I have moderately severe ADHD, and have good reasons to not use medication.
My first response to this is that it solves problems that I don't have, and ignores the ones I do have.
Organizing my day on paper is trivial. I'm also married to someone with a good partnership, and we offload different types of tasks to each other. She might enjoy having software assistants to be more productive, but I don't need that. I have her.
The trick for me is that it is important that my life be organized around engaging with things that I want to do. And thereby having my wants reinforce executive control so that I can do what I think that I should. This involves a lot of managing of my emotional state, and a lot of REJECTING of outside demands by the world that I conform to how the world wants me to be. I see nothing about this app that helps me do either thing.
Yes, yes, I know the idea of eliminating distractions so that I can focus. Honestly, that's crap that leads to disasters every time I try it. If I have positive motivations to do X, distractions are easy to set aside. If motivations are negative, I will be unable to resist creating distractions. And a straightjacket that prevents that leads to insanity.
Which returns me to my point. The key, for me, in handling ADHD is emotional tools to find positive motivations, and social tools to resist the world attempting to load me with tasks through negative motivations.
> it solves problems that I don't have, and ignores the ones I do have
This is exactly what I suspect of virtually any kind of app, software, platform, etc. I’m advertised as intended to help me with ADHD. ADHD is expresses itself in such a broad variety of ways. I just don’t trust that any kind of app is actually so tuned into my experience of ADHD that it could actually be helpful.
I hesitate to say this: but, it’s hard hard not to feel offended at times by the ways in which ADHD appears to be radically oversimplified to fit into a narrow product specification and pitched to people who might really need help.
The problem with any kind of organisational system like GTD, software like Rescuetime, org-mode, and probably this thing, is that they don't really help me because I don't even have the executive function to get started using them in a structured way in the first place. I'm unable to establish routines, and using these things is just yet another routine to fail at.
At least this seems to be free to use. I really hate when solutions like this cost money and advertise specifically for ADHD. Because, being impulsive, of course I sign up for the thing, use it for maybe a couple days, then stop using it, but forget to unsubscribe for like 5 months, wasting a bunch of money...
Besides that, the main thing I've learned is there's no one-size-fits-all type solution. Sit down and pick one thing you want to improve on, the smaller the better. E.g. procrastination of chores is a big issue for me, and there I realised I'd been looking at it from the wrong point of view. Trying to motivate/schedule chores was completely pointless. The real issue was how easy it was to procrastinate it for something else. Once I reframed it as making procrastination harder, solutions were easier to find. One problem was I would just stop by my computer in the morning to check social media or HN or what have you, and end up sitting there for 5 hours doing various things. So I time-locked my computer using pam_time on linux. Sure, I could perfectly well bypass it by booting up a usb stick and editing the configuration, but that would take time, and some planning(gotta find a usb stick, write an ISO from some old laptop, etc). That provided enough friction to stop the impulse to procrastinate, and enough time to stop and realise I actually can't "just check something real quick", I'll always end up moving from distraction to distraction for hours on end. That's the real issue; the time frame where you actually believe that is short, but long enough to get sucked in.
In other words, and it took me years to realise this, the key cause of procrastination is impulsivity, and impulsivity follows the path of least resistance. So if doing the dishes is actually the easiest thing to start doing, that's also what will come to mind.
I agree with some exceptions.
Apps that take the friction out of certain tedious processes could actually help. Think about an app to order the medication easily or an app to set up an appointment with a psychotherapist easily.
Think about how those neo bank applications make banking accessible and easier to people (in certain countries or circumstances).
For me, even though I generally dislike apps to do certain processes, I really think digitalization and the fact that I can almost all "adulting responsibility tasks" online is very helpful considering the ADHD.
So I think these services always take the wrong approach. Instead of promising to make the ADHD disappear or take a disciplined all-or-nothing blocking approach, they need to consider the fact that people with ADHD are aware that it's a thing they have to life with and generally try to optimize their lives to best cope with it.
So any such company should probably take on whatever tasks one has to do in life to survive in general and try to make all of that more accessible and disability-friendly to be of most help.
And we still live in a world with a lot of stigma, the ideas that adult ADHD isn't a thing or that medication is outright bad or literally cheating in life, or that ADHD doesn't exist or is overdiagnosed. There's A LOT to tackle in this lane.
Don't get me wrong, I really believe there are helpful tools out there. For instance, Notion has been one of the most genuinely useful applications I've ever used (like, it has genuinely improved my quality of life by helping me organize things for work, my personal life, household chores, side projects, etc). On the other hand, I also see how for others like me with ADHD, something like Notion could be overwhelming and therefore totally useless.
I suppose that's my point. ADHD has such a diverse battery of symptoms (many of which are also expressed in other pathologies) that targeting just one of them with an app and then pitching it as "an app to help with ADHD" is very unconvincing (if not downright lazy, if not cynical). An app made to do a generally useful thing pitched to anyone who has the need for that thing, however…
I agreed with most of what you said. Right until the end.
Medication is a mixed bag. Great for those that it is great for, but not great for others. ADHD is way over diagnosed. Many disorders can cause lack of executive function, and if you have one of those, a specific treatment is better than masking one of the symptoms.
Yes. There is a lot to tackle in this lane. But part of it is that we need to clearly understand what the lane actually looks like. It isn't simple.
But that's exactly what I meant. There is often a "it is outright bad" mentality, even it is effective and helps certain people. I don't disagree with you.
Productivity apps miss the mark but I get good value out of Forest on Android, just that slight nudge reminding I just absentmindedly picked up my phone to doom scroll and it's only been 12 seconds since the last time I tried is valuable when the executive function is really bad
I didn't know up until the last few years that I had ADHD, and had just always assumed that I was just crap at organisation and lazy.
I've been through a degree, a masters and years of work using every trick in the book to force myself to work and not get distracted. I have super detailed plans, all of my work is accountable, I write down everything I have to do. It goes on and on how I micro-manage my day just to force myself to work or do my tasks.
Then I got an ADHD diagnosis, started medication and my life changed. Suddenly I can just sit down and get to work instead of fighting myself to put the phone down and close reddit. I don't get up and wander off unexpectedly, I don't feel a physical urge to walk off out of my seat and in my 30s I realised that's what normal is. I don't put off every little 5 minute task, I just do them without a second thought.
Sure, I can survive without the meds, but life is so much easier not having to fight against myself for every single damn task.
I also take antidpressants and I view them in the same way. The tablets don't "cure" me, but they clear my head enough so that I can make the conscious decision to improve my behaviour.
I assumed I wasn’t applying myself, or didn’t use the right learning style, or whatever else was being offered as a suggestion. It didn’t help that I was a kid in the early 90s, when Ritalin was getting big, and some parents (like mine) were staunchly opposed to medicating kids for supposed normal behavior.
I found much later in life that the only things that consistently motivated me were a looming deadline, or severe consequences to failure. The lone exception was computer puzzles, by which I mean things like “how do I get this obscure Chinese sound card running in Gentoo,” or “how does a file actually get written to a drive? oh look blkparse…”
About a year ago, I got an ADHD diagnosis for primarily inattentive type, and my life changed. There have been some tweaks here and there to medication and dosage, but the amount of focus I can now devote to tasks which previously would be monstrously difficult - like writing Jira stories - is amazing.
It's crazy, huh? Nobody would ever say "how dare physically disabled people rely on things like wheelchairs to be less disabled" (well, nobody I would consider worth listening to at least). Yet medication for ADHD, depression, and other mental health issues are stigmatized.
> My first response to this is that it solves problems that I don't have, and ignores the ones I do have.
That's the hallmark of applying technology for technology's sake, which is a lot of what engineers and tech entrepreneurs do nowadays. Especially for technologies that are getting a lot of hype. AI is blockchain all over again, a lot of "let me try to shoehorn this sexy tech where it doesn't really belong."
You nailed it on the end for me as an Adult with ADHD diagnosed in my 30s.
Motivation has been my biggest A-Ha with ADHD and trying my absolute best to align what I do with what I want to do otherwise I am setting myself up for failure and others for disappointment with me.
ADHD is a neurodevelopmental disorder. The symptoms of this disorder are caused by physical differences in the brain, right there in the prefrontal cortex where those responses to inputs are generated.
It sometimes happens that I just physically can't bring myself to complete some simple but important chore. That's not because I'm mentally weak, but because my ADHD brain does not provide the right amount of dopamine which everyone else with a more typical brain would get.
ADHD is diagnosed by the occurance of defined symptoms. like most things in the DSM. Many things can manifest psychologically to give the collection of symptoms. Its not purely or even needs to be structural differences in the prefrontal cortex
The specific set of symptoms and the diagnosis they would lead to according to the DSM, are in fact rooted in a set of interconnected structural neurological differences in the prefrontal cortex.
The ability to recognise when someone might be thirsty, doesn't mean dehydration no longer exists. They go together.
> in a set of interconnected structural neurological differences in the prefrontal cortex.
Can you prove that? Because my understanding is that ADHD isn't diagnosable by imaging the brain. If there was a structural difference, presumably it would show up on scans? Or at least post-mortems?
My brain exhibits significant differences on EEG that the neuro-doctor said are suggestive of ADHD or ASD.
AFAIK it is visible on fMRI, but doing so is incredibly expensive and taxing on the person - you'd need to keep them in the fMRI for very long time, repeatedly, and watch them doing different tasks.
But I've seen papers about this where they did that with some people. The brain simply doesn't fire up like a normal brain does. The structural difference itself might be too small (on cellular or even molecular level) to see with current resolution, but the effect is clearly visible - as well as that medication makes the brain behave more like normal brains, as opposed to normal brains on stimulants (which puts them into overdrive).
ADHD brains operate differently, which is clearly visible on imaging. However, this is not sufficient for a diagnosis because you still need impairment in your life.
The diagnosis is a continual process. My psychiatrist first did many questionnaires with me to determine whether it might be ADHD or something else, and then prescribed ADHD medication (first Strattera but that gave me significant side effects, now I'm on Concerta).
But this doesn't end with the prescription - I visit the doctor every 2 weeks and he continually questions me about the effects the medication has on my life, and tries to see whether it matches the expected outcome for a person with ADHD. If it did not, they would change the diagnosis.
In my case, everything fits - the stimulants make me slow down or even sleep, I'm less angry and overall more emotionally stable, less impulsive, and finally able to work on a task that I choose for an extended period of time. If this was not the case, I'm sure the doctor would be looking for a different diagnosis.
I prefer the procedure from 20 years ago. Where ADHD was defined by having the systems, and then testing every other thing that it could be.
It took my son 2 months to be officially diagnosed. A real pain? Sure. But a heck of a lot better than the situation today where kids with chronic sleep deprivation are given an ADHD diagnosis, then sent home with a medication that masks the sleep deprivation while giving them insomnia.
My ADHD medication (yes, stimulants - and a pretty high dosage in my case) causes me to slow down and sleep. Then I wake up about an hour or so after taking it and am a normal person. I was diagnosed as an adult, but this was always the case for me - as a teen I drank 3 redbulls in the evening and went to sleep, because I finally could as my brain stopped keeping me awake with millions of thoughts.
I would drink about a pot of coffee per day as a teenager, throughout the day. Never had any impact on my sleep either, which I always assumed was just tolerance.
Turns out once medicated, if I have caffeine after about 15:00 I’m in for a bad night. Brains are extremely weird.
At first i wanted to disagree, then i realized why. Disorder means wrongly ordered or sickness. ADHD is classified as such, and if you want treatment, you need to get yourself diagnosed.
I really dislike the pathologizing of every neurotype that deviates from the imaginary normal person. I'm pretty sure, if you look closely you'll find something "broken" in everybody.
ADHD can also be totally debilitating and I - a person with strong ADHD - don't think this talk of "it's an advantage" is helping anyone. Yeah in very few cases there are some positives, but usually not.
In my case, I was hyper-focused on computers since I was a child, and that got me my career/business and that probably saved my life -- because I was totally unable to do anything in school and wasn't able to finish first year of high school and dropped out of it. I wouldn't call it an advantage even though it's probably the reason why I'm so good with computers.
In many cases like the CEOs you speak of, you see the surface - their success - but you ignore the problems they have in day-to-day life, the ruined childhood and the ruined relationships in adulthood. Many would trade all their success for normal life.
It's definitely a disorder. A weird one that might give you above average abilities in some very specific cases and areas of life, but still a disorder. You wouldn't say autism isn't a disorder just because there are few autistic savants.
Also consider - ADHD is much more often present in highly intelligent people. What you see might be a person that was able to overcome their disorder through their intelligence, but their life would be much better and they'd be way more successful had they not have the disorder. And now imagine how a person of average intelligence with ADHD must struggle with their life.
ADHD really doesn't correlate with IQ, I think what you meant is that adults with ADHD who can get their life together enough to get diagnosed are more likely to also be intelligent, which is true, and those with ADHD and cognitive deficits on top are far more likely to be forgotten and to end up in a prison, which is also sadly true.
I have an IQ of 136, which is considered to be very gifted, but my performance and life success thus far are decidedly average. It's a debilitating condition if it's not detected in time and not managed.
Same here. I'm sure I'd be able to do much better if it was not for my ADHD. I don't even care about business - but I'm really sad about my childhood, and about the adult relationships I ruined before I knew what's up with me.
It is indeed a sad state of affairs and a continuously deteriorating one at that. Ironically unhelpful are all the extra hoops society makes us "neurodivergents" jump through again and again before they'll give us the the things we need that will let us become more like them.
With regards to the second half of your post: I understand how you meant for it to come across and that you posted it with the best of intentions, but it still hurts a little bit to read. To save you the sob story, let's just say it's a bit similar to telling paraplegic to be happy with his cool motorised wheelchair that he gets to ride around in all day, and that some of the greatest achievements in history were made by people who often sat in chairs also :)
Being fundamentally incapable of feeling content, relaxed, and at ease for more than about three seconds is certainly not the most debilitating thing that could happen to you, and it can make you dogged and tireless, but it’s also not the normal human condition.
It’s a cruel paradox. A constant background of quiet anxiety, permanent absence of satisfaction, risk taking behavior combined with gripping fear of failure, and a perpetual quest for more can be a great adaptation in an unstable and insecure environment. However, it’s not exactly a blessing.
It’s more insidious. The condition mucks with your priorities & how you think you should approach problems, so even if you know how to hack yourself to be motivated, will it be for the right things?
As far as I can tell, focus and motivation are just a symptom of the deeper discomfort and anxiety caused by lower neurotransmitter levels. In turn, that shapes your relationship with the world.
It is. I've been trying to offer tips on how it works in my comments in this discussion.
If you want some personal books for yourself, try Meditations (by Marcus Aurelius), The Gentle Art of Not Giving a F_ck, and Atomic Habits. If you want some management books to help with your team, try Peopleware (a classic), First, Break All The Rules (much better than the title suggests), and Tribal Leadership.
Motivation has always been my biggest issue, even for relatively small tasks like picking up a wrapper after I've snacked. It's not just the big things like trying to concentrate at work, it even stops you doing relatively short, low effort tasks until everything builds up or it becomes too late
I'm hesitant to make any assumptions about your decision to not medicate, but if it has anything to do with addictive properties, you should look into guanfacine. I have very severe ADHD and was unable to use the common medications for the reason listed. This last year I stumbled upon guanfacine, which is usually a blood pressure reduction med, but is prescribed off-label as an ADHD med. It has no noticeable effects other than having basically been a miracle for me in its reduction of my ADHD symptoms. No addictive properties. YMMV but it changed my life after 41 years of struggling with ADHD.
Guanfacine is approved to treat ADHD in the United States and several other countries.
Technically, extended-release Guanfacine is approved because that's what was used in the trials. The brand name is Intuniv and the generic is Guanfacine ER.
The generic guanfacine (non-ER) can also be used, though technically off label. The only difference is that it must be dosed twice a day instead of once a day and the absorption is different so you can't do a 1:1 translation of your dose to the ER.
Now that Guanfacine ER is generic and cheap, you might want to consider it for once daily dosing.
The non-stimulant medications are very good, but require some patience to get started with. Too many people give up in the first week or month because the side effects haven't settled yet. Straterra (Atomoxetine) is another one that can take 1-2 months for good efficacy. Clinical trials show the positive effects continue to build over the course of a year. Surprisingly, Atomoxetine has a lower relapse rate after discontinuation too, suggesting it might be making some long-term positive changes to the brain. This is a nice contrast to stimulants, where the patient becomes essentially dependent on the medication and can go through a protracted rebound if they ever have to discontinue.
Can Guanfacine be taken pro re nata like stimulants? If so, how long is the duration on average?
One reason I have never considered the blood pressure medications is because, and correct me if I am wrong, if one takes them too consistently for too long, then sudden cessation can be dangerous and/or deadly.
> The non-stimulant medications are very good
Define very good. From what I have gathered during my browsing of research papers of varying quality, it seems that that non-stimulant options are perhaps at the level of "better than nothing."
If I remember correctly, those who do well on MPH tend to do better on Atomoxetine, but even then, it's no guarantee. I've also read plenty of anecdotal evidence from people using Atomoxetine, and it seems like a large majority either cannot even make it past a few weeks due to intolerable side-effects.
Also, the wikipedia page for Atomoxetine is not very reassuring with the statement:
A 2020 meta-analysis found that atomoxetine was associated with anorexia, weight loss, and hypertension, rating it as a "potentially least preferred agent based on safety" for treating ADHD.
What I really want to see if more head-to-head drug trials with all these medications and non-pharmaceutical alternatives.
For example, how much more effective on average are stimulants than non-stimulants? Are things like caffeine, nicotine, or both combined more effective than non-stimulants? What about compared to stimulants?
All I can ever find is research supporting if a medication is successful in reducing symptoms compared to a placebo. I just want to see them all ranked against themselves. Of course, I understand individual experiences would vary wildly, but I do think there is a potential for some utility in this data.
I can't take stimulants for many reasons, but mostly they just make me a miserable A-hole to live with so I tried Atomoxetine/Strattera which worked for a few months and then my anxiety went from 0-1000.
Even getting in a small argument with my kids would increase my heart rate and blood pressure to unsafe levels. However, it did help me focus and pay attention, it also helped me kick my Marijuana habit (Legal state) which looking back just fueled my ADHD symptoms. It was also being used as a crutch to avoid dealing with my emotions and problems in life which just added to my anxiety.
Going back to the studies, another issue is that these medications can vary wildly from person to person based upon our own perceptions, experiences, and other comorbidities combined.
I’m on guanfacine and I’ve ceased it several times without issue. (Due to running out) It’s discouraged but my understanding from researching it is that’s more as a precaution. The bp drop from ceasing is rarely dangerous.
Started on atomoxetine in February - I was 47 - the difference it has made with regards to staying on task, and short term memory is staggering. Doesn't really help with motivation though, sadly.
I wasn't aware of the long term positive changes, perhaps this is what my psych should have said instead of giving me an analogy of floating down a river and wanting me to carry on down that same stream without the meds...
It really does vary wildly from person-to-person. I know folks for whom atomoxetine did wonders, but 4 months on it for me had almost no improvements in my symptoms but a bunch of minor side effects.
Like lots of medications, you really do just have to try out several until something works well with your particular body.
I was previously on Guanfacine in combination with Adderall for my blood pressure so I don't have experience taking it solely. I did learn I cannot take stimulants at all, it takes my anxiety to 1000 and makes me a complete a-hole around my house which helps nobody.
Can you elaborate which ADHD symptoms it has helped the most? I'm currently not taking any meds but I can't focus or concentrate to save my life which makes a demanding IT job difficult at times.
I had already achieved quite a lot in the way of symptom management through cognitive behavioral tools and physical exercise, but consistent application of tools and discipline broadly are exactly what ADHDrs often struggle with. Clearly, it's problematic to rely on a treatment for unreliability which is itself unreliable. So good results, but inconsistent.
The guanfacine has been much more stably effective at reducing the general baseline tendencies. For me, like I said, it was a miracle, since like you, but for a different reason, I can't take simulants.
Are you able to hyper-fixate on things you need to get completed? I rely on that heavily in my life. Without, I am as good as useless.
I've noticed that stimulants can make me hyper-fixate, which often times, can be very beneficial. I relied on hyperfocus prior to being medicated, and it seems like medication is just a on switch for hyperfocusing. At least, some of the time...
How effective was it on your blood pressure? I'm currently on Modafinil and it's been a life-changer but it doesn't help with some of the killer symptoms of ADHD that still plague me (like task avoidance, distractibility, task completion, time management, planning, consistency, etc.). But I was recently diagnosed with hypertension so need to deal with that. I'm worried the GP will say that I need to discontinue the Modafinil as it's not recommended for people with cardiovascular issues. But maybe with guanfacine it might balance out?
As someone in the spectrum with Demand Avoidance, guanfacine has been a godsend. It's cheap, not controlled, and for me, it works better than any stimulant in regulating my attention.
My problems are loss of appetite, trouble sleeping (leading to sleep deprivation that itself causes loss of executive control), and irritability. This is in addition to the fact that I have high blood pressure, and would rather not have to increase the cocktail of medications that I'm taking for that.
You might already be taking it if you have high blood pressure, potentially under a branded name. One of the things it's used for is high blood pressure, and due to not being a stimulant and also not being FDA approved for ADHD adults specifically (only children for now), doctors are far more likely to prescribe it under the high blood pressure umbrella for adults.
This needs more context, because unlike stimulants, you can't quit guanfacine instantly or you'll feel pretty ill. You have to taper off it for a week or two.
Also, you can't drink on it (enjoyably) and it made me feel tired and emotional.
There are many more offlabel meds for ADHD eg Bupropion. Daniel Amen gives tailored recommendations for meds and supplements for each type in his book Healing ADD. There is one type he called Ring Of Fire, which can only be helped without meds. Highly recommended!
With such a vague warning you might want to add more context or references before making those claims. While it may be your opinion or experience that "Psychs are actively trying to ruin your life", those kinds of statements can also deter people who need actual medical help from seeking said help.
Directing people by default, especially ones with ADHD, is equally dangerous. People need to understand the threat to them.
"ADHD types" as I understand, are pretty controversial. If you're going to say that one "type" should not get medicine for a morbid condition, you should have a good reason.
What happens is a substantial percentage of people with ADHD get hurt by a system that uses them, chews them up, and spits them out with nothing, after taking every cent they have. Often times, we die from associated conditions, so it just gets swept under the rug. The industry isn't exactly searching for answers here, so their death is in vein, which infuriates me.
This is a known problem that I'm talking about, because I want it to change. Healthcare for people with ADHD is openly bigoted, degrading, and often harmful.
I'm astonished that despite all the news, conditions for people with ADHD are as bad as ever, and maybe getting worse. I think there's an interesting link to the trans community as well, since some of the psych issue overlap.
It may seem that trans have it better than ever, but they're up against whole armies now. There may be acceptance now, but I can imagine it being even harder to lay low. Mental health is less taboo, but people with ADHD are increasingly being marginalized, told to just give up on their aspirations, and accept life being disabled.
I have an entire rant about how ADHD kids are abused by the public school system.
The worst idea ever is assigning them "monitors". The kid is in a classroom that goes too slow to hold their interest. And there is an adult whose job is to torture them with reminders to return to task every time they get distracted. Guess how well this works? And yet it is a standard IEP intervention used across the country!
For less than the cost of adding the monitor, you could move the same kid into an environment where they can learn at their own pace. Thereby saving money, having the child learn faster, and removing a major source of disruptions for the rest of the class. But we've literally passed a law mandating "mainstreaming", which makes the common-sense and effective intervention illegal unless the parent pays for it out of pocket.
Having a child myself with an IEP I absolutely agree with how utterly useless it is and how horribly the system works in practice. It's even worse nowadays as accountability has been completely removed from students and parents leaving the teachers to fend for themselves without help from the administration that collects fat paychecks.
Eat the rich I say, then we can start solving some of societies problems.
Until then we are all just walking dollar signs, I imagine ADHD is particularly profitable to companies due to our impulse purchases and lack of executive function.
Yes, I've been thinking for quite some time of the many creative ways the condition is exploited by society. From social media to credit, advertising, social engineering, and psychological tricks.
Great fodder for the criminal industrial complex too.
Thank you for taking the time to respond and expand. I totally agree with the context you provided as you also see these same types of systems gobbling up many minority groups for profit or puritanical religious reasons.
In my personal experience, my current behavior health provider (which is not a psych) has been very interested in trying to find whatever works to help me get along in this world, be it medication or not. Maybe I got lucky there.
I've always been gotten the impression that ADHD is just another hurdle in my life and that I just have to work harder than more neurotypical people to achieve the same results.
I am curious to know about what age range you are in as I wonder if this is also a generational / parenting difference? I am almost 40 myself and see many hurdles and issues that my kids are facing nowadays which I can't even imagine sometimes.
This hits the nail on the head for me and why productivity apps usually aren't worth much.
> This involves a lot of managing of my emotional state, and a lot of REJECTING of outside demands by the world that I conform to how the world wants me to be.
A hallmark of ADHD is emotional dysregulation and impulsivity, so what exactly does rejecting "outside demands" look like? How exactly are you managing emotional state if not with medication? Ironically the only way I've managed my emotional state off medication is by conforming to outside demands and ignoring my individual desires/motivations as much as possible.
An example of rejecting outside demands is seeking out work environments where I can cooperatively seek out tasks, rather than having someone try to order me to do what they want me to do. If I encounter someone who wants to order me around, I'll ignore if possible. And if not possible, I'll change jobs before complying.
Trying to do things because someone is pushing me to do them will result in my becoming resentful, and losing my ability to get into an effective state of flow. But enough places in tech provide enough flexibility that I've been able to find places where I can be productive. And, in a virtuous cycle, productivity can make all sorts of oddities acceptable in an employee.
As for emotional dysregulation, let me address that. ADHD is caused by weak executive function. People with ADHD are slow to realize that we SHOULD do X, and the SHOULD is fairly weak. Therefore it becomes hard to resist emotions telling us we want to do Y instead.
I have two tools to address that.
The first is that at a purely emotional level, I strive to be fairly balanced. I work to address things that cause me negative emotions, like resentment, so that I don't have negative emotions to fight against.
The second is that I attach my "shoulds" to my understanding of what I actually want and care about. As a result the idea "I should X" is reinforced by a DESIRE to do X. And this emotional reinforcement makes it easy to do it.
Ironically, it is always easier to motivate myself in the short term with negative emotions. But the effect of doing so is a breakdown of the positive feedback loop that I'm using to maintain myself. Thus forcing myself only works for a limited time, and then falls apart. And so that short-term solution is toxic for me. I suspect that it is toxic for most people - but my ADHD makes it harder to deal with for me.
That said, everything that I do for me involves doing the opposite of what society pushes me towards. This makes for an interesting balancing act.
Have you looked into Pathological Demand Avoidance, a subtype of ASD? I was misdiagnosed with ADHD, but a psychologist steered me in the right direction. What you describe, avoiding demands, both external and internal, deeply resonates with me, and something I've struggled with since childhood. In my case it is certainly not ADHD, and stimulants don't get me unstuck, and sometimes they increase my avoidance. Guanfacine really helps, though.
I have not. But looking at it, that is clearly not a fit for me.
I've always had a pretty classic presentation of ADHD. Demands were hard for me to comply with, but I never lacked a willingness to comply when I could.
The pushing back against demands that I am describing is a coping mechanism that I find improves my self-control. But I don't avoid demands. In fact I make a lot of demands of myself - as long as they are tied to accomplishing things that I want.
> seeking out work environments where I can cooperatively seek out tasks, rather than having someone try to order me to do what they want me to do.
This is precisely why I chose academia. My whole day is mine, no one tells me what to do except which class to teach, and even then I can teach it how I please. It’s perfect for my adhd. They just let me loose and I do science and bring them money. Perfect arrangement. Sometimes I can be a stereotypical absent minded professor tho, but that doesn’t ever really cut against me. Students complain sometimes but I do my best for them and get high reviews, so I think I’m managing okay.
> An example of rejecting outside demands is seeking out work environments where I can cooperatively seek out tasks, rather than having someone try to order me to do what they want me to do.
In reading your replies.. you've got it straight, from another long time ADHDer.
Tools are useful in as much as they help you control your attention.
The only ones I've found truly useful are ER4SRs. (In ear monitors, -35DB to the environment. I listen to music while I work, at ~70DB. If you do the math about the only thing I can hear is a fire alarm... and that's about right. :) )
Tools are useful even with medication. It's a myth that ADHD meds just fix you, they simply make things easier. And when that motivation is easier to overcome is when you use that to consciously make changes to your behaviour.
And in that case, the organisational tools are still helpful
I'm now very sad about Etymotics not sealing in my ear canals properly lol
Currently on the lookout for other IEMs with decent sound, I heard good things about Crinacle's 7Hz Dioko that have a flat-ish signature similar to Etymotics.
There are 3 different triflange tip sizes, and foamies. Getting the seal right for me is about being willing to put them in deep enough. It certainly takes a bit of adjustment to how deep you have to insert them. There are plenty of non-deep insertion IEMs, but they are "only" usually around -20DB.
I've used the 7HZ Timeless, and it is an excellent IEM... But it doesn't match the ER4, for my use-case.
I know that Etymotics must violate the ear canal to work, but for me the right monitor (and only the right monitor) gets some sort of incorrect seal that muffles the driver after some seconds regardless of the tips used and after cleaning the ears thoroughly, that disappears if I press lightly on the outside, so I suspect a problem with the ear canal shape. I tried swapping the monitors as the cables are detachable, and tried different output devices, didn't work either, so it's not an electronic problem. It's just weird and frustrating.
I'm thinking of simply buying a pair of reasonably priced over-ear muffs, maybe with active noise cancelling, and wearing IEMs under them. It would look strange, but comfort is more important.
Can you really work while listening to music?
Having ADHD also, I can only perfectly focus if there is silence. Luckily I have over ear headphones that do noise cancellation when nothing is playing.
The style of music matters. For example lyrics kill my ability to think.
For a long time I thought I couldn't. Then I found lots of playlists of pretty good music. Try https://www.programmersmusic.com/ and see if any of those styles work for you.
Note, I now find that music helps me focus, but lessens my creativity. So I only sometimes use music.
Everyone is different. What works for one person, doesn't work for another.
Even for "normies" this is true. We all forget this. Medicine is often an art as much as a science.
As far as my ability to work to music... It beats office noise, and I have always had tinnitus, so... total silence is actually bad for me. Background noise saves me.
With myself it depends on the task and genre of music. I often turn to music without lyrics if I really need to focus as it drowns out distractions and doesn’t create one itself.
Mostly a lot of mind-body stuff to develop self-awareness, and adjusting my life, routines, and priorities to fit the needs that I find are not being met.
I can ramble on for ages about it. But it is also a highly personal journey - what works for me won't for the next person and vice versa. However KNOWING that it is important is huge.
I found your original comment very informative. Did you pick this up through your own experiences? Would love to hear if you’ve read anything in particular that helped you form a routine that worked for you.
He does fine until he starts spouting dogma about what all interventions must look like. That part is BS. BY FAR the most effective intervention that I've seen for ADHD in children is https://www.cdc.uci.edu/. It does none of what he claims you need to do. And it routinely takes people who can't perform in a normal classroom, and turns them into people who can.
I just watched a bit of the second video.
One problem with his model. One of the classic presentations of ADHD is hyperfocus. A state in which everything he says about ADHD is wrong.
The problem with both videos is that he is focused on control as accomplished through executive control. But there is a second path towards emotional control involving dealing with our emotions. And if you succeed in THAT, then your basic emotional makeup is supporting your self-control. Rather than imposing control through executive function, your executive function is being supported by your emotional makeup.
I've found this to be a far more effective way to do things. But it requires unlearning a whole lot about how we think that things should be done.
I could write a book, and it would still feel vague. And what I do for myself, isn't going to work the same way for you.
I will say that my path involved a lot of work on self-honesty. A lot of work on body awareness. (A lot of emotions show up in your body.) A lot of work on building empathy and gratitude. Meditation played more than a small role.
All of that just to get to the point where I'm aware of what I need to be aware of to start finding what works for me.
Once here on HN, someone wrote that meditation helps him/her better than all medication. Well, it strenghtens the "minds muscle" if you will, calms down and teaches handling distractions.
[edit]
The best book on meditation might be John Yates - Mind Illuminated. Got it after a recommendation here on HN.
Forgive me if I'm wrong, but this sounds a lot like dialectical behavioral therapy (DBT), which focuses a lot on mindfulness and emotional regulation to identify "triggers" for impulsive behavior.
Yeah, about that. I fell into the same trap. Now I have someone who thinks her relative superpower makes her more mature and me more infantile even though she grew up dyslexic and still cannot distinguish to/too/two (and even though my income, while more highly variable than hers, is also far, far greater). Apparently it's fairly common for this to very negatively affect relationships. How in the heck did you manage that?? (assuming you did)
> The trick for me is that it is important that my life be organized around engaging with things that I want to do.
> Yes, yes, I know the idea of eliminating distractions so that I can focus. Honestly, that's crap that leads to disasters every time I try it. If I have positive motivations to do X, distractions are easy to set aside.
I don't have ADHD but this is something I struggle with/keep at the back of my head constantly. It took me a very long time to accept that (to put it bluntly) it's almost impossible for me to force myself to work on something I find useless. I wrote about this here: https://sonnet.io/posts/hummingbirds/ and here: https://sonnet.io/posts/sit/
Do you have any resources on the subject you could recommend?
my number one problem is motivation and number two problem is forgetfullness. The forgetfullness part is something I have been working on recently, using stuff like Alexa. I don't see any app ever solving that. I could use a pen and paper for this stuff and I am also seeking a therapist to talk to (had one before but had a negative experience)
> If I have positive motivations to do X, distractions are easy to set aside. If motivations are negative, I will be unable to resist creating distractions. And a straightjacket that prevents that leads to insanity.
First, a direct positive emotion - I'm aware of how much my doing routine chores helps my wife and family. And it is a trade, I'd much rather do the chores than the routine paperwork that my wife does instead!
Second, I use doing routine chores as meditation and thinking time. It does lead to doing the chore less efficiently - I might break off loading the dishwasher to pace, think, and jot down a note. But it is also personally productive time for me.
These are really good tips which have an added benefit mentally with the positivity you are bringing to your own headspace.
I think meditation is overlooked in favor of medications as a valid aid in folks with executive function disorders.
I personally just listen to music with noise cancelling headphones while doing chores. It also helped that I took the time to explain to my family that I am not trying to ignore them but sometimes I need to unwind after a mentally taxing day at work with some distraction free cleaning.
Not OP, but I give myself a little reward. Specifically, I "X" out the task on my daily task list. I take this so far as to add items I just completed to my list just so that I can mark them off.
It's stupid, but it works. At least for me. I think it comes down to 2 different types of positive reinforcement:
1. It feels good to mark a task done.
2. It feels good to look at a list of all of the things I did that day, even if they were the size of taking out the trash.
Automate as much as possible. I cannot live without a washing machine, dryer, and dishwasher inside my apartment. I tried once and I just had dirty clothes and dishes all the time. Beyond that I just pay for it! I love in an hoa so I don’t have to do yard work or trash, so cores are minimized as much as possible.
not OP, but what works surprisingly well for me, is doing chores when I am in the mood. That does sometimes mean cleaning out the dishwasher at 3AM, but at least it gets done sometimes instead of never.
Just keep an eye out for productive moods. Keep checking with yourself if you feel like doing chore X and if the answer is "yeah I guess" drop everything and do the chore.
This is the first post I've read about ADHD that makes me think that there are multi-dimensional qualities and that the general public treats ADHD as a binary yes/no. Very interesting and great self-awareness too.
Do you struggle more on days where you don't sleep enough? I find that on 9hrs of sleep, I'm able to manage my focus, but any less and it's a waste of a day.
Lack of sleep reduces executive control in everyone.
For me, that happens with chronic lack of sleep. Particularly when combined with stress. But in general I'm not too sensitive to sleep. I just start with a low baseline of executive control.
I believe this is very common to be honest. Issues with serotonin can cause anxiety, depression and ADHD, so it's common to have multiple.
I have all three and I'm on Elvanse. When I first started it sent my anxiety through the roof, but my clinician wanted me to stick with it for a few weeks to wait for me to level out, and we increased dosage a few times.
When I found a dose that worked for me, it's a bit of a trade-off. I am a bit jittery for the first hour or two of the day, but that's "jittery" anxiety rather "doom" anxiety. The sort of fidgeting in your chair kind of feeling but the rest of the day is fine. I find the trade off is worth it for me.
When i tried methylphenidate, it gave me the "sense of impending doom" sort of anxiety. That deep feeling in your chest that something terrible is imminent, I didn't like it at all and that's part of why I started antidepressants in the first place.
Two things that all types of ADD have in common are impaired emotional regulation and impulse control.
A combination with Anxiety/Depression meds and therapy might help. Some types only need an offlabel antidepressant like Bupropion for both impairments. All the best.
This is also hard because effective treatment of the ADHD with medication may negatively affect the anxiety or worsen it.
Stimulants especially in some people can increase anxiety and so on. And the worst would probably be sleeplessness as a aide effect of the stimulants that would affect the anxiety.
My son has anxiety. That's no fun. I'm glad I don't have that.
I'm sure a psychologist could load me down with some list of diagnoses if I was particularly curious. I haven't been curious, and I'm rather skeptical about the current state of psychology.
We are each individuals. I just know what works for me and those I care about.
That said, I would not discount that it works. Motivation only works for me if it is either overwhelming, or I'm in a good space. And that mostly means only when I'm in a good space.
Getting into that good space requires keeping my shoulds only things I want for a long enough time to condition my brain to the idea. This is hard to arrange, takes a good while to start working properly, and is easy to accidentally undo. It certainly isn't something I can just turn on.
Oh my god you’re describing all of my days every day. I’ve thought maybe I had ADHD or something but I’ve never read a more accurate depiction of my day to day.
Mild ADHD: You're more distractable and forgetful than most. You have techniques to get around this such as reminders, planners, assistants etc.
Moderate ADHD: You struggle with important task completion all the time. You've experienced consequences from it such as job loss or dropping out of college You may have depression or anxiety related to your ADHD
Severe ADHD: You're in prison because of a violent outburst caused by your emotional disregulation. You're homeless because you can't hold down a job or a relationship. You're dead because you crashed your car while distracted.
ADHD is not a true or false thing, which is what leads to the "everyone is a bit ADHD" myth.
Some people struggle in some situations, but with behavioural management can control it. Some people will find any excuse to not do what they're supposed to do, and have to fight the urge all day every day.
I personally had a bit of the latter, in that I often found myself just unexpectedly walking off mid work and finding myself across the building for no reason. It was just a physical urge to get up and do anything apart from work
My first response to this is that it solves problems that I don't have, and ignores the ones I do have.
Organizing my day on paper is trivial. I'm also married to someone with a good partnership, and we offload different types of tasks to each other. She might enjoy having software assistants to be more productive, but I don't need that. I have her.
The trick for me is that it is important that my life be organized around engaging with things that I want to do. And thereby having my wants reinforce executive control so that I can do what I think that I should. This involves a lot of managing of my emotional state, and a lot of REJECTING of outside demands by the world that I conform to how the world wants me to be. I see nothing about this app that helps me do either thing.
Yes, yes, I know the idea of eliminating distractions so that I can focus. Honestly, that's crap that leads to disasters every time I try it. If I have positive motivations to do X, distractions are easy to set aside. If motivations are negative, I will be unable to resist creating distractions. And a straightjacket that prevents that leads to insanity.
Which returns me to my point. The key, for me, in handling ADHD is emotional tools to find positive motivations, and social tools to resist the world attempting to load me with tasks through negative motivations.