12 ms·

It’s clearly not the case for everyone, but I struggled for an extended period of time with a few things in my personal and professional life: 1. Remarkable fo

It’s clearly not the case for everyone, but I struggled for an extended period of time with a few things in my personal and professional life: 1. Remarkable focus in topics which interest me and remarkable lack of focus in topics which do not. 2. Leaving “must do” tasks in areas of little interest until the very last moment, resulting in a predictable lack of excellence in execution. 3. Periodic deep dives into topics which go beyond the aforementioned “areas of interest”. 4. Driven by a motor in meetings: itching to get up and walk around as we talk, feeling more comfortable with any kind of low level motor action happening concurrently to my thinking and speaking. Also led to me leaping to the end of a person’s sentence and others experiencing me as highly impatient / excitable at times. 5. The need to have a TV show or other media playing as I fall asleep. Ideally something I’ve seen before and which is enjoyable but not too engrossing. Almost like one of the cores in my processor couldn’t be idle — it actually made it hard to sleep. (Conversely I always fell asleep watching films with my partner.) 6. Various odd elements of disorganisation — never at work but eg. losing my keys and documents. If you’re reading this and hearing elements of your own experience, and in particular if this is familiar to you from childhood (“Why can’t you apply yourself to X like you do Y?!”) then I would encourage you to speak to a serious psychiatrist about the possibility that you have ADHD. Not everyone has it and I accept that many are probably misdiagnosed with it. My experience of clicking every link on HN with hacks for focusing and not procrastinating was actually a very sad one and I didn’t realise how profoundly it had affected me until I sat in the office of a psychiatrist and he rattled off a range of specific experiences he wagered I had had during my life. It’s been a remarkable process for me of feeling emotional relief as well as receiving medication which improves my life. Again if you’re looking for a productivity hack you do not need to consider that you have any sort of chemical disregulation, but I did not consider the possibility of a medical condition and found myself often in rabbit holes of productivity hacks feeling deeply unproductive.

elchief 6y ago
If you suffer ADHD, I strongly recommend reading Scattered Minds, by Gabor Mate. I found it enlightening
- georgespencer 6y ago
  Thanks! I have a fortnight off coming up shortly and have added it to my queue. An area I spent a long time discussing in multiple consultations was the tension between genetic predisposition and environment. Interesting for a few reasons: firstly there’s some limited evidence that early treatment with medication can have a permanent positive impact on the condition in children. Which to my pea sized brain is suggestive of the possibility that we have sufficient elasticity during our brain’s formative years to consider this, sometimes, an illness not a condition. Secondly there is some evidence to suggest that other disregulations such as dyspraxia and dyslexia are linked to ADHD. A common question in diagnosis is about family history of those conditions. I was also concerned when my doctor and two psychiatrists told me that therapy was certainly an option but highly unlikely to be successful for me. It seems like this book may paint a different picture. Thanks for the recommendation! If you suffer from ADHD, do you mind sharing if the book changed your approach to treatment?
  - chemeng 6y ago
    While Scattered Minds does a good job describing the “experience” of ADHD and will likely resonate with people who have the condition, a lot of its conclusions are not scientifically supported. ADHD is a nuerodevelopmental disorder, it has strong genetic components and the only strongly supported intervention that improves life outcome is stimulant medication. Unfortunately medication doesn’t work or cannot be taken by all of those with the condition. That said, Scattered may help someone work through other common comorbidities of ADHD (depression, low self esteem, etc). It may shine light on the complex interactions between ADHD, the family and society in a way that’s helpful for understanding ones own experience.
  - elchief 6y ago
    It didn't change my approach to treatment, no (I continue to take vyvanse) However, the description of behavior of people with ADHD, made me say "oh, shit, that's 100% me". So, it was nice to know that I am not alone. It's comforting to know that some of my weirdness is from ADHD, and not inherently "me"
carabiner 6y ago
With #1, someone told me 90% of K12 education is supposed to help you get over this. School is supposed to train you to focus on and produce work on subjects that you have zero interest in. I was pretty good at that before, now I think I'm just burnt out.
- non-entity 6y ago
  Heh, didnt work for me. I just failed the classes I didn't give a damn about.
- georgespencer 6y ago
  I think that's probably right in neurotypical folks! Maybe I wasn't clear, but I exhibit what people characterise to me as a remarkable ability to focus and remarkable ability to not focus. Huge deviations from the mean in both directions! The other thing to remember is that whilst ADHD is likely overdiagnosed, that doesn't mean that many kids who have it will simply not respond to K12 education as an environment which conditions them. This is not something which can be corrected with hard work and thought, although people who do not experience ADHD often (understandably) say things like "just sit still!" or "don't interrupt people it's rude!". The crux of ADHD is that it's a neurodevelopmental disorder and a disregulation of dopamine and chemicals designed to help regulate executive function, focus, anxiety, etc. It is generally not possible to see significant results with therapy, although there is some limited evidence that early intervention through medication has long-lasting effects in children who are able to move off medication in the medium term.
non-entity 6y ago
Ok serious question: Every one of these points is very applicable to me, especially 1,2 and 3. I haven't been to a doctor in years outside occasional emergency trips. How do you bring this up without seriously. I don't want to come off as the guy who compulsively self diagnoses based off what they read on the internet.
- laurex 6y ago
  Go to a psychiatrist. Report your symptoms. They will give you a diagnostic and make the call. As long as you go in without stating your suspected diagnosis, you're not "diagnosing."
- stevewodil 6y ago
  Do you have a PCP? You just say that you want to get referred to someone to get tested for ADHD because of x, y, and z and you think a diagnosis would help you
- robmerki 6y ago
  There's nothing wrong with using self-diagnosis as a way to inform a professional inquiry. In my unqualified opinion, you probably have ADHD.
- anon9001 6y ago
  No problem, serious answer: This is the DSMV criteria: https://www.cdc.gov/ncbddd/adhd/diagnosis.html https://www.cdc.gov/ncbddd/adhd/diagnosis.html Doctors are typically screening with a quiz that looks something like this: https://psychcentral.com/quizzes/adhd-quiz/ https://psychcentral.com/quizzes/adhd-quiz/ It's perfectly reasonable to say "I think I may have ADHD based on what I've read online, my symptoms match and people who know me have suggested I try adderall". Some doctors are fine with letting everyone have stimulants, because they're pretty harmless unless you're really binging on them, and they won't give you enough to do that for very long. Other doctors would prefer to put you on an SSRI or SNRI or wellbutrin or some other "non-addictive" medication (which ironically are more addictive, dangerous, and less effective), so avoid those IMO. You may have to shop around a bit, but your primary care doctor technically can write the prescription, but some prefer not to and you might need to find a specialist. Contraindications for stimulants are if the patient has a history of heart conditions, complains about racing heart rate, excessive sweating, trouble sleeping, trouble eating, etc. You generally want to start with a low dose of "instant release" as opposed to "extended release" pills, so you can have more fine grained control over the dose. IR pills can be broken in half, XR cannot. Some doctors are more nervous about IR than XR because they think it has more abuse potential (not true, but it's a common belief). With all that said, stimulants will fix the problems OP described, but don't mistake that for a pleasant experience. The truth is that amphetamines are extremely mentally exhausting, and if you don't take good care of yourself (planning proper meals, staying hydrated, resting at appropriate times, not taking more pills when you shouldn't), you can quickly spiral out of control. It's hard to explain to someone that doesn't do drugs, but stimulants can leave you feeling like a shell of yourself, and it's really disconcerting. It's sort of like being over-tired where you're awake but your judgment is clearly impaired and you don't feel like "you". If you stay on them long enough, you'll start to feel like a zombie just going through the motions (successfully, mind you), but without identity. I make sure to take weekends off to preserve their efficacy for the work week and to make sure I don't become too dependent. I'd 100% recommend having stimulants in your toolkit, and chances are you're already supplementing with worse stimulants (like mountains of coffee or soda), so do give them a try, but be careful.
jaybeeayyy 6y ago
Well, you've convinced me to go back to the doctor. I was on the cusp of taking one of the ADHD tests but my insurance couldn't tell me how much it would be and the doctor's office said they couldn't either. I was told it would be between $200 and $900 and couldn't afford the $900 risk. I ended up being billed $200 just for the initial visit of course. But the longer I wait the more damage it's doing to my life. Out of your list I'd say 5/6 affect me, 5 being the odd one out as I can't sleep with anything but a fan on. I'll be making my appointment today...well, probably tomorrow now. Let's hope I don't procrastinate.
- georgespencer 6y ago
  I'm glad you're doing that! Feel free to email me (mistergeorgespencer+HN@gmail.com) if it would be useful for you to hear more about my experience or for you to share some of what you're experiencing. I have an iCloud note with every shared symptom I see someone else describing on the web, and it's getting pretty huge -- and makes me super happy that other people have had the same experience. I put off the diagnosis process for a year and regret it, but don't consider that a pressure for you to do it. If you have ADHD, one of the things you can't really know (in my experience) is the feeling of a balanced ability to focus and be productive. Feeling compelled to seek a diagnosis is a big step. I had a lot of serious conversations with the doctor about the impact of medication, the causes of ADHD, potential neurotoxicity, neuronal elasticity, etc. before I committed to taking medication. Here if you want to talk!
- sosuke 6y ago
  Yes, do it now, make appointment today. Stop everything else and do it. If you have a doctor that hems and haws about it find another doctor. I got my diagnosis and prescription without any formal test. I have stopped seeing my psychiatrist but once a year since my general practice doctor decided they could fill my prescriptions. The medicine, even the expensive stuff, has payment help programs. Like print out a PDF payment help program easy. If you want more pushing or personal story my email is in my profile. Best single thing I've done in my life to date.
  - projektfu 6y ago
tsjq 6y ago
nicely written. that point-2 totally resonates here :(
Bedon292 6y ago
Obviously you feel the medication is useful, but do you think just knowing vs the medication has any positive benefit? I have read dozens of articles online, and replies like yours and can always relate extremely well to all of the symptoms. Taken the online quizzes and all that. I am pretty much certain I have ADHD. And I have known for years. But, I have educated myself on it, understand how I work (or don't work) and just kinda roll with it. But I have been thinking about it more lately, and wonder if its really worth more steps and medication.
- georgespencer 6y ago
  There is definitely a deep, abiding sense of relief and peace at the fact that a lot of things which caused me pain in the past now make sense. That doesn't help with the day-to-day of things, but it does contribute to an overall happiness which I do not think the medication alone would offer me.
  - james_s_tayler 6y ago
    Agreed 100%
- james_s_tayler 6y ago
  Emotional relief like "I'm not a shitty selfish person after all and it isn't my fault". But if you employ a tonne of ADHD coping mechanisms and they work for you it'll improve things a decent amount. I haven't tried CBT but it's a recommend approach. I'm trying (painfully slowly because it's not super interesting) to teach myself DBT to help with it too. Dx is only strictly required to get Rx but an additional benefit is they do a differential diagnosis so they make sure it isn't down to depression, anxiety, sleep problems, trauma etc. All of which can cause some of the same symptoms. There are a tonne of people who get diagnosed with depression and anxiety and the recommended treatments just don't work that well for them. Then they get diagnosed with ADHD, everything falls into place and they can get their life together so they're not anxious they're going to constantly screw things up nor depressed from shit life syndrome and the depression and anxiety go away.
czbond 6y ago
Why see a psychiatrist? Are those really things to 'fix' on the whole - given the upsides? I'm incredibly energetic. I can't sit down for long - so I just stand in meetings. TV is a waste of time, so is social small talk, I do what I care about (and it rewarded me well). I've just felt like the speed, risk tolerance, freedom it provides me, and intuition make a powerful combination. I'd say the ADHD (if it is) makes you unique. All the world needs is more conformists... [I may be conflating ADHD with my incredibly independent personality]
- czbond 6y ago
  To expand - why not use it to your advantage? Consultants for larger, competitive companies do well w/ ADHD. Leaders do well. Founders do well (if they can stay focused on the opportunity). I have a CompSci degree, and loved doing algorithms, etc - but can't be bothered to sit behind an IDE for hours. So what - enough of people can do that well. I've found leadership to be the best use of skillsets where these 'symptoms' appear.
  - georgespencer 6y ago
    I think this is a really interesting, nuanced point. It's one I talked to my doctor about because it was a concern I felt (and feel). Thanks for sharing it here! HN is usually a good space for contrarian opinions, but even so this sort of thing might get shot down a good percentage of the time. The way I would express it is: ADHD medication curbs the downside of ADHD, but many people report and experience significant upsides to their condition too. The traditional view of ADHD medication is also that it turns children into "zombies". Do I run the risk of losing my 'edge' as a person? I'm not a scientist, and I'm not a doctor. With that said, here are my notes from my doctor when we discussed this: 1. I feel that oftentimes negative and positive personality traits in people go hand in hand, outside of ADHD. For example, the calm, methodical, detail-oriented people who make excellent assimilators and "deliverers" in startups are often a necessity to building something incredible, but can also be the very *worst* people to have around you when you're trying to "yes and" about fragile ideas, because they live relentlessly in the real world. Do the traits I exhibit in my ADHD also make me a more effective leader? Do I simply not understand the upsides because they exhibit as personality traits? 2. Dr. X: There is little in the way of conclusive evidence, but he believes that it's possible that ADHD medication can curb traits that are either perceived as positive or genuinely positive in ADHD patients. This is why a key assessment is the extent to which negative traits manifest themselves. If you have ADHD but do not suffer from life-deranging consequences in some material sense (executive function impaired to the point where your career, relationships, or emotional wellbeing are suffering), then it's often not necessary to take medication at all. 3. Dr. X: the common impression of ADHD medication -- and in particular Ritalin -- seems to be magnified by the fact that parents are in general deeply worried about their children and the sense that their personalities are altered in some way. In adults, the available treatments do not appear to have serious long term consequences for personality and cognitive function. So it's completely permissible to take XR/IR medication for ADHD on days when you especially need to focus, for example, and not worry about "missing" a day. Equally, if -- in consultation with your doctor during titration and your family and friends -- you feel that there is an untenable negative consequence of medicating, then you can of course stop. 4. Dr. X: Anecdotally, ADHD sufferers frequently both underestimate and ignore the consequences of the disorder in their lives. Sometimes it's necessary to have them tell stories about areas of their relationships and personal lives which they find are surprising or hard which are unrelated to their ADHD, and very often doing so reveals that their ADHD manifests itself in ways which are wholly unsurprising but not visible to the patient. 5. Taking the time to find the right medication and dosage is vital. Diagnosis is step one, and after that it is very often months of tweaking, talking, and collaboration with the doctor to establish the right dosage level (strength), formulation (XR/IR, and within that e.g. prodrug is an XR which is a sort of "prequel" to the chemicals you need -- so it stimulates the body creating them rather than dumping the chemicals themselves into your system), and brand (e.g. Ritalin, Concerta, and Medikinet are all methylphenidate, but Concerta is commonly a 25/75 release, Ritalin is available in IR or XR although XR is less popular than Concerta XR, and Medikinet is a 50/50 timed release). Finding something which works for you takes time, and is not an easy feat. It's fantastic that you're not experiencing significant downsides to ADHD! I'm glad you were as clear as you were in your articulation of your concern, I worry that when some people express things like this they cause unnecessary worry in those who are experiencing meaningful downsides which put them off seeking medication. The tradeoffs are different for everyone.
mmanfrin 6y ago
Hah, reading through that list I thought 'hey this is my ADHD', and sure enough that is where you went with it.
- georgespencer 6y ago
  After 30-odd years of feeling alone on this front, it's always lovely hearing that others have had similar experiences. Thank you!
jw1224 6y ago
Whilst furloughed from my job during lockdown, I found myself bouncing off the walls at home consistently enough to finally seek out the ADHD diagnosis I’ve always suspected. I’m 29 years old, and one of my earliest memories is of my parents (lovingly) threatening to put an electric fence around my seat at the dinner table. I’d be up and down like a yo-yo after each mouthful. For the last 5 years, “my friend” has been obtaining prescription pharmaceutical meds from the dark web to treat “his” symptoms. They’ve been life changing — one day of medication leads to more productive output than would ever be imaginable the rest of the week without them. But they’re a double-edged sword. Like another commenter says, overdoing them leads to one feeling like a shell of their former self. But at least you have something to show for it. I put off my diagnosis for years, because I was afraid. I was terrified I would be told I didn’t have ADHD — at which point I would have no answers or excuses any more. If it’s not ADHD (that I know I can treat), then what the hell else is wrong with me? Or, worse, I feared I would be told that I was simply drug-seeking. I felt like I’d entered the Matrix — you take the red pill, you stay in Wonderland. I’ve had 3 appointments with a psychiatrist so far, and, finally, my prescription begins next week. If you seriously think you have ADHD, don’t make the same mistakes I did. Life is too short to waste time fighting against yourself.
- wccrawford 6y ago
  Just because you don't have "ADHD" doesn't mean you don't have a problem. If someone is hesitating for the same reason you were, they should seek help because there is something wrong, even if it's not what they thought.
- georgespencer 6y ago
  > I put off my diagnosis for years, because I was afraid. I was terrified I would be told I didn’t have ADHD — at which point I would have no answers or excuses any more. If it’s not ADHD (that I know I can treat), then what the hell else is wrong with me? This is an amazing thing to share. Reading some of the other replies in this thread from folks who are now motivated to seek help because they experience the same range of symptoms others are expressing, I bet your comment is going to have a direct and positive impact on someone's life. It's not easy to share things like this and folks will definitely feel supported by you. Thank you. > But they’re a double-edged sword. Like another commenter says, overdoing them leads to one feeling like a shell of their former self. I firmly believe that self-medicating in the manner your friend did exposes you to a heightened risk of this sort of experience. As noted elsewhere, there are so many variables to consider with the various medications that it really does require a committed, serious doctor to collaborate with you during titration. My journey so far has been four different drugs, with seven different dosages, and 4 different timed release / instant release formulations. > I’ve had 3 appointments with a psychiatrist so far, and, finally, my prescription begins next week. This is really wonderful news. I've found that the process of ironing out the right medication can be a frustrating one, because my doctor is a careful and methodical person and my instinct is to say "hey let's skip from 18mg to 54mg". No advice, but sharing my story just in case you experience the same thing. I've found that it has gotten a lot better, and I was surprised by the different experience of the different medications.
james_s_tayler 6y ago
Getting diagnosed this year changed my life too. I'm sure at some level the standard science and advice still applies but it's truly as those mechanisms aren't likely missing in our brains, but it's truly remarkable how the developmental delays change your brain such that things really are different for you and it's not just a matter of "trying harder" or "applying yourself". I was absolutely stunned at the profound impact it had on my life once I was able to connect the dots together. Equally stunned at the drastic improvements I've been able to make without following the standard advice but by following what works specifically for ADHD e.g externalize information, externalize decision making etc.
- georgespencer 6y ago
  > Getting diagnosed this year changed my life too. This is awesome! > following what works specifically for ADHD e.g externalize information, externalize decision making etc. I bet everyone would love to hear a little more context around what this is, and how it impacted you, if you have the energy to share. (Me most of all!)
  - james_s_tayler 6y ago
    Don't leave it up to yourself to decide what to do and when. Find a way to put the environment in control. Pre-diagnosis I would try this and it wouldn't work that well or it would work for a short time then after the novelty wore off it'd stop working. Things like set an alarm/reminder for throwing out the rubbish. But then eventually you ignore it and swipe it away or you're dealing with something urgent that day etc. Getting diagnosed allowed me to commit my being 100% to that strategy. I reexamined it and found that it works reliably if you're able to layer systems several layers deep, so that they reinforce one another and act as failsafes. Alarmy plus the barcode mission has been an absolute revelation in my household. I'm now able to throw out the trash, do the washing, use a calendar and mark things off on my to-do list. I finally became able to use a calendar as I have a whiteboard in my kitchen that I put a barcode on that alarmy makes me scan once at night. That kicks off an hour dedicated to maintenance tasks. It starts with a habit stack of basic self maintenance tasks one of which is "check the calendar for the entire week". Things like that aye. The difference is huge. I'm getting healthier physically, and my marriage has improved a lot as I'm not constantly getting yelled at for letting my wife down or putting too much of the housework/parenting on her.
throwawayaug20 6y ago
a big question is how does one find a therapist/psychiatrist? a seemingly simple yelp/google search yields a sea of anonymous faces and trusting these strangers with your brain already feels daunting. i'm in san francisco and am on a PPO if anyone has any recs. email in bio, thank you!
- georgespencer 6y ago
  This was daunting for me too. I had a series of private evaluations in London, and the proxy I used was to seek a consultant psychiatrist (just about as senior as they come) who had a longstanding relationship with his local NHS trust (hadn't jumped from one area to another), looked him up on the GMC (registry of doctors in the UK which would report malpractice or other issues), and asked for a telephone consultation to discuss his work in this area and his approach. I appreciate many of these will not be possible in SF, so I would try to move back in stages towards a person you trust. Do you have a good relationship with your regular doctor? If no, do you have a trustworthy friend who does? Etc.
  - throwawayaug20 6y ago
    hi george thank you for your response here and elsewhere in the comments. i have found them very helpful. i did indeed just reach out to a friend who recommended i talk to my primary care provider (PCP) and go from there. now that i'm looking into all this, mental health is a luxury in america. sessions are approx $200/visit here in san francisco.
    - PoachedSausage 6y ago
      It is not that much better here in the UK for specialised things like mental health. My local private specialist for ADHD charges around £1500 for the consultation, and it is hard to justify risking that much money to just be told you're lazy.
      - georgespencer 6y ago
Aerroon 6y ago
I think #2 is actually great. Without this trigger things never got done for me. University taught me that failure is okay, which removed the trigger for me. End result was that things got even worse. I hope one day I'll be able to find a replacement for it.
- georgespencer 6y ago
  > I think #2 is actually great. Remember that there are a range of intensities to all of these symptoms! A lot of people I know find that leaving things to the last minute can help them focus and they're good at assessing the time required to deliver something high quality. For me it results in disaster more often than not. > University taught me that failure is okay, which removed the trigger for me. End result was that things got even worse. Ah sorry to hear that. Do you generally exhibit other symptoms consistent with others in this thread, or do you think it's just one area which you suffer in?
  - Aerroon 6y ago
    >Do you generally exhibit other symptoms consistent with others in this thread, or do you think it's just one area which you suffer in? I think I exhibit pretty much all of them. From the chronic lateness to being unable to start doing something that doesn't interest me to being unable to put something down that does interest me. This was just the one thing that I didn't realize how useful it was until it stopped working for me. Sure, my work was shoddy compared to what it could've been and I could never feel pride in it, but at least I had something to show for it.
    - georgespencer 6y ago
      You sound very similar to me in that respect. I found it a real grind and pretty demoralising in general. Is there anything I can give you comfort on regarding the process of speaking to a doctor or psychiatrist about it? Or is it something you feel is not having serious enough downsides in your life to warrant the time?
krono 6y ago
Very well written! Recently I was diagnosed with severe ADHD. The struggle finally became too much. Perhaps the effects of the health crisis on my work and finances gave me the final push, I don't know. My life is so much more enjoyable now I am medicated and have had some very minimal therapy. In hindsight all the tricks and strictness I forced onto myself to be able to keep up were very unhealthy, unsustainable, and not even that effective. The psych even seemed quite concerned when I did a show and tell. To anyone else struggling: Just make that appointment and find out what's up. Even if it doesn't turn out to be ADHD these people can help you get so much more out of your life. Nothing ventured nothing gained, right?
- georgespencer 6y ago
  So glad you're in a better place now. This: > To anyone else struggling: Just make that appointment and find out what's up. Even if it doesn't turn out to be ADHD these people can help you get so much more out of your life. Nothing ventured nothing gained, right? Is great advice and lots of people reading this thread are emailing me to say how supported they feel by hearing others' stories. Nice one for sharing.
  - krono 6y ago
    Thanks, I really appreciate that! Good to know people are getting something out of this.
wtracy 6y ago
If all you have to go by is the popular stereotypes, you will be shocked by the number of engineers with ADD.

elchief 6y ago

If you suffer ADHD, I strongly recommend reading Scattered Minds, by Gabor Mate. I found it enlightening

georgespencer 6y ago
Thanks! I have a fortnight off coming up shortly and have added it to my queue. An area I spent a long time discussing in multiple consultations was the tension between genetic predisposition and environment. Interesting for a few reasons: firstly there’s some limited evidence that early treatment with medication can have a permanent positive impact on the condition in children. Which to my pea sized brain is suggestive of the possibility that we have sufficient elasticity during our brain’s formative years to consider this, sometimes, an illness not a condition. Secondly there is some evidence to suggest that other disregulations such as dyspraxia and dyslexia are linked to ADHD. A common question in diagnosis is about family history of those conditions. I was also concerned when my doctor and two psychiatrists told me that therapy was certainly an option but highly unlikely to be successful for me. It seems like this book may paint a different picture. Thanks for the recommendation! If you suffer from ADHD, do you mind sharing if the book changed your approach to treatment?
- chemeng 6y ago
  While Scattered Minds does a good job describing the “experience” of ADHD and will likely resonate with people who have the condition, a lot of its conclusions are not scientifically supported. ADHD is a nuerodevelopmental disorder, it has strong genetic components and the only strongly supported intervention that improves life outcome is stimulant medication. Unfortunately medication doesn’t work or cannot be taken by all of those with the condition. That said, Scattered may help someone work through other common comorbidities of ADHD (depression, low self esteem, etc). It may shine light on the complex interactions between ADHD, the family and society in a way that’s helpful for understanding ones own experience.
- elchief 6y ago
  It didn't change my approach to treatment, no (I continue to take vyvanse) However, the description of behavior of people with ADHD, made me say "oh, shit, that's 100% me". So, it was nice to know that I am not alone. It's comforting to know that some of my weirdness is from ADHD, and not inherently "me"

carabiner 6y ago

With #1, someone told me 90% of K12 education is supposed to help you get over this. School is supposed to train you to focus on and produce work on subjects that you have zero interest in. I was pretty good at that before, now I think I'm just burnt out.

non-entity 6y ago
Heh, didnt work for me. I just failed the classes I didn't give a damn about.
georgespencer 6y ago
I think that's probably right in neurotypical folks! Maybe I wasn't clear, but I exhibit what people characterise to me as a remarkable ability to focus and remarkable ability to not focus. Huge deviations from the mean in both directions! The other thing to remember is that whilst ADHD is likely overdiagnosed, that doesn't mean that many kids who have it will simply not respond to K12 education as an environment which conditions them. This is not something which can be corrected with hard work and thought, although people who do not experience ADHD often (understandably) say things like "just sit still!" or "don't interrupt people it's rude!". The crux of ADHD is that it's a neurodevelopmental disorder and a disregulation of dopamine and chemicals designed to help regulate executive function, focus, anxiety, etc. It is generally not possible to see significant results with therapy, although there is some limited evidence that early intervention through medication has long-lasting effects in children who are able to move off medication in the medium term.

non-entity 6y ago

Ok serious question: Every one of these points is very applicable to me, especially 1,2 and 3. I haven't been to a doctor in years outside occasional emergency trips. How do you bring this up without seriously. I don't want to come off as the guy who compulsively self diagnoses based off what they read on the internet.

laurex 6y ago
Go to a psychiatrist. Report your symptoms. They will give you a diagnostic and make the call. As long as you go in without stating your suspected diagnosis, you're not "diagnosing."
stevewodil 6y ago
Do you have a PCP? You just say that you want to get referred to someone to get tested for ADHD because of x, y, and z and you think a diagnosis would help you
robmerki 6y ago
There's nothing wrong with using self-diagnosis as a way to inform a professional inquiry. In my unqualified opinion, you probably have ADHD.
anon9001 6y ago
No problem, serious answer: This is the DSMV criteria: https://www.cdc.gov/ncbddd/adhd/diagnosis.html https://www.cdc.gov/ncbddd/adhd/diagnosis.html Doctors are typically screening with a quiz that looks something like this: https://psychcentral.com/quizzes/adhd-quiz/ https://psychcentral.com/quizzes/adhd-quiz/ It's perfectly reasonable to say "I think I may have ADHD based on what I've read online, my symptoms match and people who know me have suggested I try adderall". Some doctors are fine with letting everyone have stimulants, because they're pretty harmless unless you're really binging on them, and they won't give you enough to do that for very long. Other doctors would prefer to put you on an SSRI or SNRI or wellbutrin or some other "non-addictive" medication (which ironically are more addictive, dangerous, and less effective), so avoid those IMO. You may have to shop around a bit, but your primary care doctor technically can write the prescription, but some prefer not to and you might need to find a specialist. Contraindications for stimulants are if the patient has a history of heart conditions, complains about racing heart rate, excessive sweating, trouble sleeping, trouble eating, etc. You generally want to start with a low dose of "instant release" as opposed to "extended release" pills, so you can have more fine grained control over the dose. IR pills can be broken in half, XR cannot. Some doctors are more nervous about IR than XR because they think it has more abuse potential (not true, but it's a common belief). With all that said, stimulants will fix the problems OP described, but don't mistake that for a pleasant experience. The truth is that amphetamines are extremely mentally exhausting, and if you don't take good care of yourself (planning proper meals, staying hydrated, resting at appropriate times, not taking more pills when you shouldn't), you can quickly spiral out of control. It's hard to explain to someone that doesn't do drugs, but stimulants can leave you feeling like a shell of yourself, and it's really disconcerting. It's sort of like being over-tired where you're awake but your judgment is clearly impaired and you don't feel like "you". If you stay on them long enough, you'll start to feel like a zombie just going through the motions (successfully, mind you), but without identity. I make sure to take weekends off to preserve their efficacy for the work week and to make sure I don't become too dependent. I'd 100% recommend having stimulants in your toolkit, and chances are you're already supplementing with worse stimulants (like mountains of coffee or soda), so do give them a try, but be careful.

jaybeeayyy 6y ago

Well, you've convinced me to go back to the doctor. I was on the cusp of taking one of the ADHD tests but my insurance couldn't tell me how much it would be and the doctor's office said they couldn't either. I was told it would be between $200 and $900 and couldn't afford the $900 risk. I ended up being billed $200 just for the initial visit of course. But the longer I wait the more damage it's doing to my life. Out of your list I'd say 5/6 affect me, 5 being the odd one out as I can't sleep with anything but a fan on. I'll be making my appointment today...well, probably tomorrow now. Let's hope I don't procrastinate.

georgespencer 6y ago
I'm glad you're doing that! Feel free to email me (mistergeorgespencer+HN@gmail.com) if it would be useful for you to hear more about my experience or for you to share some of what you're experiencing. I have an iCloud note with every shared symptom I see someone else describing on the web, and it's getting pretty huge -- and makes me super happy that other people have had the same experience. I put off the diagnosis process for a year and regret it, but don't consider that a pressure for you to do it. If you have ADHD, one of the things you can't really know (in my experience) is the feeling of a balanced ability to focus and be productive. Feeling compelled to seek a diagnosis is a big step. I had a lot of serious conversations with the doctor about the impact of medication, the causes of ADHD, potential neurotoxicity, neuronal elasticity, etc. before I committed to taking medication. Here if you want to talk!
sosuke 6y ago
Yes, do it now, make appointment today. Stop everything else and do it. If you have a doctor that hems and haws about it find another doctor. I got my diagnosis and prescription without any formal test. I have stopped seeing my psychiatrist but once a year since my general practice doctor decided they could fill my prescriptions. The medicine, even the expensive stuff, has payment help programs. Like print out a PDF payment help program easy. If you want more pushing or personal story my email is in my profile. Best single thing I've done in my life to date.
- projektfu 6y ago

tsjq 6y ago

nicely written. that point-2 totally resonates here :(

Bedon292 6y ago

Obviously you feel the medication is useful, but do you think just knowing vs the medication has any positive benefit? I have read dozens of articles online, and replies like yours and can always relate extremely well to all of the symptoms. Taken the online quizzes and all that. I am pretty much certain I have ADHD. And I have known for years. But, I have educated myself on it, understand how I work (or don't work) and just kinda roll with it. But I have been thinking about it more lately, and wonder if its really worth more steps and medication.

georgespencer 6y ago
There is definitely a deep, abiding sense of relief and peace at the fact that a lot of things which caused me pain in the past now make sense. That doesn't help with the day-to-day of things, but it does contribute to an overall happiness which I do not think the medication alone would offer me.
- james_s_tayler 6y ago
  Agreed 100%
james_s_tayler 6y ago
Emotional relief like "I'm not a shitty selfish person after all and it isn't my fault". But if you employ a tonne of ADHD coping mechanisms and they work for you it'll improve things a decent amount. I haven't tried CBT but it's a recommend approach. I'm trying (painfully slowly because it's not super interesting) to teach myself DBT to help with it too. Dx is only strictly required to get Rx but an additional benefit is they do a differential diagnosis so they make sure it isn't down to depression, anxiety, sleep problems, trauma etc. All of which can cause some of the same symptoms. There are a tonne of people who get diagnosed with depression and anxiety and the recommended treatments just don't work that well for them. Then they get diagnosed with ADHD, everything falls into place and they can get their life together so they're not anxious they're going to constantly screw things up nor depressed from shit life syndrome and the depression and anxiety go away.

czbond 6y ago

Why see a psychiatrist? Are those really things to 'fix' on the whole - given the upsides? I'm incredibly energetic. I can't sit down for long - so I just stand in meetings. TV is a waste of time, so is social small talk, I do what I care about (and it rewarded me well). I've just felt like the speed, risk tolerance, freedom it provides me, and intuition make a powerful combination. I'd say the ADHD (if it is) makes you unique. All the world needs is more conformists... [I may be conflating ADHD with my incredibly independent personality]

czbond 6y ago
To expand - why not use it to your advantage? Consultants for larger, competitive companies do well w/ ADHD. Leaders do well. Founders do well (if they can stay focused on the opportunity). I have a CompSci degree, and loved doing algorithms, etc - but can't be bothered to sit behind an IDE for hours. So what - enough of people can do that well. I've found leadership to be the best use of skillsets where these 'symptoms' appear.
- georgespencer 6y ago
  I think this is a really interesting, nuanced point. It's one I talked to my doctor about because it was a concern I felt (and feel). Thanks for sharing it here! HN is usually a good space for contrarian opinions, but even so this sort of thing might get shot down a good percentage of the time. The way I would express it is: ADHD medication curbs the downside of ADHD, but many people report and experience significant upsides to their condition too. The traditional view of ADHD medication is also that it turns children into "zombies". Do I run the risk of losing my 'edge' as a person? I'm not a scientist, and I'm not a doctor. With that said, here are my notes from my doctor when we discussed this: 1. I feel that oftentimes negative and positive personality traits in people go hand in hand, outside of ADHD. For example, the calm, methodical, detail-oriented people who make excellent assimilators and "deliverers" in startups are often a necessity to building something incredible, but can also be the very *worst* people to have around you when you're trying to "yes and" about fragile ideas, because they live relentlessly in the real world. Do the traits I exhibit in my ADHD also make me a more effective leader? Do I simply not understand the upsides because they exhibit as personality traits? 2. Dr. X: There is little in the way of conclusive evidence, but he believes that it's possible that ADHD medication can curb traits that are either perceived as positive or genuinely positive in ADHD patients. This is why a key assessment is the extent to which negative traits manifest themselves. If you have ADHD but do not suffer from life-deranging consequences in some material sense (executive function impaired to the point where your career, relationships, or emotional wellbeing are suffering), then it's often not necessary to take medication at all. 3. Dr. X: the common impression of ADHD medication -- and in particular Ritalin -- seems to be magnified by the fact that parents are in general deeply worried about their children and the sense that their personalities are altered in some way. In adults, the available treatments do not appear to have serious long term consequences for personality and cognitive function. So it's completely permissible to take XR/IR medication for ADHD on days when you especially need to focus, for example, and not worry about "missing" a day. Equally, if -- in consultation with your doctor during titration and your family and friends -- you feel that there is an untenable negative consequence of medicating, then you can of course stop. 4. Dr. X: Anecdotally, ADHD sufferers frequently both underestimate and ignore the consequences of the disorder in their lives. Sometimes it's necessary to have them tell stories about areas of their relationships and personal lives which they find are surprising or hard which are unrelated to their ADHD, and very often doing so reveals that their ADHD manifests itself in ways which are wholly unsurprising but not visible to the patient. 5. Taking the time to find the right medication and dosage is vital. Diagnosis is step one, and after that it is very often months of tweaking, talking, and collaboration with the doctor to establish the right dosage level (strength), formulation (XR/IR, and within that e.g. prodrug is an XR which is a sort of "prequel" to the chemicals you need -- so it stimulates the body creating them rather than dumping the chemicals themselves into your system), and brand (e.g. Ritalin, Concerta, and Medikinet are all methylphenidate, but Concerta is commonly a 25/75 release, Ritalin is available in IR or XR although XR is less popular than Concerta XR, and Medikinet is a 50/50 timed release). Finding something which works for you takes time, and is not an easy feat. It's fantastic that you're not experiencing significant downsides to ADHD! I'm glad you were as clear as you were in your articulation of your concern, I worry that when some people express things like this they cause unnecessary worry in those who are experiencing meaningful downsides which put them off seeking medication. The tradeoffs are different for everyone.

mmanfrin 6y ago

Hah, reading through that list I thought 'hey this is my ADHD', and sure enough that is where you went with it.

georgespencer 6y ago
After 30-odd years of feeling alone on this front, it's always lovely hearing that others have had similar experiences. Thank you!

jw1224 6y ago

Whilst furloughed from my job during lockdown, I found myself bouncing off the walls at home consistently enough to finally seek out the ADHD diagnosis I’ve always suspected. I’m 29 years old, and one of my earliest memories is of my parents (lovingly) threatening to put an electric fence around my seat at the dinner table. I’d be up and down like a yo-yo after each mouthful. For the last 5 years, “my friend” has been obtaining prescription pharmaceutical meds from the dark web to treat “his” symptoms. They’ve been life changing — one day of medication leads to more productive output than would ever be imaginable the rest of the week without them. But they’re a double-edged sword. Like another commenter says, overdoing them leads to one feeling like a shell of their former self. But at least you have something to show for it. I put off my diagnosis for years, because I was afraid. I was terrified I would be told I didn’t have ADHD — at which point I would have no answers or excuses any more. If it’s not ADHD (that I know I can treat), then what the hell else is wrong with me? Or, worse, I feared I would be told that I was simply drug-seeking. I felt like I’d entered the Matrix — you take the red pill, you stay in Wonderland. I’ve had 3 appointments with a psychiatrist so far, and, finally, my prescription begins next week. If you seriously think you have ADHD, don’t make the same mistakes I did. Life is too short to waste time fighting against yourself.

wccrawford 6y ago
Just because you don't have "ADHD" doesn't mean you don't have a problem. If someone is hesitating for the same reason you were, they should seek help because there is something wrong, even if it's not what they thought.
georgespencer 6y ago
> I put off my diagnosis for years, because I was afraid. I was terrified I would be told I didn’t have ADHD — at which point I would have no answers or excuses any more. If it’s not ADHD (that I know I can treat), then what the hell else is wrong with me? This is an amazing thing to share. Reading some of the other replies in this thread from folks who are now motivated to seek help because they experience the same range of symptoms others are expressing, I bet your comment is going to have a direct and positive impact on someone's life. It's not easy to share things like this and folks will definitely feel supported by you. Thank you. > But they’re a double-edged sword. Like another commenter says, overdoing them leads to one feeling like a shell of their former self. I firmly believe that self-medicating in the manner your friend did exposes you to a heightened risk of this sort of experience. As noted elsewhere, there are so many variables to consider with the various medications that it really does require a committed, serious doctor to collaborate with you during titration. My journey so far has been four different drugs, with seven different dosages, and 4 different timed release / instant release formulations. > I’ve had 3 appointments with a psychiatrist so far, and, finally, my prescription begins next week. This is really wonderful news. I've found that the process of ironing out the right medication can be a frustrating one, because my doctor is a careful and methodical person and my instinct is to say "hey let's skip from 18mg to 54mg". No advice, but sharing my story just in case you experience the same thing. I've found that it has gotten a lot better, and I was surprised by the different experience of the different medications.

james_s_tayler 6y ago

Getting diagnosed this year changed my life too. I'm sure at some level the standard science and advice still applies but it's truly as those mechanisms aren't likely missing in our brains, but it's truly remarkable how the developmental delays change your brain such that things really are different for you and it's not just a matter of "trying harder" or "applying yourself". I was absolutely stunned at the profound impact it had on my life once I was able to connect the dots together. Equally stunned at the drastic improvements I've been able to make without following the standard advice but by following what works specifically for ADHD e.g externalize information, externalize decision making etc.

georgespencer 6y ago
> Getting diagnosed this year changed my life too. This is awesome! > following what works specifically for ADHD e.g externalize information, externalize decision making etc. I bet everyone would love to hear a little more context around what this is, and how it impacted you, if you have the energy to share. (Me most of all!)
- james_s_tayler 6y ago
  Don't leave it up to yourself to decide what to do and when. Find a way to put the environment in control. Pre-diagnosis I would try this and it wouldn't work that well or it would work for a short time then after the novelty wore off it'd stop working. Things like set an alarm/reminder for throwing out the rubbish. But then eventually you ignore it and swipe it away or you're dealing with something urgent that day etc. Getting diagnosed allowed me to commit my being 100% to that strategy. I reexamined it and found that it works reliably if you're able to layer systems several layers deep, so that they reinforce one another and act as failsafes. Alarmy plus the barcode mission has been an absolute revelation in my household. I'm now able to throw out the trash, do the washing, use a calendar and mark things off on my to-do list. I finally became able to use a calendar as I have a whiteboard in my kitchen that I put a barcode on that alarmy makes me scan once at night. That kicks off an hour dedicated to maintenance tasks. It starts with a habit stack of basic self maintenance tasks one of which is "check the calendar for the entire week". Things like that aye. The difference is huge. I'm getting healthier physically, and my marriage has improved a lot as I'm not constantly getting yelled at for letting my wife down or putting too much of the housework/parenting on her.

throwawayaug20 6y ago

a big question is how does one find a therapist/psychiatrist? a seemingly simple yelp/google search yields a sea of anonymous faces and trusting these strangers with your brain already feels daunting. i'm in san francisco and am on a PPO if anyone has any recs. email in bio, thank you!

georgespencer 6y ago
This was daunting for me too. I had a series of private evaluations in London, and the proxy I used was to seek a consultant psychiatrist (just about as senior as they come) who had a longstanding relationship with his local NHS trust (hadn't jumped from one area to another), looked him up on the GMC (registry of doctors in the UK which would report malpractice or other issues), and asked for a telephone consultation to discuss his work in this area and his approach. I appreciate many of these will not be possible in SF, so I would try to move back in stages towards a person you trust. Do you have a good relationship with your regular doctor? If no, do you have a trustworthy friend who does? Etc.
- throwawayaug20 6y ago
  hi george thank you for your response here and elsewhere in the comments. i have found them very helpful. i did indeed just reach out to a friend who recommended i talk to my primary care provider (PCP) and go from there. now that i'm looking into all this, mental health is a luxury in america. sessions are approx $200/visit here in san francisco.
  - PoachedSausage 6y ago
    It is not that much better here in the UK for specialised things like mental health. My local private specialist for ADHD charges around £1500 for the consultation, and it is hard to justify risking that much money to just be told you're lazy.
    - georgespencer 6y ago

Aerroon 6y ago

I think #2 is actually great. Without this trigger things never got done for me. University taught me that failure is okay, which removed the trigger for me. End result was that things got even worse. I hope one day I'll be able to find a replacement for it.

georgespencer 6y ago
> I think #2 is actually great. Remember that there are a range of intensities to all of these symptoms! A lot of people I know find that leaving things to the last minute can help them focus and they're good at assessing the time required to deliver something high quality. For me it results in disaster more often than not. > University taught me that failure is okay, which removed the trigger for me. End result was that things got even worse. Ah sorry to hear that. Do you generally exhibit other symptoms consistent with others in this thread, or do you think it's just one area which you suffer in?
- Aerroon 6y ago
  >Do you generally exhibit other symptoms consistent with others in this thread, or do you think it's just one area which you suffer in? I think I exhibit pretty much all of them. From the chronic lateness to being unable to start doing something that doesn't interest me to being unable to put something down that does interest me. This was just the one thing that I didn't realize how useful it was until it stopped working for me. Sure, my work was shoddy compared to what it could've been and I could never feel pride in it, but at least I had something to show for it.
  - georgespencer 6y ago
    You sound very similar to me in that respect. I found it a real grind and pretty demoralising in general. Is there anything I can give you comfort on regarding the process of speaking to a doctor or psychiatrist about it? Or is it something you feel is not having serious enough downsides in your life to warrant the time?

krono 6y ago

Very well written! Recently I was diagnosed with severe ADHD. The struggle finally became too much. Perhaps the effects of the health crisis on my work and finances gave me the final push, I don't know. My life is so much more enjoyable now I am medicated and have had some very minimal therapy. In hindsight all the tricks and strictness I forced onto myself to be able to keep up were very unhealthy, unsustainable, and not even that effective. The psych even seemed quite concerned when I did a show and tell. To anyone else struggling: Just make that appointment and find out what's up. Even if it doesn't turn out to be ADHD these people can help you get so much more out of your life. Nothing ventured nothing gained, right?

georgespencer 6y ago
So glad you're in a better place now. This: > To anyone else struggling: Just make that appointment and find out what's up. Even if it doesn't turn out to be ADHD these people can help you get so much more out of your life. Nothing ventured nothing gained, right? Is great advice and lots of people reading this thread are emailing me to say how supported they feel by hearing others' stories. Nice one for sharing.
- krono 6y ago
  Thanks, I really appreciate that! Good to know people are getting something out of this.

wtracy 6y ago

If all you have to go by is the popular stereotypes, you will be shocked by the number of engineers with ADD.