.

There is this thing called Constraint-Induced Movement Therapy (CIMT) developed by Edward Taub, a behavioral neuroscientist. There was extreme skepticism and resistance from the established medical and scientific communities. Taub's work challenged the prevailing belief that little could be done to improve function in limbs affected by neurological damage. At the time, it was widely believed that once certain neural pathways were damaged, they could not be repaired or compensated for effectively. Over time, however, through persistent research and clinical trials, CIMT gained evidence-based support and has become a recognized therapy in neurorehabilitation.

My point is that we should not build a cult of personality and take everything an "expert" is saying as absolute truth. He is right about many things. He could be wrong about some things as well. That's not a bad thing. That is how progress is made.

There is research being done by those who have analyzed nomadic tribes and they found high levels of ADHD like characteristics in those tribe members. The study noted that the traits associated with ADHD, such as impulsivity and a short attention span, which are often seen as challenges in modern structured environments like schools and workplaces, might have been beneficial in the unpredictable and varied challenges of a nomadic lifestyle.

Re:Adult ADHD Is the Wild West of Psychiatry by TheBen1 on Monday January 22, 2024 @02:21AM (#39087179)
There are plenty of jobs out there that are perfectly compatible with ADHD. It's just that in our society, we strive to be our best self. Why would I want to build my life around that disorder? Why I would I want to build society around that disorder? You have to deal with it somehow, of course, and a more flexible work environment is beneficial for everybody. But the society is not the problem, having that disorder is the problem.

Just like when you are blind or lost an arm. It's not a problem because society is build around the assumption that people have two arms, it's not a problem because society is build around the assumption that you can see. We should help people to deal with this issues, but saying society is the problem is the wrong way to think about it.

Re:Adult ADHD Is the Wild West of Psychiatry by lolinder on Sunday January 21, 2024 @12:00AM (#39075731)
Care to elaborate, or was your goal just to be insulting for the sake of it? What specifically did I say that was "uninformed nonsense"? What are the facts that contradict what I said?

If you can't provide something more substantial than vague insults then you're never going to persuade anyone of anything.

Re:Adult ADHD Is the Wild West of Psychiatry by halayli on Saturday January 20, 2024 @11:25PM (#39075550)
Do you have ADHD?
Re:Adult ADHD Is the Wild West of Psychiatry by TheBen1 on Sunday January 21, 2024 @03:21AM (#39076640)
I had undiagnosed ADHD for 35 years and I suffered a lot. When my future girlfriend came to visit my place for the first time, I feard that we would not have electricity because I did not pay the bills. Not a money issue, but between all the daunting daily tasks I just was not able to accomplish that task for MONTHs. I was working on my PhD in CS and didn't get anything done at all. I was in constant fear of getting a task related to Excel, because all these little cells have always made me nervous and furious. I would invest 2-3 hours working around a repetitive task of maybe 20 minutes, because doing it was unbearable. I had always been socially anxious, because for being socially active you need that type of attention that is just hard to maintain. I love being in nature, but going for a walk through the woods? Not possible, because it's "not exciting" enough.

Then a friend gave me some of his pills. I took them for a few days and for the first day of my life I understood how everybody else was feeling, how everybody else could be so confident, behaving confident, just being and feeling normal. I knew that feeling from rare occasions, the absence of all that struggle you are constantly feeling in your body. I had my first normal workday ever. Just going to work, doing work, having a break, later going home. I had never experienced that ever before. And still I didn't believe I had ADHD, never slipped my mind, lol. But then COVID hit and we went into lockdown and homeoffice and I could not work at all and I suffered immensly. I knew that feeling of "I want to do it SO hard, but I just CAN'T" very well, but this time it hit me very hard, for weeks. She convinced me to get diagnosed and here I am, it feels like a distant past already. It was like an instant switch, even though it's a journey to retrain my brain after for decades it had to come up with mechanics to deal with the disorder.

I know there many out there that are/were like me and I know there are many out there that had a quite different experience with their ADHD. Please don't walk around saying society is the problem. Society is not the problem when it comes to depression and it's not the problem when it comes to ADHD. A lot of people would benefit from a different society for sure, but for me and many others it's nothing more than a disorder. It was a miracle I could start a PhD to begin with (and of course getting my Master's was a constant struggle, just as my whole life had been miserable and a struggle). Many others end up drug addicted, dropping out ot school, having a clinical depression, and other nasty stuff. As all mental disorders, we do not know too much about it, but as a matter of fact the medication helps greatly and I am so glad I got finally diagnosed. Some that have ADHD do not suffer that much as I did, but a lot of do. I only wish that my disorder does not get misrepresented as "wouldn't be a big deal in a more open society".

Re:Adult ADHD Is the Wild West of Psychiatry by lolinder on Sunday January 21, 2024 @10:22AM (#39079227)
I know that a lot of people struggle a lot with ADHD, and I'm not at all opposed to medication for you and them. My dad struggled to hold down a job for most of my childhood. Had he received his ADHD diagnosis earlier, my early life would have been much more stable. I'm not trying to downplay the degree to which people suffer and their need for help.

However, what you describe feels to me like validation of my point, not a contradiction. Undiagnosed ADHD overwhelmingly becomes manifest in times exactly like what you describe—you were working on a PhD! You were overwhelmed by Excel. You hated repetitive tasks. COVID lockdowns were impossible for you.

The depression and anxiety associated with ADHD are not inherent to the ADHD traits, they're the result of feeling incapable to cope with the modern world. All of the things that you described as overwhelming are accidental complexity that we can and should get rid of. Being a great researcher shouldn't require all of the overhead that we impose on modern PhD candidates. Just living in the modern world shouldn't require all that overwhelming bookkeeping—as just one example, taxes and bills can be and should be mostly automated, but they're not. If you didn't have to keep track of a million tiny things in your life, would you have been anxious and depressed?

Again, in the present reality medication is hugely important for a lot of people like you. But that doesn't mean that the world shouldn't also change to not require keeping track of so many things that add so little value.

Re:Adult ADHD Is the Wild West of Psychiatry by TheBen1 on Monday January 22, 2024 @02:09AM (#39087105)
It didin't manifest in particular while I did my PhD, that was just the latest phase of my life. Took me 10 years for the Master's and another 10 years for my PhD. I don't think you can imagine the struggle, the fear, the shame, the sadness that came with it my whole life.

As already said, going for a walk was very difficult. Social interactions were very difficult and they can still be difficult when medication wears off in the evening. In general, all my life I wanted to do all kind of stuff, but couldn't. There's nothing society can do about that. It's not all about work either. So, to answer your question: Yes, I still would be anxious and depressed, because I was not able to do what made me relief stress and feel good in general.

I could've learned to be totally fine with ADHD, I was just too stubborn to build my life around that disorder. I kept doing what I wanted to do, not what I could do. I bet your father could've been a perfectly fine sports instructor or carpenter or find another fitting job. I certainly could've, but it luckily never slipped my mind. So we wouldn't need to adapt society, just teach people better what they can and cannot do. That's also much more realistic than "make jobs easier". I don't think, anyone should build his or her life around that disorder and I don't think society should. I did learn how to deal with it though and society should as well, of course. As often, it comes down to balance. A simpler life would've helped definetely.

I oppose your perspective in particular because it's mostly shared by people who deny that ADHD is a disorder, which is just wrong and terrible to think for many that are affacted.

Re:Adult ADHD Is the Wild West of Psychiatry by ddmf on Monday January 22, 2024 @07:26AM (#39088732)
<3

The constant hope that "tomorrow I will go out and do the thing!" followed by the self imposed guilt of "why can I not just go out and do the thing."

Re:Adult ADHD Is the Wild West of Psychiatry by mhss on Sunday January 21, 2024 @11:41AM (#39080038)
Thank you for writing this. I have young family members with ADHD and I really hope they can find the help they need as you did.
Re:Adult ADHD Is the Wild West of Psychiatry by mhss on Sunday January 21, 2024 @10:57AM (#39079566)
As someone with family members with ADHD and as a manager who has had employees with ADHD, the challenge is differentiate and find those cases where it can be "advantageous". Is not easy at all. Also, there are different types and levels of ADHD. It's not a super power to forget things you wanted to remember and being late all the time, there's no benefit on that for anyone. Sometimes the extra creativity or hyper-focus on things that are not a goal for an organization is not an advantage. It's very complicated. I wish I had a solution.
Re:Adult ADHD Is the Wild West of Psychiatry by lolinder on Sunday January 21, 2024 @11:06AM (#39079677)
Yeah, agreed. My dad had undiagnosed ADHD until a year or so ago. He loved research and got a PhD, but couldn't do the tasks that were expected of a professor and ended up not getting tenure. After that he struggled to hold a job for most of my childhood.

It's definitely not all upside, especially in modern contexts. But I do believe what I said—he would have thrived in the more Wild West academia of Isaac Newton and John Locke. The things he struggled to do were the accidental complexities of the job of professor, not the truly important aspects of that role.

Re:Adult ADHD Is the Wild West of Psychiatry by mhss on Sunday January 21, 2024 @11:36AM (#39079988)
> He loved research and got a PhD, but couldn't do the tasks that were expected of a professor and ended up not getting tenure. After that he struggled to hold a job for most of my childhood.

This sounds horrific for both the individuals and their families. Talented individuals with so much to offer not finding their place.

> He would have thrived in the more Wild West academia of Isaac Newton and John Locke.

Yes, I agree. I just don't know how to create a system where the strengths of such individuals are leveraged. If an organization of 100 people is trying to build a bridge and the tasks required are challenging for the 1-5 ADHD individuals in the group, the persons will struggle and the organization will struggle. Both individuals and organizations need to get better at routing those individuals to the right places to leverage their strengths. This is true of anyone but 10x more important for ADHD or other disabilities.

> The things he struggled to do were the accidental complexities of the job of professor, not the truly important aspects of that role.

I have mixed feelings about this because sometimes I have heard people dismiss aspects of work they're not good at as not important. E.g I have had sw engineers claim they solved the problem in their head and writing it down and communicating it to others is not important. At large organizations is just as important unfortunately.

Re:Adult ADHD Is the Wild West of Psychiatry by lolinder on Sunday January 21, 2024 @11:47AM (#39080091)
> I have mixed feelings about this because sometimes I have heard people dismiss aspects of work they're not good at as not important. E.g I have had sw engineers claim they solved the problem in their head and writing it down and communicating it to others is not important. At large organizations is just as important unfortunately.

Yeah, I get that. I guess when I say "important" I mean that we have hundreds of years' worth of examples of people doing great research and teaching without doing the kind of bookkeeping tasks that my dad couldn't keep up with (I honestly don't remember what they were, but it wasn't communicating—he's an avid writer).

There's no question that that part of the job isn't an inherent part of the researcher skillset, and to the extent that we need it to happen there's no reason it couldn't be either automated or done by a different group of people who have that skillset. For example, I often wonder how much we lost when having a secretary or executive assistant stopped being a available to anyone but the highest level employees.

Re:Adult ADHD Is the Wild West of Psychiatry by mhss on Sunday January 21, 2024 @12:33PM (#39080529)
Yes. I think is key to re-assess assumptions about what a job or role profile "should be" and make the requirements and expectations flexible to make room for those differences.
Re:Adult ADHD Is the Wild West of Psychiatry by ddmf on Monday January 22, 2024 @07:24AM (#39088718)
> The people with ADHD aren't a problem, the unnatural world we've created is the problem, and we risk losing an important part of the larger organism that is civilization if we force these people to conform.

This is pretty much what the social model of disability pushes: if society changed with a thought for all some of us wouldn't be as disabled - in my specific case reducing bright lighting, reducing noise pollution, and reducing specific smells would help me a stupendous amount.