5 ms·

Treating ADHD as executive function disorder

pedalpete 3y ago
This is interesting, and a few years ago I was reading about ADHD as a superpower. Neurodiversity isn't all something to be cured. However, I don't have ADHD, so I can't comment on living with it. The video is from 2014 - their are probably better treatments now https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2019.3b15 https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2... And there is a Show HN post on the front-page right about ADHD coaching for adults. https://news.ycombinator.com/item?id=37252231 https://news.ycombinator.com/item?id=37252231
- jprd 3y ago
  This is the reason HN is special. Thank you for providing insight, perspective and additional links that aren't just logs on a fire. You promote civilization with such discourse, and I personally just felt the need to throw a TY out there.
- aidenn0 3y ago
  I do have ADHD. Living with it kind of sucks for a lot of the reasons mentioned in TFV. It can also be a superpower, particularly with adaptive coping skills. I should also point out that I have both ADHD and rather high general intelligence. At any given IQ, measures of academic success are lower for those with ADHD. There's also survivor-bias in that I couldn't be posting this if I had died from reckless behavior.
- selfhoster11 3y ago
  It's not a superpower. In my experience, it makes it greatly more difficult to survive as an adult.
- pornel 3y ago
  It's a superpower in the same way a person with dwarfism has a superpower of having plenty of legroom on planes. Sometimes if you're lucky a different way of thinking/working happens to be useful, but most of the time it's a burden, and makes functioning in a society harder.
  - brailsafe 3y ago
    As a really tall person with ADHD, I feel like this is probably an apt analogy.
    - salad-tycoon 3y ago
      You have 2 superpowers. And all I got is this lousy t-shirt (and adhd). This whole “neurodivergecy is a gift!” “Celebrate your differences! Embrace your kinks!” thing is irksome to me. I know it isn’t intended in a bad way but, sometimes things aren’t a socially repressed positive just looking for love and attention. Not everybody gets a trophy. Stimulants though, I know they work for some but boy, adhd + addictive drugs? Head scratcher. I have a nagging suspicion it’s the next OxyContin, personally. Maybe not on such a grand scale but I see negative effects in myself and others regularly. Maybe humans shouldn’t be hopped on speed so much?
      - hirvi74 3y ago
        > adhd + addictive drugs? Head scratcher. I have a nagging suspicion it’s the next OxyContin, personally. If I am Icarus, then stimulants are my wax wings. Stimulants have been the cause and solution to most of my problems in life over the past decade. Some days, I truly feel like I made a deal with the Devil. But what alternative do I have? The world has no sympathy and even less empathy. I want to survive in this world like everyone else. Sure, I do not technically need them to survive. I wasn't even diagnosed until my early 20s. However, I've had a taste of the good life, and I can't go back. I do not think I am clinically addicted, but I am very psychologically and physically dependent on stimulants. One sick thought that occasionally ruminates inside my mind is that while I feel like the medications have helped me so much, I look around me -- look back on my life -- and I literally have accomplished nothing. I have nothing to show for any of it. Life is "stable", for sure. Same underpaid, miserable job for 7 years now, but really, that's it... I do not care what any medical research paper or any doctor says. These medications are powerful psychoactive substances. I think they absolutely fuck with one's mind, and one's perception of reality albeit in subtle ways. I am starting to wonder if my perception of reality has been warped in to making me think I have been performing better than I actually have been all these years. I'm not really sure how to end this scattered rant, but all I can say is that I've lost a lot of faith in psychiatry and psychology because of ADHD and its treatments. ADHD is the most treatable psychiatric condition? Seriously?
- SkyPuncher 3y ago
  I'm concluding that I might have ADHD. The major challenge for me is my attention gets "hung" in a way that I don't fully control. Sometimes it can get hung on a work topic, in which case I absolutely crush the project/feature etc. Other times, it gets hung on something it shouldn't and I can't be productive to save my life. It also seems to come into play right at the end of a major project. It's very hard to wrap up the little details when I'm mentally ready to move onto the next thing.
  - hirvi74 3y ago
    ADHD != a lack of attention. It's a lack of control of one's attention. What you are experiencing mirrors my ADHD symptoms. I can't even read a page of a novel without getting slightly distracted, having to re-read sentences, etc. but I can program for 6+ hours straight. When the hyperfocus kicks in, then it's really hard to break away/distract myself. I'll forgo standing up, eating, etc. because I'm in the "zone" and I can't make myself break away until it's damn near unbearable.
  - pxc 3y ago
    Incidentally, that feature of ADHD (hung attention) is the one that stimulant medication doesn't help with (and is in fact likely to actively exacerbate). That's something you have to address in other (harder) ways. And yeah, everything you describe is characteristic of ADHD. :)
- NoZebra120vClip 3y ago
  [flagged]
  - callalex 3y ago
    ADHD drugs are not methamphetamine, and it’s very ignorant, bigoted, and harmful for you to imply that they are. What scientific research did your pastor study before forming that opinion?
    - hirvi74 3y ago
      > ADHD drugs are not methamphetamine https://www.drugs.com/pro/desoxyn.html https://www.drugs.com/pro/desoxyn.html Sure, there is a slight difference in amphetamines and methampetamines, but by and large the positive and negative effects are damn near identical. The difference, as I understand it, are in the dosages required. The methyl group makes meth pass the blood-brain barrier much easier, which makes it much stronger and neurotoxic, but the substances are not too dissimilar. So what if ADHD drugs are meth and/or meth-like? Cocaine derivatives are common in medicine (Lidocaine, Novocaine, etc..). Opium derivatives too. The dosage, not the substance, makes the poison. The only reason people get so up in arms about this topic is due to social stigmas and the BS propaganda from The War on Drugs.
      - callalex 3y ago
        I want to make sure you are aware that ADHD prescriptions for desoxyn are extremely rare to the point of being basically zero. While I am sympathetic to your point that there shouldn’t be a stigma around using any prescribed medicine, I think it is irrelevant to this discussion because the fact of the matter is ADHD drugs just really aren’t the same thing as meth.
        hirvi74 3y ago
        > desoxyn are extremely rare to the point of being basically zero. It's truly a shame, because from anecdotes I have read, it apparently works so much better and with less side-effects. But you are right, it's not very common. I've asked doctors about it before. Some have literally never heard of it (though they could be feigning ignorance). None have been open to the idea, and from what some have told me -- good luck getting insurance to cover it. > I think it is irrelevant to this discussion because the fact of the matter is ADHD drugs just really aren’t the same thing as meth. "ADHD drugs" are a very wide brush. There are 4 commonly used non-stimulants, for example, and a few others used off-label (Wellbutrin, Modafinil, etc..) Adderall and its ever increasing array of delivery mechanisms are the most common ADHD medication(s). Hell, you can lump Dex in there too since it's 75% the same drug. But as for the difference in effects between M. Amp. and Mixed Amp. Salts, even this psychiatrist doesn't think the difference is as profound as I am lead to believe you think: https://astralcodexten.substack.com/p/know-your-amphetamines https://astralcodexten.substack.com/p/know-your-amphetamines
sph 3y ago
Here's a playlist of Dr. Barkley about ADHD split into bite-sized videos: https://youtube.com/playlist?list=PLzBixSjmbc8eFl6UX5_wWGP8i0mAs-cvY&si=2Ku_ZfL02c7quTfj https://youtube.com/playlist?list=PLzBixSjmbc8eFl6UX5_wWGP8i...
- deleted 3y ago
  [deleted]
programmer_dude 3y ago
Does YouTube know we have ADHD even before we do? This was in my recommendations this week. I did not think I had ADHD since I am rarely hyperactive. But everything in this video fits me to a tee. Been looking for adult ADHD treatment here in India but apparently every single one of them is a pediatrician.
- andenacitelli 3y ago
  There’s two entire halves to ADHD. The hyperactive part is the one people usually know, but the attentive half is the part people aren’t aware of. Diagnosed myself, predominantly inattentive with bits of hyperactive, mostly fidgeting. Executive dysfunction, issues keeping my train of thought, poor short term memory, motivation issues, and more are the other half.
  - programmer_dude 3y ago
    > mostly fidgeting Yeah I do this too. Never thought this could be classified as hyperactive.
    - hirvi74 3y ago
      Here's how it was explained to me once: 1. There is external hyperactivity (like Ace Ventura or any other Jim Carey character) 2. There is internal hyperactivity (Racing thoughts, excessive talking, anxiety-like symptoms, etc.). Those with ADHD all have hyperactivity, it just manifests differently across the subtypes (ADHD-Predominately Hyperactive, ADHD Predominately Inattentive, and ADHD-Combined).
- sheepscreek 3y ago
  Look up Vimhans. Treatment isn’t some magic pill. It’s a lot of trial and error, trying various things and getting the dosing right. Don’t give up.
DiabloD3 3y ago
Dr Russell Barkley is one of the world's leading ADHD researchers. I've seen this talk before, its really good and reflects modern diagnostics and treatment. I'm surprised this ended up on HN.
- salad-tycoon 3y ago
  ADHD pops up here a lot. If you don’t have it organically maybe you have some approximation from all the internet and electronics you interact with.
JimtheCoder 3y ago
"He has been a paid consultant for pharmaceutical companies including Eli Lilly, McNeil, Janssen-Orth, Janssen-Cilag, Novartis, Shire, Takeda pharmaceuticals, and Theravance" https://en.wikipedia.org/wiki/Russell_Barkley https://en.wikipedia.org/wiki/Russell_Barkley
- navjack27 3y ago
  In this case there is absolutely zero conflict of interest I can assure you of that. The only conflict of interest he has is making people understand the severity of actual ADHD in adults and in children and how you don't grow out of it and how it can 100,000% ruin your life as it did to his brother.
- hirvi74 3y ago
  He's also a psychologist and not a psychiatrist, so take that for what it's worth.
joker_minmax 3y ago
Most of my friends in my circle have either been diagnosed with ADHD, are pursuing diagnosis, or/and are trying to convince me to pursue a diagnosis, despite me personally not feeling like I have anything. I can't help but feel like something worse is going on here. I know my sample size is small but is the prevalence really this high? From my perspective it seems like ADHD is becoming a "new normal", and I'm starting to question whether the "normal" person who does everything exactly on time with no hesitation, who is truly perfectly organized, even exists. Curious to hear others' thoughts on this.
- binary132 3y ago
  I resonate with this — there are certainly disordered brains, and I think perhaps there are also well-ordered brains which are more sensitive to certain kinds of disruptions than other brains, but I definitely think a major aspect that many people are oblivious to (or willfully ignore) is the increasingly severe disorder of our modern society and workplace.
lifeisstillgood 3y ago
Just a note to say thank you to those who left personal notes about your experiences - very helpful for a out of depth father. thank you.

This is interesting, and a few years ago I was reading about ADHD as a superpower. Neurodiversity isn't all something to be cured. However, I don't have ADHD, so I can't comment on living with it. The video is from 2014 - their are probably better treatments now https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2019.3b15 https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2... And there is a Show HN post on the front-page right about ADHD coaching for adults. https://news.ycombinator.com/item?id=37252231 https://news.ycombinator.com/item?id=37252231

jprd 3y ago
This is the reason HN is special. Thank you for providing insight, perspective and additional links that aren't just logs on a fire. You promote civilization with such discourse, and I personally just felt the need to throw a TY out there.
aidenn0 3y ago
I do have ADHD. Living with it kind of sucks for a lot of the reasons mentioned in TFV. It can also be a superpower, particularly with adaptive coping skills. I should also point out that I have both ADHD and rather high general intelligence. At any given IQ, measures of academic success are lower for those with ADHD. There's also survivor-bias in that I couldn't be posting this if I had died from reckless behavior.
selfhoster11 3y ago
It's not a superpower. In my experience, it makes it greatly more difficult to survive as an adult.
pornel 3y ago
It's a superpower in the same way a person with dwarfism has a superpower of having plenty of legroom on planes. Sometimes if you're lucky a different way of thinking/working happens to be useful, but most of the time it's a burden, and makes functioning in a society harder.
- brailsafe 3y ago
  As a really tall person with ADHD, I feel like this is probably an apt analogy.
  - salad-tycoon 3y ago
    You have 2 superpowers. And all I got is this lousy t-shirt (and adhd). This whole “neurodivergecy is a gift!” “Celebrate your differences! Embrace your kinks!” thing is irksome to me. I know it isn’t intended in a bad way but, sometimes things aren’t a socially repressed positive just looking for love and attention. Not everybody gets a trophy. Stimulants though, I know they work for some but boy, adhd + addictive drugs? Head scratcher. I have a nagging suspicion it’s the next OxyContin, personally. Maybe not on such a grand scale but I see negative effects in myself and others regularly. Maybe humans shouldn’t be hopped on speed so much?
    - hirvi74 3y ago
      > adhd + addictive drugs? Head scratcher. I have a nagging suspicion it’s the next OxyContin, personally. If I am Icarus, then stimulants are my wax wings. Stimulants have been the cause and solution to most of my problems in life over the past decade. Some days, I truly feel like I made a deal with the Devil. But what alternative do I have? The world has no sympathy and even less empathy. I want to survive in this world like everyone else. Sure, I do not technically need them to survive. I wasn't even diagnosed until my early 20s. However, I've had a taste of the good life, and I can't go back. I do not think I am clinically addicted, but I am very psychologically and physically dependent on stimulants. One sick thought that occasionally ruminates inside my mind is that while I feel like the medications have helped me so much, I look around me -- look back on my life -- and I literally have accomplished nothing. I have nothing to show for any of it. Life is "stable", for sure. Same underpaid, miserable job for 7 years now, but really, that's it... I do not care what any medical research paper or any doctor says. These medications are powerful psychoactive substances. I think they absolutely fuck with one's mind, and one's perception of reality albeit in subtle ways. I am starting to wonder if my perception of reality has been warped in to making me think I have been performing better than I actually have been all these years. I'm not really sure how to end this scattered rant, but all I can say is that I've lost a lot of faith in psychiatry and psychology because of ADHD and its treatments. ADHD is the most treatable psychiatric condition? Seriously?
SkyPuncher 3y ago
I'm concluding that I might have ADHD. The major challenge for me is my attention gets "hung" in a way that I don't fully control. Sometimes it can get hung on a work topic, in which case I absolutely crush the project/feature etc. Other times, it gets hung on something it shouldn't and I can't be productive to save my life. It also seems to come into play right at the end of a major project. It's very hard to wrap up the little details when I'm mentally ready to move onto the next thing.
- hirvi74 3y ago
  ADHD != a lack of attention. It's a lack of control of one's attention. What you are experiencing mirrors my ADHD symptoms. I can't even read a page of a novel without getting slightly distracted, having to re-read sentences, etc. but I can program for 6+ hours straight. When the hyperfocus kicks in, then it's really hard to break away/distract myself. I'll forgo standing up, eating, etc. because I'm in the "zone" and I can't make myself break away until it's damn near unbearable.
- pxc 3y ago
  Incidentally, that feature of ADHD (hung attention) is the one that stimulant medication doesn't help with (and is in fact likely to actively exacerbate). That's something you have to address in other (harder) ways. And yeah, everything you describe is characteristic of ADHD. :)
NoZebra120vClip 3y ago
[flagged]
- callalex 3y ago
  ADHD drugs are not methamphetamine, and it’s very ignorant, bigoted, and harmful for you to imply that they are. What scientific research did your pastor study before forming that opinion?
  - hirvi74 3y ago
    > ADHD drugs are not methamphetamine https://www.drugs.com/pro/desoxyn.html https://www.drugs.com/pro/desoxyn.html Sure, there is a slight difference in amphetamines and methampetamines, but by and large the positive and negative effects are damn near identical. The difference, as I understand it, are in the dosages required. The methyl group makes meth pass the blood-brain barrier much easier, which makes it much stronger and neurotoxic, but the substances are not too dissimilar. So what if ADHD drugs are meth and/or meth-like? Cocaine derivatives are common in medicine (Lidocaine, Novocaine, etc..). Opium derivatives too. The dosage, not the substance, makes the poison. The only reason people get so up in arms about this topic is due to social stigmas and the BS propaganda from The War on Drugs.
    - callalex 3y ago
      I want to make sure you are aware that ADHD prescriptions for desoxyn are extremely rare to the point of being basically zero. While I am sympathetic to your point that there shouldn’t be a stigma around using any prescribed medicine, I think it is irrelevant to this discussion because the fact of the matter is ADHD drugs just really aren’t the same thing as meth.
      - hirvi74 3y ago
        > desoxyn are extremely rare to the point of being basically zero. It's truly a shame, because from anecdotes I have read, it apparently works so much better and with less side-effects. But you are right, it's not very common. I've asked doctors about it before. Some have literally never heard of it (though they could be feigning ignorance). None have been open to the idea, and from what some have told me -- good luck getting insurance to cover it. > I think it is irrelevant to this discussion because the fact of the matter is ADHD drugs just really aren’t the same thing as meth. "ADHD drugs" are a very wide brush. There are 4 commonly used non-stimulants, for example, and a few others used off-label (Wellbutrin, Modafinil, etc..) Adderall and its ever increasing array of delivery mechanisms are the most common ADHD medication(s). Hell, you can lump Dex in there too since it's 75% the same drug. But as for the difference in effects between M. Amp. and Mixed Amp. Salts, even this psychiatrist doesn't think the difference is as profound as I am lead to believe you think: https://astralcodexten.substack.com/p/know-your-amphetamines https://astralcodexten.substack.com/p/know-your-amphetamines

sph 3y ago

Here's a playlist of Dr. Barkley about ADHD split into bite-sized videos: https://youtube.com/playlist?list=PLzBixSjmbc8eFl6UX5_wWGP8i0mAs-cvY&si=2Ku_ZfL02c7quTfj https://youtube.com/playlist?list=PLzBixSjmbc8eFl6UX5_wWGP8i...

deleted 3y ago
[deleted]

programmer_dude 3y ago

Does YouTube know we have ADHD even before we do? This was in my recommendations this week. I did not think I had ADHD since I am rarely hyperactive. But everything in this video fits me to a tee. Been looking for adult ADHD treatment here in India but apparently every single one of them is a pediatrician.

andenacitelli 3y ago
There’s two entire halves to ADHD. The hyperactive part is the one people usually know, but the attentive half is the part people aren’t aware of. Diagnosed myself, predominantly inattentive with bits of hyperactive, mostly fidgeting. Executive dysfunction, issues keeping my train of thought, poor short term memory, motivation issues, and more are the other half.
- programmer_dude 3y ago
  > mostly fidgeting Yeah I do this too. Never thought this could be classified as hyperactive.
  - hirvi74 3y ago
    Here's how it was explained to me once: 1. There is external hyperactivity (like Ace Ventura or any other Jim Carey character) 2. There is internal hyperactivity (Racing thoughts, excessive talking, anxiety-like symptoms, etc.). Those with ADHD all have hyperactivity, it just manifests differently across the subtypes (ADHD-Predominately Hyperactive, ADHD Predominately Inattentive, and ADHD-Combined).
sheepscreek 3y ago
Look up Vimhans. Treatment isn’t some magic pill. It’s a lot of trial and error, trying various things and getting the dosing right. Don’t give up.

DiabloD3 3y ago

Dr Russell Barkley is one of the world's leading ADHD researchers. I've seen this talk before, its really good and reflects modern diagnostics and treatment. I'm surprised this ended up on HN.

salad-tycoon 3y ago
ADHD pops up here a lot. If you don’t have it organically maybe you have some approximation from all the internet and electronics you interact with.

JimtheCoder 3y ago

"He has been a paid consultant for pharmaceutical companies including Eli Lilly, McNeil, Janssen-Orth, Janssen-Cilag, Novartis, Shire, Takeda pharmaceuticals, and Theravance" https://en.wikipedia.org/wiki/Russell_Barkley https://en.wikipedia.org/wiki/Russell_Barkley

navjack27 3y ago
In this case there is absolutely zero conflict of interest I can assure you of that. The only conflict of interest he has is making people understand the severity of actual ADHD in adults and in children and how you don't grow out of it and how it can 100,000% ruin your life as it did to his brother.
hirvi74 3y ago
He's also a psychologist and not a psychiatrist, so take that for what it's worth.

joker_minmax 3y ago

Most of my friends in my circle have either been diagnosed with ADHD, are pursuing diagnosis, or/and are trying to convince me to pursue a diagnosis, despite me personally not feeling like I have anything. I can't help but feel like something worse is going on here. I know my sample size is small but is the prevalence really this high? From my perspective it seems like ADHD is becoming a "new normal", and I'm starting to question whether the "normal" person who does everything exactly on time with no hesitation, who is truly perfectly organized, even exists. Curious to hear others' thoughts on this.

binary132 3y ago
I resonate with this — there are certainly disordered brains, and I think perhaps there are also well-ordered brains which are more sensitive to certain kinds of disruptions than other brains, but I definitely think a major aspect that many people are oblivious to (or willfully ignore) is the increasingly severe disorder of our modern society and workplace.

lifeisstillgood 3y ago

Just a note to say thank you to those who left personal notes about your experiences - very helpful for a out of depth father. thank you.