4 ms·

A third option is that he does have ADHD and you, a bystander, are doing the misdiagnosis. IMO for disorders like this it’s almost better to view it through th

A third option is that he does have ADHD and you, a bystander, are doing the misdiagnosis. IMO for disorders like this it’s almost better to view it through the lens of the available treatments. Is the treatment, on net and relative to other possible strategies, going to be a positive impact on this person? If yes, then whether they have apparent Disorder X (a figment of imagination) versus actual Disorder X (which is itself also a figment of our collective imagination) isn’t super relevant. Obviously in the case of ADHD the prescription drugs are pretty intense and have pretty severe negative consequences, so this framework in that case would probably even yield that people with actual ADHD but mild forms shouldn’t have those drugs pushed on them either.

satysin 4y ago
> A third option is that he does have ADHD and you, a bystander, are doing the misdiagnosis. Very possible. To me it is just very suspect given my near 30 years of knowing them and other events in their life not long before all of this started. They have never presented any ADHD traits until recently when suddenly they went from 0 to 100. From being a successful engineer to being unable to concentrate on a crossword. My personal opinion is they have untreated PTSD following a violent animal attack in early 2020 that caused life-long damage to their dominant hand. This in turn led to them suffering panic attacks around animals, anxiety due to the Covid lockdowns making treatment/physio complicated, furlough leading to isolation at home and being unable to do many of their hobbies from the physical injury (unable to play video games, the guitar, drums, etc) Tangentially related but they have a history of drug misuse and when I asked if they just wanted the medication their response was "Absolutely". I have mentioned seeking therapy as I suspected PTSD (I myself have C-PTSD from childhood abuse) but he made it clear he has no interest in therapy and just wants the medication which to me is not a great sign. Of course I could be wrong but I know him well and my worry is they will happily throw medication at him which will do nothing to help him deal with what I believe are the actual issues he is suffering from.
- meowfly 4y ago
  > Tangentially related but they have a history of drug misuse There might be a tighter correlation than it seems. What makes drugs addictive is that they work on the dopamine pathways. ADD medications do this directly. Drug abuse causes damaged memory and executive function because drug use downregulates and sometimes damages dopamine receptors. > Thus, in addition to reward, addicted individuals can experience severe disruptions in learning (memory, conditioning, habituation), executive function (impulse inhibition, decision making, delayed gratification), cognitive awareness (interoception) and even emotional (mood and stress reactivity) functions. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948245/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948245/
- evol262 4y ago
  > My personal opinion is they have untreated PTSD following a violent animal attack in early 2020 that caused life-long damage to their dominant hand. This in turn led to them suffering panic attacks around animals, anxiety due to the Covid lockdowns making treatment/physio complicated, furlough leading to isolation at home and being unable to do many of their hobbies from the physical injury (unable to play video games, the guitar, drums, etc) You answered your question. I was diagnosed later in life, as a successful engineer. I am not and never was at the "unable to concentrate on a crossword" level, but you seem to have some misunderstanding about what ADHD is. It is not the inability to concentrate on things. It is the inability to concentrate on _appropriate_ things. It's perfectly possible for them to just be completely disinterested in the crossword, yet able to be engrossed for hours in something which interests them. The medication levels this out so you are able to keep your attention on mundane tasks and complete them after the "interesting" part is over, or to start on mundane tasks at all instead of procrastinating until it's do-or-die. Fundamentally, there's a strong intersection with the dopamine reward system, and a "history of drug misuse" and poor impulse control is completely in line with a diagnosis. Personally, I went through a close family member's suicide, followed rapidly by moving across the country to an isolated town where my spouse developed a problem with alcohol, a couple years of abuse, a divorce, another move to a different area of the country, then all of the lockdown stuff. All of my (and their) unconsciously constructed support structures, reward activities, and safety nets evaporated. Stop.
  - satysin 4y ago
    > but you seem to have some misunderstanding about what ADHD is. It is not the inability to concentrate on things. It is the inability to concentrate on _appropriate_ things. I appreciate you taking the time to reply and clarify things but I would like to say I have a pretty good understanding of ADHD. As I have mentioned my son was diagnosed with ADHD a couple of years ago. I go with him to every appointment and support groups we are in. I have spent dozens of hours with his doctor, psychologists, etc. to try and learn as much as possible about ADHD to support him as best I can and to ensure I can get the support he needs in school. My comment about the other family member not being able to concentrate on a crossword was more a summation of the issue not a specific example. He has always been an intelligent guy, he wasn't gifted nor did he need to push himself extra hard to succeed. He never had issues concentrating on "boring" tasks for all the time I have known him (30+ years at this point). Sure he was never super engaged with them (who would be?) but he didn't get lost in procrastination. What I mean is these are all very new things for him. Even for things he used to love such as games he cannot find the "mental energy" (as he puts it) to play. To begin with I put this down to his injury and while his hand will never be as good as it was he can use it "fine" for such things now. He just has no interest. No interest in anything. Basically all he wants to do is just sit on the computer and mindlessly consume. He stopped coding, stopped playing games, stopped reading, not taking his drone out, stopped doing some 3D stuff in Blender, stopped watching the kind of shows he used to love, etc. Pretty much the only thing he does still do that he did before is go to gigs. And perhaps this is unfair of me but I suspect that is because he always takes some drugs while there. What I mean is he had a large change in personality over the past two years since the attack, not just his executive functioning. Now it is very possible he always had ADHD but like many he managed to cope with it via systems he developed and perhaps the attack (or the pandemic) caused those systems to fail him and maybe just medication will help him. My worry is that he has some other issues and for one reason or another he convinced himself it is ADHD and only ADHD. This is a concern his wife also shares and we have discussed. When she has suggested therapy he dismisses it as "not something that works for him" (even though he has never actually had any to validate that claim). It is a tricky subject and he is now sure he is "fixed" as his concentration is indeed better as he is taking some kind of amphetamine 4 times a day, however his wife has told me there is no improvement in any other areas which she is worried will lead to a crash at some point.
Chernobog 4y ago
I have ADHD and my flavor makes me look well adjusted on the outside while struggling hard. My mother completely dismissed the possibility of ADHD based on things like me getting a Master's degree. People see the decent grades, but don't see that you put in three times the effort. Everything got much easier after getting the diagnosis and medication as a 33 year old.
- amf12 4y ago
  > I have ADHD and my flavor makes me look well adjusted on the outside while struggling hard. This is me. Looking back at my school days, it is very obvious I had ADHD but neither my parents and I, nor my teachers knew such a thing existed to get diagnosed. In adulthood, others might think I am doing well, but they don't know the constant struggle my life has. > but don't see that you put in three times the effort. This is on point. Sure, I am getting my work done, but they don't see how my constant procrastination, zoning out means it takes me 3x the time to get something done, and it makes me feel 24 hours aren't enough to have my life in order.
tsol 4y ago
>Is the treatment, on net and relative to other possible strategies, going to be a positive impact on this person? If yes, then whether they have apparent Disorder X (a figment of imagination) versus actual Disorder X (which is itself also a figment of our collective imagination) isn’t super relevant. Just about every human being operates better on amphetamines. It increases dopamine and adrenaline, increasing attention span and motivation significantly while decreasing the need for food or rest. Medication simply improving performance is not really a working metric in this case
- ethanbond 4y ago
  Very true if you’re counting only the positive effects, in which case it’s not “on net.” There are obviously significant downsides to amphetamines which is why we don’t treat them like caffeine or even vitamins.
  - zozbot234 4y ago
    The obvious downside to caffeine is pretty much the same: it stops working if you take too much of it too often. Reserve your coffee for special occasions, and it will work as well as any stimulant.
    - ethanbond 4y ago
      If you don’t see the obvious differences between amphetamine and caffeine, not sure what to tell you.

satysin 4y ago

> A third option is that he does have ADHD and you, a bystander, are doing the misdiagnosis. Very possible. To me it is just very suspect given my near 30 years of knowing them and other events in their life not long before all of this started. They have never presented any ADHD traits until recently when suddenly they went from 0 to 100. From being a successful engineer to being unable to concentrate on a crossword. My personal opinion is they have untreated PTSD following a violent animal attack in early 2020 that caused life-long damage to their dominant hand. This in turn led to them suffering panic attacks around animals, anxiety due to the Covid lockdowns making treatment/physio complicated, furlough leading to isolation at home and being unable to do many of their hobbies from the physical injury (unable to play video games, the guitar, drums, etc) Tangentially related but they have a history of drug misuse and when I asked if they just wanted the medication their response was "Absolutely". I have mentioned seeking therapy as I suspected PTSD (I myself have C-PTSD from childhood abuse) but he made it clear he has no interest in therapy and just wants the medication which to me is not a great sign. Of course I could be wrong but I know him well and my worry is they will happily throw medication at him which will do nothing to help him deal with what I believe are the actual issues he is suffering from.

meowfly 4y ago
> Tangentially related but they have a history of drug misuse There might be a tighter correlation than it seems. What makes drugs addictive is that they work on the dopamine pathways. ADD medications do this directly. Drug abuse causes damaged memory and executive function because drug use downregulates and sometimes damages dopamine receptors. > Thus, in addition to reward, addicted individuals can experience severe disruptions in learning (memory, conditioning, habituation), executive function (impulse inhibition, decision making, delayed gratification), cognitive awareness (interoception) and even emotional (mood and stress reactivity) functions. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948245/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948245/
evol262 4y ago
> My personal opinion is they have untreated PTSD following a violent animal attack in early 2020 that caused life-long damage to their dominant hand. This in turn led to them suffering panic attacks around animals, anxiety due to the Covid lockdowns making treatment/physio complicated, furlough leading to isolation at home and being unable to do many of their hobbies from the physical injury (unable to play video games, the guitar, drums, etc) You answered your question. I was diagnosed later in life, as a successful engineer. I am not and never was at the "unable to concentrate on a crossword" level, but you seem to have some misunderstanding about what ADHD is. It is not the inability to concentrate on things. It is the inability to concentrate on _appropriate_ things. It's perfectly possible for them to just be completely disinterested in the crossword, yet able to be engrossed for hours in something which interests them. The medication levels this out so you are able to keep your attention on mundane tasks and complete them after the "interesting" part is over, or to start on mundane tasks at all instead of procrastinating until it's do-or-die. Fundamentally, there's a strong intersection with the dopamine reward system, and a "history of drug misuse" and poor impulse control is completely in line with a diagnosis. Personally, I went through a close family member's suicide, followed rapidly by moving across the country to an isolated town where my spouse developed a problem with alcohol, a couple years of abuse, a divorce, another move to a different area of the country, then all of the lockdown stuff. All of my (and their) unconsciously constructed support structures, reward activities, and safety nets evaporated. Stop.
- satysin 4y ago
  > but you seem to have some misunderstanding about what ADHD is. It is not the inability to concentrate on things. It is the inability to concentrate on _appropriate_ things. I appreciate you taking the time to reply and clarify things but I would like to say I have a pretty good understanding of ADHD. As I have mentioned my son was diagnosed with ADHD a couple of years ago. I go with him to every appointment and support groups we are in. I have spent dozens of hours with his doctor, psychologists, etc. to try and learn as much as possible about ADHD to support him as best I can and to ensure I can get the support he needs in school. My comment about the other family member not being able to concentrate on a crossword was more a summation of the issue not a specific example. He has always been an intelligent guy, he wasn't gifted nor did he need to push himself extra hard to succeed. He never had issues concentrating on "boring" tasks for all the time I have known him (30+ years at this point). Sure he was never super engaged with them (who would be?) but he didn't get lost in procrastination. What I mean is these are all very new things for him. Even for things he used to love such as games he cannot find the "mental energy" (as he puts it) to play. To begin with I put this down to his injury and while his hand will never be as good as it was he can use it "fine" for such things now. He just has no interest. No interest in anything. Basically all he wants to do is just sit on the computer and mindlessly consume. He stopped coding, stopped playing games, stopped reading, not taking his drone out, stopped doing some 3D stuff in Blender, stopped watching the kind of shows he used to love, etc. Pretty much the only thing he does still do that he did before is go to gigs. And perhaps this is unfair of me but I suspect that is because he always takes some drugs while there. What I mean is he had a large change in personality over the past two years since the attack, not just his executive functioning. Now it is very possible he always had ADHD but like many he managed to cope with it via systems he developed and perhaps the attack (or the pandemic) caused those systems to fail him and maybe just medication will help him. My worry is that he has some other issues and for one reason or another he convinced himself it is ADHD and only ADHD. This is a concern his wife also shares and we have discussed. When she has suggested therapy he dismisses it as "not something that works for him" (even though he has never actually had any to validate that claim). It is a tricky subject and he is now sure he is "fixed" as his concentration is indeed better as he is taking some kind of amphetamine 4 times a day, however his wife has told me there is no improvement in any other areas which she is worried will lead to a crash at some point.

Chernobog 4y ago

I have ADHD and my flavor makes me look well adjusted on the outside while struggling hard. My mother completely dismissed the possibility of ADHD based on things like me getting a Master's degree. People see the decent grades, but don't see that you put in three times the effort. Everything got much easier after getting the diagnosis and medication as a 33 year old.

amf12 4y ago
> I have ADHD and my flavor makes me look well adjusted on the outside while struggling hard. This is me. Looking back at my school days, it is very obvious I had ADHD but neither my parents and I, nor my teachers knew such a thing existed to get diagnosed. In adulthood, others might think I am doing well, but they don't know the constant struggle my life has. > but don't see that you put in three times the effort. This is on point. Sure, I am getting my work done, but they don't see how my constant procrastination, zoning out means it takes me 3x the time to get something done, and it makes me feel 24 hours aren't enough to have my life in order.

tsol 4y ago

>Is the treatment, on net and relative to other possible strategies, going to be a positive impact on this person? If yes, then whether they have apparent Disorder X (a figment of imagination) versus actual Disorder X (which is itself also a figment of our collective imagination) isn’t super relevant. Just about every human being operates better on amphetamines. It increases dopamine and adrenaline, increasing attention span and motivation significantly while decreasing the need for food or rest. Medication simply improving performance is not really a working metric in this case

ethanbond 4y ago
Very true if you’re counting only the positive effects, in which case it’s not “on net.” There are obviously significant downsides to amphetamines which is why we don’t treat them like caffeine or even vitamins.
- zozbot234 4y ago
  The obvious downside to caffeine is pretty much the same: it stops working if you take too much of it too often. Reserve your coffee for special occasions, and it will work as well as any stimulant.
  - ethanbond 4y ago
    If you don’t see the obvious differences between amphetamine and caffeine, not sure what to tell you.