The most surprising thing my adult ADHD diagnosis revealed was that as I began telling friends that I had been diagnosed positive they told me they had known that since they met me. These were childhood friends.
Thanks friends.
I thought I was bad at lots of things other people were good at, because I was more disciplined and saw the bigger picture. So I only worked on important things. Things that could matter to millions of people, or still be relevant in 100 years.
And all the side quests and rabbit holes were obviously for recharging, expanding my biological-being-on-an-odd-planet situational awareness, or benefited me as self-improvement challenges. All in service of the important things.
How would tracking the day of the week, doing homework on something I could learn later if/when I ever needed it, or mowing the lawn, help me accomplish anything important?
Wasting brain space on those kinds of things would be dysfunction. I actively culled such dreck!
Now I know my self-narrative was Stockholm Syndrome coping.
But I still don't mow lawns, and if the blinds are drawn when I finish a big task, I couldn't guess if it was am or pm better than a coin toss. My day metric is when Amazon Prime's "Your Orders" list, tells me I am a day closer to getting a crafting item I ordered for a project I may never get to.
Don't be too mad at your friends. People are not receptive to being told they're odd. And as much as they might say "we knew", they didn't really. They might have suspected, but they cannot diagnose you. Many things are very clear in hindsight that weren't actually clear at the time.
Some friends I've known for over a decade clearly have ADHD, and I'm not going to tell them unprompted.
I feel like it is very disrespectful, especially when the conversation is about something completely different. Also, I'm not a medical professional, and it is possible that their ADHD-like symptoms are caused by something else.
That being said, if they ask if I think they have ADHD, or any other form of neurodivergence, I will say yes.
Speaking as someone who only got our ADHD diagnosis in our late thirties and our autism spectrum diagnosis at forty fucking two, please consider just telling them. That could be years or decades of social, pharmacological, and even legal assistance that they deserve and need and aren't otherwise getting.
Second this too. I went through live until mid thirties thinking life just was that hard for everyone and I was just bad and shit at things, worse than others - I suffered alone thinking everyone had to be like me, because I'm normal right? It was a huge relief finally being diagnosed because I could finally understand myself better, even found community of sorts.. strategies that worked for others and most of all.. just allowing myself to be KIND to myself, not always beating myself up, being angry at myself for being shit.
Also agree with this, but want to caution: Bring this up as gently as you can
Don't accuse them of being ADHD, or insist too strongly
If you do bring it up, I would say make sure to really emphasize that you don't think they need fixing. It's something that might help them overcome their own struggles, not something to make them a better person for others, you know?
"I have always envied your ADHD hyperfocus superpowers." /h
Everything I am really good at, I am really bad at, depending on context and the wobbly compass that governs my internal motivation.
It is definitely not all bad. Without my hyperfocus, my life would be unrecognizable. I would be unrecognizable. Hyperfocus is core to so many things I am good at, care about, and have achieved.
My ever optimistic self would fail and fail and fail, create a system, fail, create another system, fail, .... at seemingly easy things.
As soon as I had a rational reason for otherwise inexplicable challenges, enormous amounts of stress evaporated.
Now I know what things are a lost cause: So I get help, delegate, find another way. Being bad at something, and recognizing it, is not the same as failing.
Not only that but it's not always clear that friends don't already know! It's entirely possible their friends might have assumed that they already were aware and had been diagnosed.
Sometimes, a little nudge is all it takes. I didn’t get diagnosed until somebody close to me asked if I’d ever been evaluated. Highly recommend finding some way to bring it up.
Then tell them about ADHD. The main problem is that most people have no idea what it is, or how effective treatment can be. ADHD is one of the most poorly named and broadly misunderstood conditions ever.
For years I heard I was ADHD from my parents, and while some questions when I got diagnosed no longer applied, weeks later, I reflected on them. One in particular was alluding to something to the effect of "has anyone ever told you to stop you're doing too much" which yeah, I was running at full speed all the time when I was younger, probably more than all my cousins.
> The most surprising thing my adult ADHD diagnosis revealed was that as I began telling friends that I had been diagnosed positive they told me they had known that since they met me. These were childhood friends.
As someone with peer reviewed ADHD but not official diagnosis, what are friends gonna do about it? They can tell you, you're always late and it's annoying but that's about it. At some point it becomes just who you are as a person, part of your character sheet. If you're not planning to change and it's mostly under control (have job, life, etc), does it even matter to put a label on the thing?
I feel like a diagnosis in my 20's would've been useful. Now it's like I got me my coping strategies and they work pretty well. If I do or don't have ADHD doesn't really change anything.
And for anyone else reading, the leading symptom of adult-diagnosed adhd is saying and thinking things like "I don't get it, ADD can't be real, that's just how everyone is"
different people with ADHD have different symptoms or effects. I think yes it absolutely matters because I have always secretly been hard on myself, that I am worse than others, struggled under extreme rejection sensitivity. It matters and helps, if only to be able to be a little kinder to yourself and have the ability to decide to get help in the form of a therapist, or medication, or find strategies that worked for others.
I'm ADHD and really struggle with similar things. I've been leading a really lonely life because I tend to isolate after any friction with people, assuming they don't like me anymore.
I know to people without this problem it probably sounds very childish and silly, but it's a real problem. I lack a lot of the inner social calibration of what is a big problem and what is not so I very often have social issues because I say something hurtful (unintentionally) and don't realize why it's a big problem. Then I say other stuff that other people are actually fine (or mostly fine) with but I stress out about it and agonize and isolate myself.
I also identify with being super hard on myself. For a recent example I replaced a door in my house recently. I had never done this before. I bought a power routing saw and cut the hinge mortises myself. Two of them were basically perfect, one of them was a bit jagged and it was off by 2 millimeters when I went to hang the door. I spent the next four hours pissed off at myself for fucking up the door!
After doing a franky great job for my first ever attempt at hanging a door, and never using a routing saw before. :/
> I feel like a diagnosis in my 20's would've been useful. Now it's like I got me my coping strategies and they work pretty well. If I do or don't have ADHD doesn't really change anything.
This is what I told myself before I started taking medication around age 30. But ultimately my coping strategies felt flimsy, and I felt like my life could fall apart at any second.
Getting medicated and getting therapy has improved my life and evened out my emotional state an incredible amount. I still feel like me, just with a bit more stability and consistency.
I don’t think it’s ever too late to start medication. If you think there’s a benefit to it, it’s worth trying out.
I didn't know - but I was adaptively self-medicating.
At one time it was Jolt Cola ("all the sugar and twice the caffeine!"), then energy drinks came along. I can drink 10 a day, because I genuinely function better that way.
But Adderall works really well now, and unlike caffeine, it doesn't set me up to lose sleep.
I found out through a friend who has ADHD just talking about it and finding myself saying "oh god I know EXACTLY what you mean" too often. Then I stumbled upon the reddit adhdmeme community and found myself laughind and saying oh god so true to many of the posts there. Funnily enough now that I'm diagnosed I am noticing that I have unconsciously surrounded myself and just meshed much easier with ADHD people. My wife also has ADHD for example and was always undiagnosed, the friends at work I mesh best with.. you guessed it, also ADHD. Then I learned about how its to a majority genetics and a couple of months after (independent, not somehow induced by me) by nephew gets diagnosed too.
I sat a similar test at the start of my ADHD diagnosis (in the UK for reference).
The one I did (QbCheck) was a similar setup but you were presented with shapes on the screen, either a square or a circle, and either blue or red. All you had to do was press the spacebar when the shape on the screen was the same shape and colour as the previous one. No sound distracitons (or maybe I just had the volume muted.)
You also had to do the test on a laptop with a forward facing camera so the software could track eye movement.
I remember starting the test and thinking "This is exactly what my brain is wired for, I'm going to be awesome at this test!"
Within a minute my mind had already moved on to "I wonder how they score this test? I guess they're looking at accuracy, reaction times, how those trend over time, whether the accuracy/reactions goes up/down if they show the same shape/colour more than twice in a row?" etc...
It didn't take long for me to then get jolted into a "wait, did I just zone out a bit there and miss one?"
Then I became overly conscious of my eyes wandering around and not looking at the screen.
Then my mind moved on to "what if I'm too good at this and it means I won't get a diagnosis?"
Soon it was "When will this ever end? This must have been going on for ages!" only to find it had only been about 3 minutes.
The test took 20 minutes or so and I was mentally exhausted by the end of it.
My actual ADHD diagnosis was backed up by an 80 minute interview, basically doing the DSM-5 questions but linking it all back to childhood experiences too. I've no idea how much weight the QbCheck test had.
Glad I got the diagnosis, I've been masking both for years (diagnosed in my late 40s) but just got burnt out doing so. Medication helps but isn't perfect and since I'm probably AuDHD I find the ADHD medication amplifies some of the Autism traits and makes me into a bit of an emotional zombie, but that seems to be better than having zero motivation (aside from stress/deadlines and serious consequences).
I feel your thoughts about "what if I'm too good at this and it means I wont get diagnosed?" and "when will this ever end?" one, felt like forever - the time blindness struggle is real. I still thought I did too well until the end where they showed me.. well I missed a lot of those little dots in the quadrants or whatever it was.
The first time I went for a diagnosis I was made to sit the same QbCheck test, which was then used as the entire justification for why I couldn't possibly have ADHD despite every other aspect saying I did. Apparently 30 years of having to sit at a computer and do a task in order to eat and pay rent means that I can sit down for 20 minutes and do a task at a computer.
I'm still quite bitter about this because it then took me another two years to work up the motivation to go get retested (this time somewhere that doesn't use snake oil), followed by an additional year to work up the motivation to sort out coordinating with my GP to get on meds. That's three years I could have been a functioning human being.
I spent a decent amount working on ADHD diagnostics and unfortunately it sucks. To my knowledge, to this day, there isn’t a single reliable biomarker that identifies autism spectrum disorders.
It’s usually correlation studies paired with questionnaires which for lack of better words can be described as “incidental” at best. Most z scored tests I know are also developed with small samples, a hundred participants with an outgroup of 20 would already be a LARGE sample. The standard ADHD questionnaire was validated on some 35 people.
There might be some hope in deep learning, particularly in observing eye movement components to deliver reliable biomarkers in the future, but I’m not so confident any time soon.
It’s dreadful and fascinating at the same time that defining and testing for ADS has been so elusive for so long…
That’s my bad for conflating the two. Indeed they are not the same in ICT-11 but! diagnostics is moving towards the direction of treating them the same. ADHD and ASD have extremely high comorbidity and it has been proposed many times to classify them together because the symptoms overlap (difficulties at school, aggressive behaviour or temper, lack of social skills, etc). In fact it has become so difficult to find distinctive features of ADHD both in diagnostics AND treatment (both are usually treated with cognitive behavioural therapy and in more severe cases medication) that it has been proposed numerous times to drop their distinction in the ICT, but this hasn’t happened yet. Good paper to the point:
I don't think that's the conclusion of the paper you linked, although there are papers suggesting that ADHD and autism are essentially subtypes of a single overarching disorder.
The more common view is that because prevalence of attentional deficit in autism is so high, it's rare to find someone with autism who isn't also able to fit an ADHD diagnosis. This might mean a shared common ancestor as it were, or perhaps autism has attentional deficit as an intrinsic part of the disorder rather than people with autism also often having ADHD.
The other direction is the amount of people who have ADHD who also have autism. In this case, while the overlap is higher than the general population, it is easy to find people with ADHD who do not meet the diagnostic criteria for autism.
Put more simply, people with ADHD aren't necessarily autistic, but people with autism are usually ADHD.
CBT is not a first line treatment for ADHD in Australia. Indeed standard CBT is contra-indicated because it requires the kind of "homework" that ADHDers struggle with. There are CBT variants tailored for ADHD however.
> distinctive features of ADHD both in diagnostics AND treatment (both are usually treated with cognitive behavioural therapy and in more severe cases medication)
Uh, what? How exactly could treatment be more distinct than ADHD people being indicated for a highly-regulated drug like amphetamines, which are extremely effective to the point of being life-changing treatment? Meanwhile nobody would consider prescribing Adderall to treat autism. What a bizarre conflation of two completely different disorders.
From a molecular neuroscience perspective, for both ADHD and ASD (autism) you're unlikely to find any pure biomarkers as clean as a disease like huntingtons disease whose mechanism is clearly understood as extra CAG repeats on the HTT gene (a clean mendelian disorder). ADHD is defined by behavior/cognitive symptoms and most all behavior/cognitive diseases are multifactoral, which ADHD is. WES/WGS and GWAS has been done and for familial ADHD and unlike ASD there is mostly no clear monogenic mutation (a single gene that would explain the phenotype) [note monogenic mutations are usually a very small subset of cases but give scientists a look into what pathway/mechanism is causing a multifactoral disease]. Thus it is not for a lack of looking classically, and deficit is speculated to likely manifest as a neural circuit organization or synaptic issue (though the latter is more closely linked to ASD). This is currently impossible (basically) to measure in alive human brain as it requires nanoscopic imaging, note how challenging the fly map was (incomplete IMO as well).
There are only papers which suggest this could be true, none that conclusively prove it. That I’m aware of.
There are some cool studies done where people with a without ADHD are tasked to forage berries. The people with ADHD do better and adhere to foraging patterns which existing theories suggest would be more optimal.
A lot of the studies like that indicate the individual with the condition might benefit more from ADHD than the group they’re in, but I’m not sure that studies have explored group benefits very much.
There’s an often cited paper in which nomadic men who carry a certain ADHD-related allele (DRD4-7R, a dopamine reception variant with ADHD traits and novelty seeking) tend to have better nutritional status. I can’t recall much about it or how high quality it is.
I’ve always thought, it’s not absurd to think there different development routes which the brain takes depending on the environment it develops in.
With your foraging example, it does make me think ADHD is a small group/individual optimisation. Prioritising high vigilance and individual productivity over social cohesion.
I speak with no authority. I don’t even know how such a theory could be tested.
I don’t mean from a nutritional standpoint, but a behavioural perspective. Smaller groups would have an higher percentage of responsibility per individual to be vigilant and proactive.
It would make sense to me that evolutionary there would be different mental development paths depending on the requirements of their situation.
This is coming from my understanding that ADHD is more prevalent in stressful upbringings.
ChatGPT's take was that 10 ADHD people/animals would go exploring and if one produced a new source of food then it would be advantageous for the group, but the other 9 could fail and be completely useless. A bit like venture capital funds haha.
So there is still room for complete failure in life, and maybe its a lot of luck/environment that some ADHD people succeed naturally.
A psychiatrist told me that people with ADHD perform better under extreme pressure and chaos. No idea if that's true. Personally I don't even think of ADHD as a deficiency. It's just a trait that is not compatible with modern society and workplace.
There might be a correlation, but I doubt causation. I would argue people with ADHD, like myself, tend to end up in situations where extreme pressure and chaos is more common. Thus, we have more exposure than the average person. I imagine it can be a trainable trait in many people.
Yeah, I think this is the key point. I am better at handling chaos because I grew up around chaos (my mom has adhd and so do I) so I am much better at handling things falling apart.
A common meme you'll see on ADHD in online posts are about how people with it are perfectly calm during emergencies, but then when any inconsequential thing happens such as e.g. breaking a shoelace and they'll just unravel and/or take forever to deal with it.
2. Assuming it really is: Why would this make it unlikely to be encoded on a single gene? As a layman, the only condition I'm aware of with this "downside but also upside" quality is sickle cell anaemia (downside is anaemia, upside is increased resistance to malaria), which is decided by a single nucleotide change on chromosome 11.
> As a layman, the only condition I'm aware of with this "downside but also upside" quality is sickle cell anaemia
Essentially all traits that you might think of as "traits" and not "features of the species" have downsides and also upsides. Where there's any significant imbalance, the genes for that trait will be purged from the gene pool (if the trait is basically all negatives) or sweep to become universal (if all positives).
By seeking out novelty, someone could be a more effective forager or better able to spot predators/prey hiding. ADHD often comes with a high attention to detail, so there's lots of advantages that could come with that (e.g. that twig wasn't broken before, something has passed through here).
Also, having different sleeping patterns can mean that the people with ADHD are likely better equipped to keep a fire burning overnight and possibly be alert for predators.
I think there is a conflation between attention and attention to details. I understand attention control can vary depending on the engagement value of a task. I have experienced the condition my entire life, I am well aware.
I am not aware of any data that supports being interested in a task lessens the likelihood of making mistakes. If you have any data, I will gladly read it.
Sometimes the upside is just being different. I heard about a group of cattle, and one of them was ill, while the others feasted. The feed was tainted, and so only the sick one survived.
Though, with ADHD, I think it's definitely more than that. It doesn't just make it hard to focus, it makes it hard to focus on what you need to, until the moment that it is obviously now or never. Focus, though - there's tons of that, flitting about, and sometimes grabbing you up and running away with you - sometimes for months. I would imagine that there are a lot of novel discoveries attributable to it.
Am biologist and keeping genes that are "advantageous" is the most common trap that people fall into about evolution. Evolution isint actually about keep advantageous traits the real idea is about differences in reproductive success, not about evolution systematically preserving only traits that are beneficial to the individual.
In fact Darwin's theory of evolution is kind of outdated as well. We now understand genetic drift and things like the neutral theory of molecular evolution from moto kimura and the nearly neutral theory of evolution from tomoko ohta may give some sort of explanation to polygenic nature of adhd.
There’s a doctor who goes by Russell Barkley, PhD on his popular YouTube channel and claims to be able to brainscan for ADHD with certainty. Is his claim legitimate?
Russel Barkley is a pioneer in the field of ADHD research. I have heard of such a claim, but not from Russel Barkley. Could you provide a link of Russel Barkley making the claim please?
It's somewhere in this talk (broken down as a playlist). It's been a while since I've watched it but I do recall him saying that they can see physically differences in the brain of adhd folks
Seeing physical differences in brain volume, connectivity or activity between groups of many adhd folks and non-adhd folks is one thing and that can be done. However, performing a clinical diagnosis of adhd in an individual, solely based on a brain scan, is a completely different thing.
He's a legit researcher though I haven't seen his work on youtube. In terms of how accurate brain scans are at diagnosing adhd you can look at recent meta analyses (gold standard of evidence based medicine pyramid).
In a 2024 meta-analysis of MRI/fMRI machine-learning studies for ADHD, the average pooled sensitivity was 74% (the ability to correctly identify people who actually have ADHD) and the average pooled specificity was 75% (the ability to correctly identify people who do not have ADHD), that also means that there is a 26% false-negative rate (miss/Type II error) and a 25% false-positive rate (accidental diagnosis/Type I error) [https://doi.org/10.1016/j.jad.2024.03.111].
Though there is no set standards but under 80% is pretty low for a clinically useful test but can still be used in some conditions such as to supplement diagnosis. To give some numbers the rapid antigen covid tests had 72% sensitivity and 98.9% specificity. (note the lower sensitivity was acceptable at the time but the CDC guideline was for symptomatic people to retest 48 hours. Viral load and other staging factors could all confound.) [https://doi.org/10.1371/journal.pmed.1004011]
If I remember correctly there are some paradigms in which you can show it in fMRI quite clearly but the trouble is of course MRIs are not accessible to a wide public. I will have to go dig through papers though, I have not read into MRI based diagnostics in a long while
Isn't this true of nearly all mental disorders in DSM-5 and ICD-11?
We don't really know what mental disorders are and so we don't have objective diagnostic tests for them. [1]
We just have treatments that sometimes work for some people (and with the replication crisis[2] that sometimes is probably a lower value than expected).
I concur that many of the diagnostics methods are small sample sized for psychological tests. However I believe we have a lot more neurological evidence for underlying conditions and mechanisms in some. Schizophrenia for example has clear neurological hypothesis relating to agency and we can clearly tell these patients in a standard MRI. The same cannot be said for ADHD or ASD
Are you familiar with any of those? I did some research after receiving my report and apparently the combination of tests listed above are well-respected, about as good as it gets. I’m curious what your take is.
The subjective part of the assessment was actually the clinician making sense of the data. My cognitive assessment (IQ and its subtypes) scored fairly high, I averaged something like 115 (84th percentile). But my memory assessment scores (audio/visual memory/working memory, immediate/delayed memory) tanked tremendously, I averaged around 90 (30th percentile).
My positive diagnosis was based on the variability of scores and the clear cognition-memory gap. The results made sense, aligned with my experience in life (I fell asleep in almost every lecture in college, sustaining attention while taking notes was a heavy audio-visual working memory exercise for me).
I personally haven’t adopted any of this as my identity but it opened a door to do some metacognition and reflect on how I interface with the world. Also the stimulant medication didn’t magically fix everything, sometimes the hyper focus is worse, but there was one HUGE benefit that I didn’t realize I was missing - emotional regulation. I’m a heavy ruminator and pretty much suffered in silence most of my life, my inner dialog is much more organized and calm, and I can comb through my thoughts easier now.
P.S. I cannot recommend enough - check out “HealthyGamerGG” on YouTube. He does some deep dives on ADHD and other diagnoses. Classically trained psychiatrist with something like 5 years of training as a Buddhist monk. Very insightful guy who’s both data-driven and spiritual, helping a lot of people.
I'm not OP but that seems like a very respectable diagnostic track. No test is 100% reliable, so you'd want multiple tests. Even then the results can realistically only be interpreted by a psychologist that is familiar with your situation (hence the clinical interview). So this seems perfectly proper.
> Also the stimulant medication didn’t magically fix everything
Sadly there is no medication that fixes adhd. The only thing these medication does is make it easier to deal with by alleviating (some of) the symptoms. Personally I've noticed from my medication (methylphenidate) that it make it easier to stay focused on whatever task I'm doing, but if that happens to be scrolling reddit, I can still waste hours, perhaps even more since I would have otherwise distracted myself from reddit long before. So it's not perfect, but it does enable me to concentrate 8h+ at work, and that's ultimately the main benefit it brings me.
Be careful and approach `HealthyGamerGG` with a bit of healthy skepticism. I have benefited from a number of his videos, but recently small things have lead to me growing concerned that as his reach/influence grows, the same motivations that existed early on mutate as with many influencers. Not suggesting anything negative per se, just recommending a variety of sources and validating his claims. For another source, Dr. Barkley's videos are very good.
I’m going to say that as you perform more clinical tests typically your chances of a wrong diagnosis will decrease proportionally. However particularly in the case of ADHD tests, if you know the test questions and the symptom description I think you could cheat your way to a diagnosis. If you went to all of these tests in earnest, without looking them up, just providing spontaneous responses, and all of them come back positive, I’d say chances are you have ADHD.
I was researching this test yesterday for my own appointment and did not expect to see it on hacker news.
I am having a really difficult time finding a reputable psychiatrist to assess adult ADHD. I called 15 places and only heard back from one. I scheduled an appointment. They had 1/5 stars, gave me a 30 year old 1 page questionnaire, and asked to see my childhood report card. I did not see them again.
Yesterday I got a callback from an office offering this online test but nothing else? It all smells fishy.
Did anyone have to cross state lines to find a reputable psychiatrist?
I used my general physician. It may not be as high quality as a psych, but he determined the symptoms correlated with the diagnosis and the medicine has helped me immensely in my life.
My psychiatrist gave me some questionnaires (BECK Depression Inventory, THE BECK Anxiety Inventory) and gave me an IQ test (Wechsler Adult Intelligence Scale), she noted in her report the fact that I had a tendency to be restless, that I was distracted by the sound of the clock in her office ticking and that the IQ test scores were very lopsided with Processing Speed being much lower than everything else (and slightly lower working memory). Total test took 8 hours. I had abysmal results on the (Picture Completion) subtest.
Because for some, an "ADHD" is like playing up a symptom to get "Medical Marijuana." It makes it hard to differentiate between people who have a legitimate need for treatment, and people who just want uppers. (There's a joke that if you want a prescription, just look for a 1-star doctor and make sure to accept the vaccinations so they can bill for more.)
Have you asked your general practitioner for help finding a psychiatrist?
This was part of how my ADHD was diagnosed. I did a full day of testing at a specialist center. First I had a conversation with a nurse, then a psychologist, then they had me do a similar test (but in a controlled environment and I also had face tracking and a motion sensor monitoring my movement). After the test, I was given lunch and a dose of adhd medication and about an hour break, then they had me do the test again. After that I met with a psychiatrist who walked me through the test results. Then I had another break while the three specialists met to discuss my case and make a diagnosis. Finally I met with the three to hear the outcome (I was also given a full write-up of my results from the day).
My one surprise from this article is that "play a web game for 18 minutes" in an uncontrolled environment was considered enough testing for a diagnosis!
It's been a trip hearing how much testing others have gone through. IIRC, we had all of one conversation with our psychiatrist (albeit one we had already been seeing for a while) and got our diagnosis. But then it wasn't exactly subtle ADHD.
For our autism assessment a couple months ago, our therapist (whom we've been seeing for about a year at that point?) had us take one or two relatively short multiple choice assessments or the like and that was enough to diagnose us as on the spectrum. Did you know: Not all autistics struggle with eye contact? Some of us (ourselves included) are actually pretty good at it. One reason it's called a spectrum!
The previous time with our mental health professionals factored into their diagnoses, though, not just the tests. The takeaway: Book a therapist and psychiatrist both if you don't already and get those balls rolling.
I took a similar test but in person at an office a few years ago. Exact same layout, of "click when x appears, do nothing if not". It was only 25 minutes I believe but felt like an eternity. I had a 100% success rate and above average reaction speed, but I still "failed" because of my observed behavior as I was taking the test.
The proctor noted my restless legs, frequent posture shifts, and "tendancy to tap the table when not responding to the stimuli" (this was a strategy I had come up with to create something to do in response to "doing nothing", as it made a sort of rhythm that gave me something to do). I then realized that the test meant very little, but the proctor was watching and diagnosing me durng the test.
I did a similar test and it came back neurotypical.
Given the overlap between ADHD and video games, I'm not convinced of the accuracy. It felt like a lame rhythm minigame to me.
I don't think the research is solid, my guess is these tests are convenient for insurance and liability paperwork since stimulants are controlled substances.
Following through on the top comment, surely you realized when you decided to forgo the back half of the test that, had the program compensated for it, you were consciously leaning into the ADHD diagnosis, right?
Which is exactly how it manifests, at least for a lot of people. ADHD isn't just "I can't focus lol", it's "trying to focus feels like dragging myself through broken glass"
One of my kids got diagnosed with ADHD and autism/asperger. He can sit for hours reading IF IT IS INTERESTING. But homework? Impossible. Even if it's just reading a couple of pages of a book it's nearly impossible for him to do it and it takes so much energy and suffering to get through it.
Have you got some fancy scroll thing for your blog? Something in my brain is noticing that scrolling feels smoother than your average site, though maybe im crazy.
No questions, but feedback for you from an engineer in a similar situation (late diagnosis), make sure you go back and get them to check for every other thing under the sun. You really don't want to dive into the ADHD side and find out it was something else (other things can masquerade as ADHD), so a good neuropsychologist is critical. And "body medicine", too, for example adrenal disorders. It's worth being extremely thorough at this point - you're off the standard path, embrace it.
Also, congratulations, once you figure it out your life is going to change for the better in a way you can't currently understand (literally, lacking the brain regions and/or development for it, take it from me), but the process can kinda suck a lot, so stick with it, it's worth it in the end, wherever you end up.
I have a question (and please take it in jest)! In between buying a telescope, seeking out an opinion on ADHD, accidentally hacking an online test, and then blogging about it, how many things on your todo list(s) did you not do?
This comment is so funny to me, because I imagine you being distracted to make the comment before making it to the end where the psych did indeed review the new results.
Well I only know that because I skipped to the end. Then, while scrolling up I realised I missed the whole side-quest about promising to not cheat the test again, taking the test again, but then "accidentally" finding an exploit the system, and then cheating the test again, but this time cheating even more to see the results.
Then, scrolling up more I see that this whole thing started with seeing stars and then buying a telescope on amazon (probably at 3am).
And here I am commenting on HN instead of replying to an email...
Brother the test is quick, easy, and painless, and the results can be lifechanging.
The other thing is, ADHD in my mind is really a syndrome that starts with a symptom - inattention - that can be caused by so, so many things.
I have both, because of course I do, I had a medical problem that exacerbated my ADHD to a significant, significant degree (it's amazing I was able to be a software engineer for so long without treatment). So don't just tunnel vision in... as we tend to be prone to do. Get the whole workup with an experienced clinician, it's so lifechanging it's hard to describe.
I want to add that the comment is also funny to me because it and the blog post are very relatable to me. I don't mean to dismiss it at all. It's really important to get a good diagnosis for anything like this and not dismiss it or lock into the wrong diagnosis because of your own tunnel vision.
You wrote "the test is quick, easy, and painless" but I also want to note that it's not always. Depending on your country, parents, specific doctor, etc it can be very difficult to get a proper diagnosis and help. In some places a big criteria is diagnosis during childhood so if you're 30 or 40 you might have no chance. Or a chance but it depends on your parents retroactively answering a questionnaire, or finding an old report card with the right words.
As you said it's life changing to get the right help and I encourage everyone to pursue this.
The thing is, the test is super quick and easy. And then they throw 50 procedurally complex and tedious tasks at someone who can definitionally not do that, and they know that. Kafkaesque.
Btw no criticism implied on my end, I'm just now constitutionally incapable of not telling people they should get screened. Hmmm I wonder why I have difficulty resisting that urge...
I think I get your point. It's cruel to require Kafkaesque testing and that just makes it not worth it try. But too simple of a test can also misdiagnose.
The chance to be diagnosed with an appropriate gate varies greatly based on where you live and which doctor you can see and more. It can be anything from a 5 minute conversation, to 6 months of inconvenience, to no chance of even existing in your lifetime, to suck it up and don't ask because your career will end.
Right let me be very explicit: TOVA or equivalent are basically "play video games for 10 minutes as a part of your diagnosis" like the OP, the kafkaesque part is getting the appointment, and getting them administered, getting the diagnosis confirmed, going through the records and getting the prescriptions, everything around it :) they're actually pretty sophisticated tests, despite their palatability - I think if they had better ones they'd obviously use them.
Or even better, "We have one available psychologist and they kinda don't believe in ADHD, so they'll see you but not actually grade the test correctly, so you'll have to try again, and as a bonus get labeled medication seeking". Not my experience, but...
" diagnosis during childhood so if you're 30 or 40 you might have no chance "
Huh? You don't have to be tested as-a-child, you don't have to call up your fourth grade teacher. You can self report your subjective experience.
"Did you have these problems as a child? Have you always had trouble doing your homework? Did stressing out about homework enable you to do the homework?"
They ask the question a few different ways typically.
I get it, perhaps it is different in your area, but I get the impression that an adult ADHD diagnosis is far from impossible.
In some countries it's almost impossible (I don't have any direct experience but I've heard tale that in e.g. aus/nz, east asia, south asia, etc people give up before getting diagnosed often), and my understanding is that in Europe it's virtually unheard of to have an adult diagnosis.
In the US, at least, it ranges from difficult to straightforward, but that's not true everywhere
IDK I'm just going by a friend moving there and not being able to get any of her existing medication prescribed, even though she's been diagnosed for literally 40 years.
Europe here. I have several friends that got diagnosed with ADHD as adults.
If you try to do it through the public system it's very difficult to even get an appointment because there's months long waiting lists. Basically if you have a job and function somewhat OK in normal life you won't be diagnosed in the public system. If you do get through it can be a long process where they want to interview your parents etc to determine if you had symptoms as a child. But you can also get a diagnosis through private practitioners and some of them function almost like diagnosis mills. A couple of video interviews and tests and you are done.
> ... my understanding is that in Europe it's virtually unheard of to have an adult diagnosis.
Can't speak for the whole of the continent but UK here and I got my ADHD diagnosis a few years shy of 50 years old. Wasn't tricky at all, just a long-ish (8 month) wait for a non-private diagnosis (not full NHS but via an outsourced provider via Right-To-Choose).
When going through the DSM-5 questions (during an ~80 minute interview) I was asked to give examples from both current life experience and from childhood, and that was enough.
Only recently in aus did an adult diagnosis get support from the government PBS scheme. And even then it's because they're letting retroactive childhood diagnoses be considered for the subsidised medication options.
As I said getting a diagnosis varies by region and doctor. A lot. It's practically impossible in some countries. And also depending on region or personal circumstances, it may not be easy to find another doctor or psychiatrist. Also note that in many countries, only a psychiatrist can diagnose it. Even if diagnosed, you might live in a region where most medicine for ADHD is illegal or have a doctor that won't prescribe them. If you just get disbelief after 6 months of waiting, and after another 6 months just get told stimulants are bad, you might give up.
If you search (eg reddit) for ADHD adult diagnosis, it is filled with horror stories. There's even lots of posts of people diagnosed and medicated for 20+ years that move to another country and can't get a prescription. Or you get a prescription, but the pharmacy won't dispense it or insurance won't pay for it. A typical post on these topics also has one or more people responding "I'm in the same place and it was easy" but also has one or more people responding "I'm in the same place and I tried for 3 years before giving up". By the way, it's also common for women to have more trouble getting a diagnosis compared to male siblings and friends with the same symptoms.
If you pair meds with therapy and adjusting your life according to the things you learn about yourself through the lens of the diagnosis your quality of life can increase dramatically (at least it did for me).
Therapy, which (at least for me) has focused dually on adhd management strategies that can be very helpful (including, in particular, enhancing relevant social skills related to setting expectations and boundaries) and on identifying and modifying negative self-image issues and counterproductive learned behaviors (e.g. various forms of self-directed hostility that attempt to assert control over a neurophysiological issue).
It’s funny, I went to therapy a lot of times before I found someone I could stick with, and if I were to give my past self a list of what I’ve gotten from therapy, I think I would’ve been unimpressed. Nevertheless, I’ve noticed that I’m more confident and calmer, and it has definitely improved my relationships.
There’s a kind of virtuous cycle that happens where you replace a grumpy mindset where you’re always mad at yourself for not meeting other peoples’ expectations and always mad at other people for making your life hard, with a confident mindset where you understand yourself, are therefore comfortable relating to other people about your abilities and needs, and can focus on putting yourself in situations where you’ll be successful.
lol, we’re all writing the same thing. I’ll give you one example, because I particularly liked it. My therapist always talks about separating people from problems, and I never had any idea wtf he was talking about. And then he gave me this exercise where he was like, “let’s construct a narrative where this person’s eccentric personality makes them really good at something specific. Where would you expect a person like that to encounter friction and how would you manage it?”
It was sort of fun, we talked about how Arthur Schawlow (who co-invented the laser and won the Nobel prize) was banned from driving on Stanford campus and had to be chauffeured. And I finally understood what he was talking about; you can access this perspective for anybody by constructing such a narrative. What if everybody’s a misunderstood genius at something? Why not? How would you live in such a world? One insight among many.
I had to come back and comment because your "misunderstood genius" really resonated with me.
It's even beyond that, in my opinion. What if everyone had perfect health, physically and mentally, and had been educated to the absolutely top tier of their ability to accept? Perfect, individual tutoring? Excellent nutrition?
How much better off would the world be if we framed everything in terms of helping everyone be their best, every day, in every way? How much of the trouble in the world is the result of just... accidental awfulness, that we collectively could just choose to stop?
It makes me very sad that we live in a world where potential Nobel winners are dying of easily preventable causes, or working dead-end jobs.
Imagine you spent your whole life crawling, and someone taught you to walk, but for your brain. It's hard to describe.
The medication unlocks your ability to learn the skills you need to cope with the problems you have, and therapy gives you the outside feedback you need to escape your own brain trying its hardest to mess things up and hide the mess.
I will say how it was life-changing for me getting diagnosed as 39M.
The quick answer:
Understanding neurobiology and the meta-cognition about the why of certain behavioural patterns and experiences is extremely helpful to just calm down and "forgive" myself, and not judge myself so harshly. It's as if I can optimise my life by leaning on my strengths and importantly recognising and dealing with my weaknesses. Just the awareness lets me catch myself getting into patterns, and act on them sometimes, and just let myself be the other times without any guilt. This insight brings peace more than you think. I can now organise my inner dialog and enjoy the diverse thoughts while also being aware of my impact on people in my life.
I was skeptical of the meds myself. I spoke with about 20 people through AHD support groups and group sessions. The drugs are mostly a trial and error affair with side-effects and altered behaviour. My subtle lifestyle changes - keeping one true todo list, always logging down my thoughts and taking comfort in the fact that they are jotted down so that I dont have to keep going down that thought and actually get up and go catch the train etc already gave me the biggest benefits. Then I wanted to see for myself what the drugs could actually do. At the end of it I may choose to take them or not. After 8 months of slow analytical trial and error with a very helpful psychiatrist who understood where I am coming from, I now take a very small dose of Elvanse(Vyvanse) + Guanfacine on some days of the week where I feel like I could use the help. They are not life-changing. They nudge me into being more capable of being me. My wife can notice the regulation the drugs let me have - A win for me. My kid has a better relationship with me than before - A win for me. Could I do without? Sure. But, I choose to have that little support to manage myself to get to who I want to be around my family without losing who I am. To each their own.
Longer background:
Despite reading about and knowing the symptoms of ADHD, and being told by a professional 10 years ago that I should consider getting formally diagnosed, I thought to myself - "Hey, I am smart. I feel happy and satisfied. I dont have any problem. I'm good as I am. I dont need to do anything about it." and promptly kept sweeping any thoughts about it under the proverbial rug.
Until, I started seeing my son develop in front of me. Seeing all those symptoms - impulsivity, hyper-focus on few things and inattentive to most others, emotional regulation issues, extreme reasoning abilities in some areas while being "immature" in other areas. This was me growing up. Being smart and intelligent, but longing to fit in, struggling to deal with the mundane. So, I decided to get diagnosed properly. Basically, I could hide behind my smartness and the ability to manage my symptoms until it just myself in my life, and then my wife, and then my son, but when the second one came along, I couldn't manage anymore and the overwhelm started to show the real patterns.
I know this is a joke, but I'd be careful about assuming: I had a trained therapist diagnose me with ADHD ... incorrectly.
It turns out, there are other conditions out there that can appear to be be ADHD. If a trained therapist can confuse them, outside observers certainly can too, so it is possible that "very ADHD-acting" person you know might not have it.
(Or, especially for females, the reverse can be true, as not everyone with ADHD manifests with the same trademark hyperactivity.)
I understand this is your personal medical info, but could you drop any hints as to the nature of the misdiagnosis? I've learned late in life that I am neurospicy and learning from other's experiences in this domain has been quite helpful.
I listen to a lot of psychiatry podcasts, and they generally think that ADHD is being seriously overdiagnosed at this point.
Executive dysfunction, especially that which was not impairing as a child, has a lot of potential causes. Anxiety, depression (yes, ADHD can cause these, but these can also cause executive dysfunction in people without ADHD), OCD, Bipolar (manic people in particular often attribute worsening of hyperactivity and distractability to ADHD instead of mania), Schizophrenia pretty much universally is related to cognitive symptoms and lowered motivation even when not psychotic, and borderline personality disorder can cause changes in interests and identity.
For many of these conditions, stimulants can act as a band aid on something else. It can superficially make people feel better (of course, it's speed), but it can distract from other symptoms that are impairing functioning, and prevent people from seeking long term solutions.
I can roll with that. I do have executive dysfunction and other "fun" facets of a funky neurobiology. I also recognize that every body and mind is different and it's a personal journey to find the right tools.
I recognize that non-medical options should always be front line approaches but there can be a chicken and egg effect as to making that happen.
In my youth I adhered to a "better living through chemistry (wink wink)", I do now too (rip Mitch Hedburg) but the wink wink part is very rare and disciplined and now it's all about pharma and supplements to wring what I can out of what I've got left.
On the non-medical options front, I will note that my lifelong hyperactive and neurotic tendencies dramatically improve with a 3-4 day a week distance running training regimen. I enjoy running enough, even though it is very difficult, that I've kept up with it for several years. I'm not as consistent about this, but I also found yoga classes to be a way to make mindfulness fun and easier.
That's not to say I'm not on the medication train (despite moaning about medications a lot). I do personally avoid taking any controlled substances. This is easy because I hate how stimulants make me feel, but in general I worry about the effects of having a direct reward signal from taking a pill.
Jumping on this conversation a bit: I was recently diagnosed and am still very much in the "what helps?" and "what parts of my personality/habits are connected to this and which aren't?" stage. Do either of you by any chance know a healthy online space to discuss this with others?
I found Finally Focused by James Greenblatt to be quite helpful. He makes sure key minerals and vitamins are in a good range before prescribing stimulants.
This sometimes solves the problem by itself, or it reduces the levels of stimulants needed.
I would recommend avoiding any subreddit related to ADHD.
I honestly would try to stick to materials written by mental health professionals and possibly talking to a therapist (your company might have an EAP that can help with this) over interacting with any online community I'm aware of on this matter.
I find online mental health communities tend to be "if I have a hammer, everything is a nail," and aren't open to other explanations for any traits or struggles. They also tend to suck in the people who aren't doing better with treatment, while the people who found systems that work for them leave for greener pastures. On the opposite side there are communities that are anti-psychiatry and refuse to consider medical treatments. In general these spaces tend to be very black and white.
I do like the Astral Codex Ten open threads as a space that's relatively neutral on the topic, though they lean very biohacker in a way that gets ahead of the science.
I wish I could run. I recognize that exercise is a foundational facet of health all the way around. I'm "blessed" with enough comorbidities that make that a challenge but I am going to get a personal trainer to help me work through that.
Good idea. Feel free to try different options until you find something that you genuinely want to stick with. Running is just what I like, but my understanding of the current research is that it's more important to do something you actually want to do consistently for years than to do the ideal workout for 6 months and then quit exercising entirely.
People are way too happy when they find out that the treatment is taking speed every day for their whole life, as if this isn't going to take its toll on the body and that the brain is not going to adapt to this.
Differentials for ADHD include: panic disorder, metabolic issues, anxiety disorder, depression, adrenal disorders including deficiency and excess like pheochromocytoma, bipolar, autism, learning disorders, personality disorders like borderline and antisocial, OCD, trauma including PTSD and CPTSD, sleep disorders including narcolepsy, sleep apnea, restless leg syndrome, insomnia, ironically substance use disorder like cocaine and amphetamine addiction, thyroid issues again ironically including both hypo and hyperthyroid, seizures, hearing and vision issues, and life stressors.
So, uh, ... a whole textbook. And I probably forgot some.
It was originally called ADD.
Then they forced the H in there for hyperactivity.
And now they say there is non-hyperactive ADHD, but... they don't call it ADD.
So the first rule of getting attention for your paper is to re-define common terms...
The word you are looking for is Inattentive - when diagnosed they should state whether the diagnosis presents as Predominantly Inattentive, Predominantly Hyperactive/Impulsive, or Combination.
I feel like I would have been a different person if I was diagnosed. Probably finished my physics/aero degree. But idk... I would buy it and it was fun to do recreationally which supposedly means you don't have ADHD. Anyway I ended up not finishing school but I got lucky that I still became an SWE.
People would say "just ask for it" but I remember having to try and do these tests like look at these abstract shapes and what not. It was multiple sessions I eventually ran out of insurance so yeah I just abandoned it. I don't like the side effect of shrinkage down there when you're on uppers.
> I would buy it and it was fun to do recreationally which supposedly means you don't have ADHD.
That’s something some people with ADHD need to hear to be ok with taking what is a powerful drug. A comorbidity of ADHD is substance abuse, and stimulants are very rewarding neuobiologically speaking (because they, especially amphetamine, promote dopamine release and persistence in the reward areas near the brainstem, as opposed to non-stimulants like Strattera which does effect dopamine reuptake but only in the prefrontal cortex, the primary area of impairment in ADHD [it does this by exploiting the fact that the NET is used for Dopamine reuptake exclusively in the PFC]), especially when treated like a recreational substance to be taken freely in a dose designed to be fun.
There is a lot of variety in people with ADHD, but I think that perception is more due to how the drugs work when taken medicinally vs recreationally and individual propensity for abuse.
I remember finding a test online for "left-right blindness" that had a similar kinda busted vibe. It was literally something where you look at arrows going up/down/left/right and you have to press a thing to match it.
I wish I could find it again and run it across some cohorts, because it was quite fascinating to feel my brain suffer more on the horizontal arrows.
I find really interesting the description of the ADHD assessments, both on the post and on the comments. It seems like everyone had one or two tests plus some interview at most.
My diagnosis came after I had multiple tests and interviews in a 2 month period, including interviews with my mother and my partner. Sure I was also diagnosed with autism, but the final report given to me was so complete and descriptive of my pains, symptoms and the impact on my day-to-day functioning that it just couldn't be made with a single interview.
That was my first thought. I only wish my type was to put in the work for a blog post instead of just thinking on it and getting overwhelmed with all I need to get done.
> Add: I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
I have been screened a few times for ADHD and each time was found to obviously have it.
Ritalin does not make me feel calmer. I have been told by those close to me that there are externally visible improvements in my behavior. At doses to reach that effect, it also impacts my sleep quality enough that I don't take it.
Adderall causes mild symptoms of psychosis and mania before it has any theraputic effect.
Dexmethylphenidate (aka Focalin) has identical theraputic effects to ritalin, but slightly reduced side-effects.
I'm still on my journey of finding meds (and dosages) that work but I would highly recommend for anyone who has a inattentive scatterbrain to try lis/dexamphetamine.
Methylphenidates can be quite numbing (zombifying) in my group of ADHD friends but dex seems to have a more consistenly helpful effect. The unfortunate caveat for me is that I personally seem predisposed to pelvic floor/urinary issues, which you'll find anecdotal evidence of being exacerbated by amphetamines (research seems yet to catch up), but aside from that the theraputic effects, particularly in emotional regulation seem so far unmatched.
It's unfortunate we have such a tentative model of how our body and, particularly, our minds work so drug treatments often require a trial and error process.
I have exactly the same problem with pelvic floor and urinary issues when I take adderall, although with continued use and PF therapy it's gotten moderately better (and my dr and I decided that the benefits outweighed the risks and issues).
I found methylphenidate-based drugs to be useless after a few days.
Have you tried pure lis or dexamphetamine? I know dex can be prescribed without the mixture, maybe lis can too. I keep meaning to ask my doctor about it.
The other issue I find is tolerance, though even with this I'm still far more focused than when I'm not taking adderall. It really is amazing how much better it makes me feel. I find no problem with addiction whatsoever -- if I forget to take it, then I just have full blown ADHD, but I'm no worse off. I also find it's more effective if I minimize coffee, but I haven't yet cut coffee entirely. (I find caffeine is vastly more addictive than amphetamines.)
I'm nearing my 40s. In my mid-twenties I was diagnosed and over the next couple of years tried all of the usual ADHD meds and none of them were short of terrible in regard to side effects. I guess I've just learned to live with it in a way that outweighs the side effects I get from the drugs.
I was diagnosed with Shiftwork Disorder at one point in time and was prescribed Modafinil and it was incredible for the most part and had zero side-effects, but my doctor wont prescribe it for ADHD. One down-side to Modafinil is that I could get stuck on an unproductive task and would realize in hindsight that I had just been hyper-attentative to this unimportant task for hours.
Studies show Modafinil isn't effective in ADHD adults. It may have benefit in children with ADHD.
I think many prescribers give ADHD adults a high dose too soon causing side-effects. In my experience, it's best to start with a low dose and slowly increase as necessary. The myth is ADHD responds quickly, but observing hundreds of patients it takes months, not days, for benefit of treatment to develop. There's wisdom in the phrase, "start low and go slow".
Yep. What you find often is that the drug is effective right away, at a 20-30-40% effectiveness level. But over time you learn to take advantage of the benefits more effectively, and get more used to the side effects, so it tends to increase significantly in effectiveness at the same dose over 6-8 weeks much like SSRIs, not because the effects last that long, but because you use the tools to improve the tools.
I had terrible brain zaps on Strattera and didn't notice anything at all in regard to benefits. Probably because I just could not get through taking it long enough.
> it also impacts my sleep quality enough that I don't take it.
Yeah, it's basically why I don't bother with it. I know it works, but trading one set of problems that I know how deal with for a different set of problems that needs more meds isn't appealing at all.
I had a doc that prescribed me amphetamine. It was glorious for work, being in one of those horrendous open table environments with only a screen in front of you to keep from staring at the person directly across.
I was able to laser focus and jam through things but the side effects were not worth it and I backed off. I've yet to find a magic pill that does that without the side effects.
I have similar stimulant intolerance since I developed bipolar 1 in my late teens (had been diagnosed with ADHD at 7). I was off ADHD meds for several years, and have now tried a few of the nonstimulants.
Strattera was subtle, but I had clearly improved feedback at work, a cleaner apartment, and no side effects.
Qelbree caused a lot of nausea.
Intuniv caused lightheadedness and got me an unnecessary cardiac workup.
Wellbutrin doesn't have as much ADHD efficacy as Strattera (my doc won't let me take both at the same time), but it improved my seasonal depression and motivation significantly. I had some irritability for the first few days after a dose increase, but otherwise the only side effect is reduced hunger and I also stopped asking people for cigarettes or zyns when I'm drunk.
That’s basically how the end of my diagnosis went because aspects of my results were borderline, so she suggested that I just try meds to see. But keep in mind that only one type of ADHD involves being hyper. Some of us are inattentive types where our brain feels like an old 70s pony car engine, and if you pull up to a stoplight you need to keep the motor revving or it will stall. Taking Ritalin for us is the equivalent of keeping the revs up.
If you're borderline, talk to the doc about a trial of guanfacine. (note that some people HATE it, for exactly this reason) It's the opposite - if your engine is always redlining, it sets a rate limiter and gives you the chance to look out the window and enjoy the scenery, metaphorically.
And in the most interesting cases, you can find a lot of value in both - stimulants keeps you going, guanfacine gives you perspective and the ability to unclench.
As an ADHD person who was already planning to ask my psychiatrist if we can try different medication at my next appointment, thank you very much! That description sounds exactly like what I want to achieve.
I cannot overstate the degree to which it has been lifechanging, after years of trials of various other things. Honestly it was overwhelming - like a months-long mild psychedelic trip. I never want to go back. I am much, much less of an asshole now, and I say that advisedly. (note: lower assholery indicates nothing in absolute terms - I am probably still quite a bit of one. But less! and gratefully, joyfully so.)
Edit: And this is me trying to restrain myself so I don't look like someone starting a cult...
This is the case for me. I finally got diagnosed last year and prescribed Ritalin this year, and it has been transformative in aiding me in getting out of ruts/stalls.
> ... I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
In ADHD (and most conditions) diagnosis by medication response is not acceptable. Response to drugs is highly variable and fails criteria for acceptable tests. Also drugs can produce side-effects. According to professional standards, it's unethical to expose people to nontrivial risks without good cause.
So this is the cheats with "give everyone ritalin and see how they feel" - it works for most neurotypical folks too. It's just a very small increase compared to the annoyance and side effects, so it's usually not worth it. To extend the car analogy from a sibling comment, putting race fuel in a volvo.
So they can't test by response, because everyone would be like "yeah I can focus better", you have to test with the drug on, and the drug off, to see whether the "horsepower increase" is worth the fuel price. Increasingly strained metaphors are my strength.
Yeah it feels like the diagnosis itself is useless, compared to just straight up trying some of those drugs and see how much you feel better. If none works, then no use in diagnosis.
> This performance pattern^H^H^H^H^H^H BLOG POST may indicate attentional difficulties, and taken together with other findings, an increased likelihood for the existence of ADHD.
The biggest risk for ADHD treatment is that most diagnosed people are told: "you brain doesn't make enough dopamine" which makes it feel safe for you and why they say non-ADHD people cannot take it.
But for your specific brain it does make enough and it will fight to maintain that via homeostasis (usually by creating more dopamine vacuums/re-uptakes that stick around a long time...there is good science on this).
So you become dependent on the medication and tolerance can occur making your situation worse than it was in the end.
ADHD-as-a-diagnosis is just a clever way to make the government okay with prescribing stimulant medication to "people who it can help" and having someone safely monitor its usage, and to assure the government that we won't end up with too large of percentage of the population taking it.
Don't know what conspiracy theory are u in but I forgot taking my meds this morning and forgot it a couple times every month. I hope I am addicted to it so I don't forget
This is just my story but before ADHD diagnosis and medication I was unemployed, on food stamps, in an abusive relationship, and struggling with alcoholism. After taking medication for a couple years I'm in a healthy relationship, making good money in a stable job, and on the wagon. The medication prescribed helped so much with my impulse control issues that it literally changed my life.
Not going to get into a back/forth due to the pseudo-conspiracy end, just stating that this is significantly inaccurate.
Those are some possible outcomes, yes, but it is not a black/white thing, and that is actually WHY it's important to work with a qualified doctor to monitor medication, effects, dosage and so on, and make adjustments as necessary.
Different medications work very differently as it relates to dopamine, uptake, production, etc. And there are also non-stimulant medications that may be effective for some folks.
As an example, President JFK received regular injections containing high doses of amphetamines from his personal physician.
Then the risk of abuse and side-effects in the population were observed and it was banned.
Did JFK have ADHD? No, it just helped him with energy levels. Like it would anyone.
There are no conclusive bio-markers for ADHD. Therefore its not possible to say who doesn't have it and should not get stimulant medication.
The only commonality is that there is an impairment. It's not possible to say: this person has difficulty focusing and has ADHD but this person has difficulty focusing but doesn't have ADHD.
The board of psychiatrists who decide what symptoms constitute it just essentially make it up.
The only thing that is real and measurable is the level of impairment to someone's life.
Stimulant medications works, but it would work for anyone regardless of an ADHD cause. ADHD is like a catch-all for people who can't focus that doesn't match any other condition that could be resolved differently.
Stimulant medication definitely carries risks and health impacts. This is black and white.
You seem to have your mind made up, so just gonna say that for anyone else reading this, this is not accurate or scientific information. Lacks an understanding of how the medication works, the differences in kinds of medications. The fact it used to be legal is not relevant. Misrepresents how ADHD is diagnosed, the criteria for it (by professionals), and even to a lesser extent the biomarkers statement.
I skimmed over that paper, and may do a deeper dive later, although doesn't really seem worth it. I thought it was going to be a scientific study, but it reads more like a essay from two authors with a specific viewpoint trying to convince others, via slanted/biased text, that other text and language is baising an entire industry and population? I find that questionable at best.
And while the authors made a lot of claims, and cited some other studies, they don't really, IMO, prove their point in any scientifically valid way, or even as a solid, well-formed argument. Add in that the authors are sociologists, not neuroscientists or psychiatrists/psychologists, and it makes me question both their claims and understanding of the topic.
I did catch that one of their main points (that you mentioned as well) boils down to not having a physical test or clear biomarker. But that applies to nearly all psychiatric conditions. Saying the absence of those kinds of tests is the same as the absence of a real condition ignores the research that has been done demonstrating functional impairment (including twin studies, some indications of genetic heritability).
The paper presents a specific sociological viewpoint, and that isn't the current scientific consensus.
Like I said, probably not gonna convince you, just dropping this for others that might see the essay link and think it might actually provide validity when it does not. That essay does not really make significant arguments against ADHD.
It does present good warnings to be aware of pressures that would distort diagnosis and I do think there is good reason to be cautious about over diagnosing, or diagnosing by unqualified personnel, both of which do happen of course. But the article goes too far beyond that.
Because others can say this much better and with better sources and citation than I can, both directly address many of the criticisms made in the essay shared and the faulty reasoning based on it.
I like how this can be summarized as a person taking part in an ADHD test before getting off-track and overanalyzing the task without actually doing it.
Reminds me of one of the first video games to get FDA approval as a medical device. EndeavorRx I believe it's called. You have to keep the character moving down the path while not paying attention to all the shit the game produces to distract you.
In the past few years the internet have been busy trying to attribute completely normal human quirks to ADHD, ADD and various levels of autism. We see these "Only people with X will understand this" and it's something stupid like forgetting why you entered a room. I don't know if neurodivergent people increasingly seeks out online "forums" like Reddit and Imgur, but they seem to be populated entirely by people with ADD, autism and depression (and Furries, but that feels less problematic). All are on a mission to convince anyone who stumble into their realm that they too have a disorder.
Understandably people want to help when they see someone struggling with the same things they did, and I'm not suggesting that you don't seek out professionals if you think you might have a disorder, but we need to stop labeling completely normal behaviour as problematic.
Just like people without various disorders can't relate well to those with e.g. ADHD, people with the these disorders also understand neurotypical behaviour way less than they think they do. A large number seems to struggle with separating "normal" quirks of the brains and their diagnoses.
Pre-taking medication, here's what my personal experience trying to focusing looks like:
I have some really interesting, but lengthy text that's really important for me to read for class. No cell phone, cleaned my room, put on specialized focus music, jot down all my random thoughts on a notepad, got myself a cup of coffee and made sure I eliminated all distractions.
I then proceed to read the first two or three sentences before I realized I have been mindlessly scanning the text with my eyes like I'm reading, but instead I am doing the equivalent of watching a movie. I'm 100% zoned out and in la la land.
I realize this, so I stop, refocus, repeat. I realize I did it again, stop, refocus and try reading out loud. I'm annoyed because I'm saying the words out loud but not comprehending it.
I meditate for 30 seconds to calm my mind, try to refocus and repeat. I finally get through it after about 30 minutes.
Here's how my personal experience looks with medication:
I pick up the damn paper, read it and summarize it with notes in 5 minutes.
Correct. People with focus issues do not necessarily have ADHD. That requires meeting a defined set of diagnostic criteria, including that it has an impairing effect on an individual's life.
Also, just because it seems like a simple lack of focus to you externally, that does not mean the person does not have a disorder.
The most surprising thing my adult ADHD diagnosis revealed was that as I began telling friends that I had been diagnosed positive they told me they had known that since they met me. These were childhood friends.
Thanks friends.
I thought I was bad at lots of things other people were good at, because I was more disciplined and saw the bigger picture. So I only worked on important things. Things that could matter to millions of people, or still be relevant in 100 years.
And all the side quests and rabbit holes were obviously for recharging, expanding my biological-being-on-an-odd-planet situational awareness, or benefited me as self-improvement challenges. All in service of the important things.
How would tracking the day of the week, doing homework on something I could learn later if/when I ever needed it, or mowing the lawn, help me accomplish anything important?
Wasting brain space on those kinds of things would be dysfunction. I actively culled such dreck!
Now I know my self-narrative was Stockholm Syndrome coping.
But I still don't mow lawns, and if the blinds are drawn when I finish a big task, I couldn't guess if it was am or pm better than a coin toss. My day metric is when Amazon Prime's "Your Orders" list, tells me I am a day closer to getting a crafting item I ordered for a project I may never get to.
Don't be too mad at your friends. People are not receptive to being told they're odd. And as much as they might say "we knew", they didn't really. They might have suspected, but they cannot diagnose you. Many things are very clear in hindsight that weren't actually clear at the time.
I call this the “this boy ain’t right” diagnosis
Some friends I've known for over a decade clearly have ADHD, and I'm not going to tell them unprompted.
I feel like it is very disrespectful, especially when the conversation is about something completely different. Also, I'm not a medical professional, and it is possible that their ADHD-like symptoms are caused by something else.
That being said, if they ask if I think they have ADHD, or any other form of neurodivergence, I will say yes.
Speaking as someone who only got our ADHD diagnosis in our late thirties and our autism spectrum diagnosis at forty fucking two, please consider just telling them. That could be years or decades of social, pharmacological, and even legal assistance that they deserve and need and aren't otherwise getting.
Resonate and agree with this 100%.
Second this too. I went through live until mid thirties thinking life just was that hard for everyone and I was just bad and shit at things, worse than others - I suffered alone thinking everyone had to be like me, because I'm normal right? It was a huge relief finally being diagnosed because I could finally understand myself better, even found community of sorts.. strategies that worked for others and most of all.. just allowing myself to be KIND to myself, not always beating myself up, being angry at myself for being shit.
Also agree with this, but want to caution: Bring this up as gently as you can
Don't accuse them of being ADHD, or insist too strongly
If you do bring it up, I would say make sure to really emphasize that you don't think they need fixing. It's something that might help them overcome their own struggles, not something to make them a better person for others, you know?
"I have always envied your ADHD hyperfocus superpowers." /h
Everything I am really good at, I am really bad at, depending on context and the wobbly compass that governs my internal motivation.
It is definitely not all bad. Without my hyperfocus, my life would be unrecognizable. I would be unrecognizable. Hyperfocus is core to so many things I am good at, care about, and have achieved.
I agree with this.
My ever optimistic self would fail and fail and fail, create a system, fail, create another system, fail, .... at seemingly easy things.
As soon as I had a rational reason for otherwise inexplicable challenges, enormous amounts of stress evaporated.
Now I know what things are a lost cause: So I get help, delegate, find another way. Being bad at something, and recognizing it, is not the same as failing.
Not only that but it's not always clear that friends don't already know! It's entirely possible their friends might have assumed that they already were aware and had been diagnosed.
Sometimes, a little nudge is all it takes. I didn’t get diagnosed until somebody close to me asked if I’d ever been evaluated. Highly recommend finding some way to bring it up.
Then tell them about ADHD. The main problem is that most people have no idea what it is, or how effective treatment can be. ADHD is one of the most poorly named and broadly misunderstood conditions ever.
Or, when the context is right, just ask, "hey, did you ever get diagnosed as ADD?"
I once had a close friend ask if I had [other syndrome], and my answer was "I have all the symptoms but don't care to seek a diagnosis."
It was a very polite way to inform me, and a polite way for me to say that I was happy living my life the way I want to live it.
For years I heard I was ADHD from my parents, and while some questions when I got diagnosed no longer applied, weeks later, I reflected on them. One in particular was alluding to something to the effect of "has anyone ever told you to stop you're doing too much" which yeah, I was running at full speed all the time when I was younger, probably more than all my cousins.
> The most surprising thing my adult ADHD diagnosis revealed was that as I began telling friends that I had been diagnosed positive they told me they had known that since they met me. These were childhood friends.
As someone with peer reviewed ADHD but not official diagnosis, what are friends gonna do about it? They can tell you, you're always late and it's annoying but that's about it. At some point it becomes just who you are as a person, part of your character sheet. If you're not planning to change and it's mostly under control (have job, life, etc), does it even matter to put a label on the thing?
I feel like a diagnosis in my 20's would've been useful. Now it's like I got me my coping strategies and they work pretty well. If I do or don't have ADHD doesn't really change anything.
And for anyone else reading, the leading symptom of adult-diagnosed adhd is saying and thinking things like "I don't get it, ADD can't be real, that's just how everyone is"
different people with ADHD have different symptoms or effects. I think yes it absolutely matters because I have always secretly been hard on myself, that I am worse than others, struggled under extreme rejection sensitivity. It matters and helps, if only to be able to be a little kinder to yourself and have the ability to decide to get help in the form of a therapist, or medication, or find strategies that worked for others.
I'm ADHD and really struggle with similar things. I've been leading a really lonely life because I tend to isolate after any friction with people, assuming they don't like me anymore.
I know to people without this problem it probably sounds very childish and silly, but it's a real problem. I lack a lot of the inner social calibration of what is a big problem and what is not so I very often have social issues because I say something hurtful (unintentionally) and don't realize why it's a big problem. Then I say other stuff that other people are actually fine (or mostly fine) with but I stress out about it and agonize and isolate myself.
I also identify with being super hard on myself. For a recent example I replaced a door in my house recently. I had never done this before. I bought a power routing saw and cut the hinge mortises myself. Two of them were basically perfect, one of them was a bit jagged and it was off by 2 millimeters when I went to hang the door. I spent the next four hours pissed off at myself for fucking up the door!
After doing a franky great job for my first ever attempt at hanging a door, and never using a routing saw before. :/
That's not normal levels of self criticism
> I feel like a diagnosis in my 20's would've been useful. Now it's like I got me my coping strategies and they work pretty well. If I do or don't have ADHD doesn't really change anything.
This is what I told myself before I started taking medication around age 30. But ultimately my coping strategies felt flimsy, and I felt like my life could fall apart at any second.
Getting medicated and getting therapy has improved my life and evened out my emotional state an incredible amount. I still feel like me, just with a bit more stability and consistency.
I don’t think it’s ever too late to start medication. If you think there’s a benefit to it, it’s worth trying out.
I didn't know - but I was adaptively self-medicating.
At one time it was Jolt Cola ("all the sugar and twice the caffeine!"), then energy drinks came along. I can drink 10 a day, because I genuinely function better that way.
But Adderall works really well now, and unlike caffeine, it doesn't set me up to lose sleep.
I found out through a friend who has ADHD just talking about it and finding myself saying "oh god I know EXACTLY what you mean" too often. Then I stumbled upon the reddit adhdmeme community and found myself laughind and saying oh god so true to many of the posts there. Funnily enough now that I'm diagnosed I am noticing that I have unconsciously surrounded myself and just meshed much easier with ADHD people. My wife also has ADHD for example and was always undiagnosed, the friends at work I mesh best with.. you guessed it, also ADHD. Then I learned about how its to a majority genetics and a couple of months after (independent, not somehow induced by me) by nephew gets diagnosed too.
I sat a similar test at the start of my ADHD diagnosis (in the UK for reference).
The one I did (QbCheck) was a similar setup but you were presented with shapes on the screen, either a square or a circle, and either blue or red. All you had to do was press the spacebar when the shape on the screen was the same shape and colour as the previous one. No sound distracitons (or maybe I just had the volume muted.)
You also had to do the test on a laptop with a forward facing camera so the software could track eye movement.
I remember starting the test and thinking "This is exactly what my brain is wired for, I'm going to be awesome at this test!"
Within a minute my mind had already moved on to "I wonder how they score this test? I guess they're looking at accuracy, reaction times, how those trend over time, whether the accuracy/reactions goes up/down if they show the same shape/colour more than twice in a row?" etc...
It didn't take long for me to then get jolted into a "wait, did I just zone out a bit there and miss one?"
Then I became overly conscious of my eyes wandering around and not looking at the screen.
Then my mind moved on to "what if I'm too good at this and it means I won't get a diagnosis?"
Soon it was "When will this ever end? This must have been going on for ages!" only to find it had only been about 3 minutes.
The test took 20 minutes or so and I was mentally exhausted by the end of it.
My actual ADHD diagnosis was backed up by an 80 minute interview, basically doing the DSM-5 questions but linking it all back to childhood experiences too. I've no idea how much weight the QbCheck test had.
Glad I got the diagnosis, I've been masking both for years (diagnosed in my late 40s) but just got burnt out doing so. Medication helps but isn't perfect and since I'm probably AuDHD I find the ADHD medication amplifies some of the Autism traits and makes me into a bit of an emotional zombie, but that seems to be better than having zero motivation (aside from stress/deadlines and serious consequences).
I feel your thoughts about "what if I'm too good at this and it means I wont get diagnosed?" and "when will this ever end?" one, felt like forever - the time blindness struggle is real. I still thought I did too well until the end where they showed me.. well I missed a lot of those little dots in the quadrants or whatever it was.
The first time I went for a diagnosis I was made to sit the same QbCheck test, which was then used as the entire justification for why I couldn't possibly have ADHD despite every other aspect saying I did. Apparently 30 years of having to sit at a computer and do a task in order to eat and pay rent means that I can sit down for 20 minutes and do a task at a computer.
I'm still quite bitter about this because it then took me another two years to work up the motivation to go get retested (this time somewhere that doesn't use snake oil), followed by an additional year to work up the motivation to sort out coordinating with my GP to get on meds. That's three years I could have been a functioning human being.
The 20 minutes was one of the longest and hardest 20 minutes of my life. The worst.
Did confirm that I have very above average reaction times though.
I spent a decent amount working on ADHD diagnostics and unfortunately it sucks. To my knowledge, to this day, there isn’t a single reliable biomarker that identifies autism spectrum disorders. It’s usually correlation studies paired with questionnaires which for lack of better words can be described as “incidental” at best. Most z scored tests I know are also developed with small samples, a hundred participants with an outgroup of 20 would already be a LARGE sample. The standard ADHD questionnaire was validated on some 35 people.
There might be some hope in deep learning, particularly in observing eye movement components to deliver reliable biomarkers in the future, but I’m not so confident any time soon.
It’s dreadful and fascinating at the same time that defining and testing for ADS has been so elusive for so long…
ADHD is not an autism spectrum disorder, is it?
That’s my bad for conflating the two. Indeed they are not the same in ICT-11 but! diagnostics is moving towards the direction of treating them the same. ADHD and ASD have extremely high comorbidity and it has been proposed many times to classify them together because the symptoms overlap (difficulties at school, aggressive behaviour or temper, lack of social skills, etc). In fact it has become so difficult to find distinctive features of ADHD both in diagnostics AND treatment (both are usually treated with cognitive behavioural therapy and in more severe cases medication) that it has been proposed numerous times to drop their distinction in the ICT, but this hasn’t happened yet. Good paper to the point:
https://pmc.ncbi.nlm.nih.gov/articles/PMC4654237/
I don't think that's the conclusion of the paper you linked, although there are papers suggesting that ADHD and autism are essentially subtypes of a single overarching disorder.
The more common view is that because prevalence of attentional deficit in autism is so high, it's rare to find someone with autism who isn't also able to fit an ADHD diagnosis. This might mean a shared common ancestor as it were, or perhaps autism has attentional deficit as an intrinsic part of the disorder rather than people with autism also often having ADHD.
The other direction is the amount of people who have ADHD who also have autism. In this case, while the overlap is higher than the general population, it is easy to find people with ADHD who do not meet the diagnostic criteria for autism.
Put more simply, people with ADHD aren't necessarily autistic, but people with autism are usually ADHD.
CBT is not a first line treatment for ADHD in Australia. Indeed standard CBT is contra-indicated because it requires the kind of "homework" that ADHDers struggle with. There are CBT variants tailored for ADHD however.
> distinctive features of ADHD both in diagnostics AND treatment (both are usually treated with cognitive behavioural therapy and in more severe cases medication)
Uh, what? How exactly could treatment be more distinct than ADHD people being indicated for a highly-regulated drug like amphetamines, which are extremely effective to the point of being life-changing treatment? Meanwhile nobody would consider prescribing Adderall to treat autism. What a bizarre conflation of two completely different disorders.
No, however they are often comorbid.
Autism Disorder with High Distractability?
I believe AuDHD is the common term.
The gold edition
From a molecular neuroscience perspective, for both ADHD and ASD (autism) you're unlikely to find any pure biomarkers as clean as a disease like huntingtons disease whose mechanism is clearly understood as extra CAG repeats on the HTT gene (a clean mendelian disorder). ADHD is defined by behavior/cognitive symptoms and most all behavior/cognitive diseases are multifactoral, which ADHD is. WES/WGS and GWAS has been done and for familial ADHD and unlike ASD there is mostly no clear monogenic mutation (a single gene that would explain the phenotype) [note monogenic mutations are usually a very small subset of cases but give scientists a look into what pathway/mechanism is causing a multifactoral disease]. Thus it is not for a lack of looking classically, and deficit is speculated to likely manifest as a neural circuit organization or synaptic issue (though the latter is more closely linked to ASD). This is currently impossible (basically) to measure in alive human brain as it requires nanoscopic imaging, note how challenging the fly map was (incomplete IMO as well).
ADHD also evolutionary advantages, so there is unlikely to be a single gene that encodes for it.
What are they? Are there papers on this?
There are only papers which suggest this could be true, none that conclusively prove it. That I’m aware of.
There are some cool studies done where people with a without ADHD are tasked to forage berries. The people with ADHD do better and adhere to foraging patterns which existing theories suggest would be more optimal.
A lot of the studies like that indicate the individual with the condition might benefit more from ADHD than the group they’re in, but I’m not sure that studies have explored group benefits very much.
There’s an often cited paper in which nomadic men who carry a certain ADHD-related allele (DRD4-7R, a dopamine reception variant with ADHD traits and novelty seeking) tend to have better nutritional status. I can’t recall much about it or how high quality it is.
I’ve always thought, it’s not absurd to think there different development routes which the brain takes depending on the environment it develops in.
With your foraging example, it does make me think ADHD is a small group/individual optimisation. Prioritising high vigilance and individual productivity over social cohesion.
I speak with no authority. I don’t even know how such a theory could be tested.
> I’ve always thought, it’s not absurd to think there different development routes which the brain takes depending on the environment it develops in.
What do you think nutritional stunting means?
https://en.wikipedia.org/wiki/Stunted_growth
I don’t mean from a nutritional standpoint, but a behavioural perspective. Smaller groups would have an higher percentage of responsibility per individual to be vigilant and proactive.
It would make sense to me that evolutionary there would be different mental development paths depending on the requirements of their situation.
This is coming from my understanding that ADHD is more prevalent in stressful upbringings.
If adhd is heritable, then the stressful upbringing could be symptomatic of the parent's condition instead of causal.
I don't know about papers but I had a doctor tell me they are overrepresented among snipers in the military. ADD could be an advantage to hunting.
Or ADD just sucks there less than in other areas.
Like being physically weak is not an advantage in white collar jobs.
ChatGPT's take was that 10 ADHD people/animals would go exploring and if one produced a new source of food then it would be advantageous for the group, but the other 9 could fail and be completely useless. A bit like venture capital funds haha.
So there is still room for complete failure in life, and maybe its a lot of luck/environment that some ADHD people succeed naturally.
A psychiatrist told me that people with ADHD perform better under extreme pressure and chaos. No idea if that's true. Personally I don't even think of ADHD as a deficiency. It's just a trait that is not compatible with modern society and workplace.
There might be a correlation, but I doubt causation. I would argue people with ADHD, like myself, tend to end up in situations where extreme pressure and chaos is more common. Thus, we have more exposure than the average person. I imagine it can be a trainable trait in many people.
Yeah, I think this is the key point. I am better at handling chaos because I grew up around chaos (my mom has adhd and so do I) so I am much better at handling things falling apart.
A common meme you'll see on ADHD in online posts are about how people with it are perfectly calm during emergencies, but then when any inconsequential thing happens such as e.g. breaking a shoelace and they'll just unravel and/or take forever to deal with it.
Evo-psych is impossible to falsify.
I wish everyone would get this!
1. How is it advantageous?
2. Assuming it really is: Why would this make it unlikely to be encoded on a single gene? As a layman, the only condition I'm aware of with this "downside but also upside" quality is sickle cell anaemia (downside is anaemia, upside is increased resistance to malaria), which is decided by a single nucleotide change on chromosome 11.
> As a layman, the only condition I'm aware of with this "downside but also upside" quality is sickle cell anaemia
Essentially all traits that you might think of as "traits" and not "features of the species" have downsides and also upsides. Where there's any significant imbalance, the genes for that trait will be purged from the gene pool (if the trait is basically all negatives) or sweep to become universal (if all positives).
By seeking out novelty, someone could be a more effective forager or better able to spot predators/prey hiding. ADHD often comes with a high attention to detail, so there's lots of advantages that could come with that (e.g. that twig wasn't broken before, something has passed through here).
Also, having different sleeping patterns can mean that the people with ADHD are likely better equipped to keep a fire burning overnight and possibly be alert for predators.
> ADHD often comes with a high attention to detail
Per the DSM-5, one of the core symptoms of ADHD:
"often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
Yes, it's both a lack of attention to details in "boring" tasks and an exceptional attention to details in "interesting" tasks.
I think there is a conflation between attention and attention to details. I understand attention control can vary depending on the engagement value of a task. I have experienced the condition my entire life, I am well aware.
I am not aware of any data that supports being interested in a task lessens the likelihood of making mistakes. If you have any data, I will gladly read it.
This isn't funny
Sometimes the upside is just being different. I heard about a group of cattle, and one of them was ill, while the others feasted. The feed was tainted, and so only the sick one survived.
Though, with ADHD, I think it's definitely more than that. It doesn't just make it hard to focus, it makes it hard to focus on what you need to, until the moment that it is obviously now or never. Focus, though - there's tons of that, flitting about, and sometimes grabbing you up and running away with you - sometimes for months. I would imagine that there are a lot of novel discoveries attributable to it.
Am biologist and keeping genes that are "advantageous" is the most common trap that people fall into about evolution. Evolution isint actually about keep advantageous traits the real idea is about differences in reproductive success, not about evolution systematically preserving only traits that are beneficial to the individual.
In fact Darwin's theory of evolution is kind of outdated as well. We now understand genetic drift and things like the neutral theory of molecular evolution from moto kimura and the nearly neutral theory of evolution from tomoko ohta may give some sort of explanation to polygenic nature of adhd.
There’s a doctor who goes by Russell Barkley, PhD on his popular YouTube channel and claims to be able to brainscan for ADHD with certainty. Is his claim legitimate?
Russel Barkley is a pioneer in the field of ADHD research. I have heard of such a claim, but not from Russel Barkley. Could you provide a link of Russel Barkley making the claim please?
It's somewhere in this talk (broken down as a playlist). It's been a while since I've watched it but I do recall him saying that they can see physically differences in the brain of adhd folks
https://www.youtube.com/watch?v=BzhbAK1pdPM&list=PLzBixSjmbc...
Seeing physical differences in brain volume, connectivity or activity between groups of many adhd folks and non-adhd folks is one thing and that can be done. However, performing a clinical diagnosis of adhd in an individual, solely based on a brain scan, is a completely different thing.
This is the intelligence of the average American voter. No wonder we got Trump.
He's a legit researcher though I haven't seen his work on youtube. In terms of how accurate brain scans are at diagnosing adhd you can look at recent meta analyses (gold standard of evidence based medicine pyramid).
In a 2024 meta-analysis of MRI/fMRI machine-learning studies for ADHD, the average pooled sensitivity was 74% (the ability to correctly identify people who actually have ADHD) and the average pooled specificity was 75% (the ability to correctly identify people who do not have ADHD), that also means that there is a 26% false-negative rate (miss/Type II error) and a 25% false-positive rate (accidental diagnosis/Type I error) [https://doi.org/10.1016/j.jad.2024.03.111].
Though there is no set standards but under 80% is pretty low for a clinically useful test but can still be used in some conditions such as to supplement diagnosis. To give some numbers the rapid antigen covid tests had 72% sensitivity and 98.9% specificity. (note the lower sensitivity was acceptable at the time but the CDC guideline was for symptomatic people to retest 48 hours. Viral load and other staging factors could all confound.) [https://doi.org/10.1371/journal.pmed.1004011]
If I remember correctly there are some paradigms in which you can show it in fMRI quite clearly but the trouble is of course MRIs are not accessible to a wide public. I will have to go dig through papers though, I have not read into MRI based diagnostics in a long while
Isn't this true of nearly all mental disorders in DSM-5 and ICD-11?
We don't really know what mental disorders are and so we don't have objective diagnostic tests for them. [1]
We just have treatments that sometimes work for some people (and with the replication crisis[2] that sometimes is probably a lower value than expected).
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC6732705/
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC5835722/
I concur that many of the diagnostics methods are small sample sized for psychological tests. However I believe we have a lot more neurological evidence for underlying conditions and mechanisms in some. Schizophrenia for example has clear neurological hypothesis relating to agency and we can clearly tell these patients in a standard MRI. The same cannot be said for ADHD or ASD
32 y/o male. I took an in-person assessment earlier this year. It was an 8 hour battery of tests split across two days. In no particular order:
- Clinical Interview
- Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV)
- Wechsler Memory Scale – Fourth Edition (WMS-IV)
- Conners Continuous Performance Test – Third Edition (CPT-3)
- Delis-Kaplan Executive Functioning System, selected subtests
- Wisconsin Card Sorting Test (WCST)
Are you familiar with any of those? I did some research after receiving my report and apparently the combination of tests listed above are well-respected, about as good as it gets. I’m curious what your take is.
The subjective part of the assessment was actually the clinician making sense of the data. My cognitive assessment (IQ and its subtypes) scored fairly high, I averaged something like 115 (84th percentile). But my memory assessment scores (audio/visual memory/working memory, immediate/delayed memory) tanked tremendously, I averaged around 90 (30th percentile).
My positive diagnosis was based on the variability of scores and the clear cognition-memory gap. The results made sense, aligned with my experience in life (I fell asleep in almost every lecture in college, sustaining attention while taking notes was a heavy audio-visual working memory exercise for me).
I personally haven’t adopted any of this as my identity but it opened a door to do some metacognition and reflect on how I interface with the world. Also the stimulant medication didn’t magically fix everything, sometimes the hyper focus is worse, but there was one HUGE benefit that I didn’t realize I was missing - emotional regulation. I’m a heavy ruminator and pretty much suffered in silence most of my life, my inner dialog is much more organized and calm, and I can comb through my thoughts easier now.
P.S. I cannot recommend enough - check out “HealthyGamerGG” on YouTube. He does some deep dives on ADHD and other diagnoses. Classically trained psychiatrist with something like 5 years of training as a Buddhist monk. Very insightful guy who’s both data-driven and spiritual, helping a lot of people.
> I’m curious what your take is.
I'm not OP but that seems like a very respectable diagnostic track. No test is 100% reliable, so you'd want multiple tests. Even then the results can realistically only be interpreted by a psychologist that is familiar with your situation (hence the clinical interview). So this seems perfectly proper.
> Also the stimulant medication didn’t magically fix everything
Sadly there is no medication that fixes adhd. The only thing these medication does is make it easier to deal with by alleviating (some of) the symptoms. Personally I've noticed from my medication (methylphenidate) that it make it easier to stay focused on whatever task I'm doing, but if that happens to be scrolling reddit, I can still waste hours, perhaps even more since I would have otherwise distracted myself from reddit long before. So it's not perfect, but it does enable me to concentrate 8h+ at work, and that's ultimately the main benefit it brings me.
Be careful and approach `HealthyGamerGG` with a bit of healthy skepticism. I have benefited from a number of his videos, but recently small things have lead to me growing concerned that as his reach/influence grows, the same motivations that existed early on mutate as with many influencers. Not suggesting anything negative per se, just recommending a variety of sources and validating his claims. For another source, Dr. Barkley's videos are very good.
I’m going to say that as you perform more clinical tests typically your chances of a wrong diagnosis will decrease proportionally. However particularly in the case of ADHD tests, if you know the test questions and the symptom description I think you could cheat your way to a diagnosis. If you went to all of these tests in earnest, without looking them up, just providing spontaneous responses, and all of them come back positive, I’d say chances are you have ADHD.
So they got so bered in ADHD test that they hacked the whole website administering the test. They are truly one of us.
https://m.youtube.com/watch?v=W99n083E0IA&pp=ygUeZnJlYWtzIGd...
Yep, I was thinking that the results of the report might as well be irrelevant
I was researching this test yesterday for my own appointment and did not expect to see it on hacker news.
I am having a really difficult time finding a reputable psychiatrist to assess adult ADHD. I called 15 places and only heard back from one. I scheduled an appointment. They had 1/5 stars, gave me a 30 year old 1 page questionnaire, and asked to see my childhood report card. I did not see them again.
Yesterday I got a callback from an office offering this online test but nothing else? It all smells fishy.
Did anyone have to cross state lines to find a reputable psychiatrist?
I used my general physician. It may not be as high quality as a psych, but he determined the symptoms correlated with the diagnosis and the medicine has helped me immensely in my life.
My psychiatrist gave me some questionnaires (BECK Depression Inventory, THE BECK Anxiety Inventory) and gave me an IQ test (Wechsler Adult Intelligence Scale), she noted in her report the fact that I had a tendency to be restless, that I was distracted by the sound of the clock in her office ticking and that the IQ test scores were very lopsided with Processing Speed being much lower than everything else (and slightly lower working memory). Total test took 8 hours. I had abysmal results on the (Picture Completion) subtest.
> It all smells fishy
Because for some, an "ADHD" is like playing up a symptom to get "Medical Marijuana." It makes it hard to differentiate between people who have a legitimate need for treatment, and people who just want uppers. (There's a joke that if you want a prescription, just look for a 1-star doctor and make sure to accept the vaccinations so they can bill for more.)
Have you asked your general practitioner for help finding a psychiatrist?
I took a similar ADHD test. It seemed so easy and simple that I always wondered how it was actually supposed to catch me.
Good to know that neurotypical people mostly likely test differently than I did.
This was part of how my ADHD was diagnosed. I did a full day of testing at a specialist center. First I had a conversation with a nurse, then a psychologist, then they had me do a similar test (but in a controlled environment and I also had face tracking and a motion sensor monitoring my movement). After the test, I was given lunch and a dose of adhd medication and about an hour break, then they had me do the test again. After that I met with a psychiatrist who walked me through the test results. Then I had another break while the three specialists met to discuss my case and make a diagnosis. Finally I met with the three to hear the outcome (I was also given a full write-up of my results from the day).
My one surprise from this article is that "play a web game for 18 minutes" in an uncontrolled environment was considered enough testing for a diagnosis!
It's been a trip hearing how much testing others have gone through. IIRC, we had all of one conversation with our psychiatrist (albeit one we had already been seeing for a while) and got our diagnosis. But then it wasn't exactly subtle ADHD.
For our autism assessment a couple months ago, our therapist (whom we've been seeing for about a year at that point?) had us take one or two relatively short multiple choice assessments or the like and that was enough to diagnose us as on the spectrum. Did you know: Not all autistics struggle with eye contact? Some of us (ourselves included) are actually pretty good at it. One reason it's called a spectrum!
The previous time with our mental health professionals factored into their diagnoses, though, not just the tests. The takeaway: Book a therapist and psychiatrist both if you don't already and get those balls rolling.
I found myself trying to come up with a system that used the position of my hands to “solve” the problem for me.
But then I worried if my system worked, I would be misdiagnosed.
It didn’t work. I was 98th percentile.
Thanks for sharing this!
this sounds interesting! would love to hear more about this
I took a similar test but in person at an office a few years ago. Exact same layout, of "click when x appears, do nothing if not". It was only 25 minutes I believe but felt like an eternity. I had a 100% success rate and above average reaction speed, but I still "failed" because of my observed behavior as I was taking the test.
The proctor noted my restless legs, frequent posture shifts, and "tendancy to tap the table when not responding to the stimuli" (this was a strategy I had come up with to create something to do in response to "doing nothing", as it made a sort of rhythm that gave me something to do). I then realized that the test meant very little, but the proctor was watching and diagnosing me durng the test.
I did a similar test and it came back neurotypical.
Given the overlap between ADHD and video games, I'm not convinced of the accuracy. It felt like a lame rhythm minigame to me.
I don't think the research is solid, my guess is these tests are convenient for insurance and liability paperwork since stimulants are controlled substances.
hi! author here, please let me know if you have any questions :-)
Following through on the top comment, surely you realized when you decided to forgo the back half of the test that, had the program compensated for it, you were consciously leaning into the ADHD diagnosis, right?
Sure! However, I think at that point I just felt trapped and overwhelmed that I no longer cared about the test or its results.
Which is exactly how it manifests, at least for a lot of people. ADHD isn't just "I can't focus lol", it's "trying to focus feels like dragging myself through broken glass"
He says while commenting on HN as CI runs...
One of my kids got diagnosed with ADHD and autism/asperger. He can sit for hours reading IF IT IS INTERESTING. But homework? Impossible. Even if it's just reading a couple of pages of a book it's nearly impossible for him to do it and it takes so much energy and suffering to get through it.
Would you mind sharing the test platform?
Not OP but I think it is moxo.ai
Have you got some fancy scroll thing for your blog? Something in my brain is noticing that scrolling feels smoother than your average site, though maybe im crazy.
I do not! Other than when clicking a section from the table of contents. Is it distracting?
No questions, but feedback for you from an engineer in a similar situation (late diagnosis), make sure you go back and get them to check for every other thing under the sun. You really don't want to dive into the ADHD side and find out it was something else (other things can masquerade as ADHD), so a good neuropsychologist is critical. And "body medicine", too, for example adrenal disorders. It's worth being extremely thorough at this point - you're off the standard path, embrace it.
Also, congratulations, once you figure it out your life is going to change for the better in a way you can't currently understand (literally, lacking the brain regions and/or development for it, take it from me), but the process can kinda suck a lot, so stick with it, it's worth it in the end, wherever you end up.
I have a question (and please take it in jest)! In between buying a telescope, seeking out an opinion on ADHD, accidentally hacking an online test, and then blogging about it, how many things on your todo list(s) did you not do?
I actually wanted to make a YouTube video for this as well! I also have a few more web fingerprinting blog posts in the backlog T_T
Oh, that reminds me...
> At the end, she told me she would review my exam and have the results ready in a few days.
Yeah man I can go ahead and let you know early if you want.
This comment is so funny to me, because I imagine you being distracted to make the comment before making it to the end where the psych did indeed review the new results.
Well I only know that because I skipped to the end. Then, while scrolling up I realised I missed the whole side-quest about promising to not cheat the test again, taking the test again, but then "accidentally" finding an exploit the system, and then cheating the test again, but this time cheating even more to see the results.
Then, scrolling up more I see that this whole thing started with seeing stars and then buying a telescope on amazon (probably at 3am).
And here I am commenting on HN instead of replying to an email...
Brother the test is quick, easy, and painless, and the results can be lifechanging.
The other thing is, ADHD in my mind is really a syndrome that starts with a symptom - inattention - that can be caused by so, so many things.
I have both, because of course I do, I had a medical problem that exacerbated my ADHD to a significant, significant degree (it's amazing I was able to be a software engineer for so long without treatment). So don't just tunnel vision in... as we tend to be prone to do. Get the whole workup with an experienced clinician, it's so lifechanging it's hard to describe.
I want to add that the comment is also funny to me because it and the blog post are very relatable to me. I don't mean to dismiss it at all. It's really important to get a good diagnosis for anything like this and not dismiss it or lock into the wrong diagnosis because of your own tunnel vision.
You wrote "the test is quick, easy, and painless" but I also want to note that it's not always. Depending on your country, parents, specific doctor, etc it can be very difficult to get a proper diagnosis and help. In some places a big criteria is diagnosis during childhood so if you're 30 or 40 you might have no chance. Or a chance but it depends on your parents retroactively answering a questionnaire, or finding an old report card with the right words.
As you said it's life changing to get the right help and I encourage everyone to pursue this.
The thing is, the test is super quick and easy. And then they throw 50 procedurally complex and tedious tasks at someone who can definitionally not do that, and they know that. Kafkaesque.
Btw no criticism implied on my end, I'm just now constitutionally incapable of not telling people they should get screened. Hmmm I wonder why I have difficulty resisting that urge...
I think I get your point. It's cruel to require Kafkaesque testing and that just makes it not worth it try. But too simple of a test can also misdiagnose.
The chance to be diagnosed with an appropriate gate varies greatly based on where you live and which doctor you can see and more. It can be anything from a 5 minute conversation, to 6 months of inconvenience, to no chance of even existing in your lifetime, to suck it up and don't ask because your career will end.
Right let me be very explicit: TOVA or equivalent are basically "play video games for 10 minutes as a part of your diagnosis" like the OP, the kafkaesque part is getting the appointment, and getting them administered, getting the diagnosis confirmed, going through the records and getting the prescriptions, everything around it :) they're actually pretty sophisticated tests, despite their palatability - I think if they had better ones they'd obviously use them.
"Sorry the psych is no longer available today. your appointment has been moved to the next available booking in 9 months time"
Or even better, "We have one available psychologist and they kinda don't believe in ADHD, so they'll see you but not actually grade the test correctly, so you'll have to try again, and as a bonus get labeled medication seeking". Not my experience, but...
" diagnosis during childhood so if you're 30 or 40 you might have no chance "
Huh? You don't have to be tested as-a-child, you don't have to call up your fourth grade teacher. You can self report your subjective experience.
"Did you have these problems as a child? Have you always had trouble doing your homework? Did stressing out about homework enable you to do the homework?"
They ask the question a few different ways typically.
I get it, perhaps it is different in your area, but I get the impression that an adult ADHD diagnosis is far from impossible.
In some countries it's almost impossible (I don't have any direct experience but I've heard tale that in e.g. aus/nz, east asia, south asia, etc people give up before getting diagnosed often), and my understanding is that in Europe it's virtually unheard of to have an adult diagnosis.
In the US, at least, it ranges from difficult to straightforward, but that's not true everywhere
In NZ it's easy, and some GPs can do it as of earlier this year.
IDK I'm just going by a friend moving there and not being able to get any of her existing medication prescribed, even though she's been diagnosed for literally 40 years.
Europe here. I have several friends that got diagnosed with ADHD as adults.
If you try to do it through the public system it's very difficult to even get an appointment because there's months long waiting lists. Basically if you have a job and function somewhat OK in normal life you won't be diagnosed in the public system. If you do get through it can be a long process where they want to interview your parents etc to determine if you had symptoms as a child. But you can also get a diagnosis through private practitioners and some of them function almost like diagnosis mills. A couple of video interviews and tests and you are done.
> ... my understanding is that in Europe it's virtually unheard of to have an adult diagnosis.
Can't speak for the whole of the continent but UK here and I got my ADHD diagnosis a few years shy of 50 years old. Wasn't tricky at all, just a long-ish (8 month) wait for a non-private diagnosis (not full NHS but via an outsourced provider via Right-To-Choose).
When going through the DSM-5 questions (during an ~80 minute interview) I was asked to give examples from both current life experience and from childhood, and that was enough.
Honestly it's really gratifying to hear that people around the world are getting the help they deserve, thanks for sharing.
Only recently in aus did an adult diagnosis get support from the government PBS scheme. And even then it's because they're letting retroactive childhood diagnoses be considered for the subsidised medication options.
As I said getting a diagnosis varies by region and doctor. A lot. It's practically impossible in some countries. And also depending on region or personal circumstances, it may not be easy to find another doctor or psychiatrist. Also note that in many countries, only a psychiatrist can diagnose it. Even if diagnosed, you might live in a region where most medicine for ADHD is illegal or have a doctor that won't prescribe them. If you just get disbelief after 6 months of waiting, and after another 6 months just get told stimulants are bad, you might give up.
If you search (eg reddit) for ADHD adult diagnosis, it is filled with horror stories. There's even lots of posts of people diagnosed and medicated for 20+ years that move to another country and can't get a prescription. Or you get a prescription, but the pharmacy won't dispense it or insurance won't pay for it. A typical post on these topics also has one or more people responding "I'm in the same place and it was easy" but also has one or more people responding "I'm in the same place and I tried for 3 years before giving up". By the way, it's also common for women to have more trouble getting a diagnosis compared to male siblings and friends with the same symptoms.
Why is it so life changing to get help? What kind of help is there besides meds?
If you pair meds with therapy and adjusting your life according to the things you learn about yourself through the lens of the diagnosis your quality of life can increase dramatically (at least it did for me).
Therapy, which (at least for me) has focused dually on adhd management strategies that can be very helpful (including, in particular, enhancing relevant social skills related to setting expectations and boundaries) and on identifying and modifying negative self-image issues and counterproductive learned behaviors (e.g. various forms of self-directed hostility that attempt to assert control over a neurophysiological issue).
It’s funny, I went to therapy a lot of times before I found someone I could stick with, and if I were to give my past self a list of what I’ve gotten from therapy, I think I would’ve been unimpressed. Nevertheless, I’ve noticed that I’m more confident and calmer, and it has definitely improved my relationships.
There’s a kind of virtuous cycle that happens where you replace a grumpy mindset where you’re always mad at yourself for not meeting other peoples’ expectations and always mad at other people for making your life hard, with a confident mindset where you understand yourself, are therefore comfortable relating to other people about your abilities and needs, and can focus on putting yourself in situations where you’ll be successful.
lol, we’re all writing the same thing. I’ll give you one example, because I particularly liked it. My therapist always talks about separating people from problems, and I never had any idea wtf he was talking about. And then he gave me this exercise where he was like, “let’s construct a narrative where this person’s eccentric personality makes them really good at something specific. Where would you expect a person like that to encounter friction and how would you manage it?”
It was sort of fun, we talked about how Arthur Schawlow (who co-invented the laser and won the Nobel prize) was banned from driving on Stanford campus and had to be chauffeured. And I finally understood what he was talking about; you can access this perspective for anybody by constructing such a narrative. What if everybody’s a misunderstood genius at something? Why not? How would you live in such a world? One insight among many.
I had to come back and comment because your "misunderstood genius" really resonated with me.
It's even beyond that, in my opinion. What if everyone had perfect health, physically and mentally, and had been educated to the absolutely top tier of their ability to accept? Perfect, individual tutoring? Excellent nutrition?
How much better off would the world be if we framed everything in terms of helping everyone be their best, every day, in every way? How much of the trouble in the world is the result of just... accidental awfulness, that we collectively could just choose to stop?
It makes me very sad that we live in a world where potential Nobel winners are dying of easily preventable causes, or working dead-end jobs.
Imagine you spent your whole life crawling, and someone taught you to walk, but for your brain. It's hard to describe.
The medication unlocks your ability to learn the skills you need to cope with the problems you have, and therapy gives you the outside feedback you need to escape your own brain trying its hardest to mess things up and hide the mess.
Imagine if every 10 seconds this guy was in your body taking over your hands for a second or two: https://www.youtube.com/watch?v=GguQu5Iderg
I will say how it was life-changing for me getting diagnosed as 39M.
The quick answer:
Understanding neurobiology and the meta-cognition about the why of certain behavioural patterns and experiences is extremely helpful to just calm down and "forgive" myself, and not judge myself so harshly. It's as if I can optimise my life by leaning on my strengths and importantly recognising and dealing with my weaknesses. Just the awareness lets me catch myself getting into patterns, and act on them sometimes, and just let myself be the other times without any guilt. This insight brings peace more than you think. I can now organise my inner dialog and enjoy the diverse thoughts while also being aware of my impact on people in my life.
I was skeptical of the meds myself. I spoke with about 20 people through AHD support groups and group sessions. The drugs are mostly a trial and error affair with side-effects and altered behaviour. My subtle lifestyle changes - keeping one true todo list, always logging down my thoughts and taking comfort in the fact that they are jotted down so that I dont have to keep going down that thought and actually get up and go catch the train etc already gave me the biggest benefits. Then I wanted to see for myself what the drugs could actually do. At the end of it I may choose to take them or not. After 8 months of slow analytical trial and error with a very helpful psychiatrist who understood where I am coming from, I now take a very small dose of Elvanse(Vyvanse) + Guanfacine on some days of the week where I feel like I could use the help. They are not life-changing. They nudge me into being more capable of being me. My wife can notice the regulation the drugs let me have - A win for me. My kid has a better relationship with me than before - A win for me. Could I do without? Sure. But, I choose to have that little support to manage myself to get to who I want to be around my family without losing who I am. To each their own.
Longer background:
Despite reading about and knowing the symptoms of ADHD, and being told by a professional 10 years ago that I should consider getting formally diagnosed, I thought to myself - "Hey, I am smart. I feel happy and satisfied. I dont have any problem. I'm good as I am. I dont need to do anything about it." and promptly kept sweeping any thoughts about it under the proverbial rug.
Until, I started seeing my son develop in front of me. Seeing all those symptoms - impulsivity, hyper-focus on few things and inattentive to most others, emotional regulation issues, extreme reasoning abilities in some areas while being "immature" in other areas. This was me growing up. Being smart and intelligent, but longing to fit in, struggling to deal with the mundane. So, I decided to get diagnosed properly. Basically, I could hide behind my smartness and the ability to manage my symptoms until it just myself in my life, and then my wife, and then my son, but when the second one came along, I couldn't manage anymore and the overwhelm started to show the real patterns.
It takes courage to be honest and vulnerable.
I know this is a joke, but I'd be careful about assuming: I had a trained therapist diagnose me with ADHD ... incorrectly.
It turns out, there are other conditions out there that can appear to be be ADHD. If a trained therapist can confuse them, outside observers certainly can too, so it is possible that "very ADHD-acting" person you know might not have it.
(Or, especially for females, the reverse can be true, as not everyone with ADHD manifests with the same trademark hyperactivity.)
I understand this is your personal medical info, but could you drop any hints as to the nature of the misdiagnosis? I've learned late in life that I am neurospicy and learning from other's experiences in this domain has been quite helpful.
I listen to a lot of psychiatry podcasts, and they generally think that ADHD is being seriously overdiagnosed at this point.
Executive dysfunction, especially that which was not impairing as a child, has a lot of potential causes. Anxiety, depression (yes, ADHD can cause these, but these can also cause executive dysfunction in people without ADHD), OCD, Bipolar (manic people in particular often attribute worsening of hyperactivity and distractability to ADHD instead of mania), Schizophrenia pretty much universally is related to cognitive symptoms and lowered motivation even when not psychotic, and borderline personality disorder can cause changes in interests and identity.
For many of these conditions, stimulants can act as a band aid on something else. It can superficially make people feel better (of course, it's speed), but it can distract from other symptoms that are impairing functioning, and prevent people from seeking long term solutions.
I can roll with that. I do have executive dysfunction and other "fun" facets of a funky neurobiology. I also recognize that every body and mind is different and it's a personal journey to find the right tools.
I recognize that non-medical options should always be front line approaches but there can be a chicken and egg effect as to making that happen.
In my youth I adhered to a "better living through chemistry (wink wink)", I do now too (rip Mitch Hedburg) but the wink wink part is very rare and disciplined and now it's all about pharma and supplements to wring what I can out of what I've got left.
On the non-medical options front, I will note that my lifelong hyperactive and neurotic tendencies dramatically improve with a 3-4 day a week distance running training regimen. I enjoy running enough, even though it is very difficult, that I've kept up with it for several years. I'm not as consistent about this, but I also found yoga classes to be a way to make mindfulness fun and easier.
That's not to say I'm not on the medication train (despite moaning about medications a lot). I do personally avoid taking any controlled substances. This is easy because I hate how stimulants make me feel, but in general I worry about the effects of having a direct reward signal from taking a pill.
Exercise is one hell of a drug, to be honest. I suppose you shouldn't exercise for a few issues in particular, but in general, boy.
Jumping on this conversation a bit: I was recently diagnosed and am still very much in the "what helps?" and "what parts of my personality/habits are connected to this and which aren't?" stage. Do either of you by any chance know a healthy online space to discuss this with others?
I found Finally Focused by James Greenblatt to be quite helpful. He makes sure key minerals and vitamins are in a good range before prescribing stimulants.
This sometimes solves the problem by itself, or it reduces the levels of stimulants needed.
I would recommend avoiding any subreddit related to ADHD.
I honestly would try to stick to materials written by mental health professionals and possibly talking to a therapist (your company might have an EAP that can help with this) over interacting with any online community I'm aware of on this matter.
I find online mental health communities tend to be "if I have a hammer, everything is a nail," and aren't open to other explanations for any traits or struggles. They also tend to suck in the people who aren't doing better with treatment, while the people who found systems that work for them leave for greener pastures. On the opposite side there are communities that are anti-psychiatry and refuse to consider medical treatments. In general these spaces tend to be very black and white.
I do like the Astral Codex Ten open threads as a space that's relatively neutral on the topic, though they lean very biohacker in a way that gets ahead of the science.
I wish I could run. I recognize that exercise is a foundational facet of health all the way around. I'm "blessed" with enough comorbidities that make that a challenge but I am going to get a personal trainer to help me work through that.
Good idea. Feel free to try different options until you find something that you genuinely want to stick with. Running is just what I like, but my understanding of the current research is that it's more important to do something you actually want to do consistently for years than to do the ideal workout for 6 months and then quit exercising entirely.
People are way too happy when they find out that the treatment is taking speed every day for their whole life, as if this isn't going to take its toll on the body and that the brain is not going to adapt to this.
Differentials for ADHD include: panic disorder, metabolic issues, anxiety disorder, depression, adrenal disorders including deficiency and excess like pheochromocytoma, bipolar, autism, learning disorders, personality disorders like borderline and antisocial, OCD, trauma including PTSD and CPTSD, sleep disorders including narcolepsy, sleep apnea, restless leg syndrome, insomnia, ironically substance use disorder like cocaine and amphetamine addiction, thyroid issues again ironically including both hypo and hyperthyroid, seizures, hearing and vision issues, and life stressors.
So, uh, ... a whole textbook. And I probably forgot some.
It was originally called ADD. Then they forced the H in there for hyperactivity. And now they say there is non-hyperactive ADHD, but... they don't call it ADD.
So the first rule of getting attention for your paper is to re-define common terms...
The origin of ADD as a diagnosis is the DSM-III (1980), which calls it "attention-deficit disorder with or without hyperactivity". Do better.
The word you are looking for is Inattentive - when diagnosed they should state whether the diagnosis presents as Predominantly Inattentive, Predominantly Hyperactive/Impulsive, or Combination.
I feel like I would have been a different person if I was diagnosed. Probably finished my physics/aero degree. But idk... I would buy it and it was fun to do recreationally which supposedly means you don't have ADHD. Anyway I ended up not finishing school but I got lucky that I still became an SWE.
People would say "just ask for it" but I remember having to try and do these tests like look at these abstract shapes and what not. It was multiple sessions I eventually ran out of insurance so yeah I just abandoned it. I don't like the side effect of shrinkage down there when you're on uppers.
> I would buy it and it was fun to do recreationally which supposedly means you don't have ADHD.
That’s something some people with ADHD need to hear to be ok with taking what is a powerful drug. A comorbidity of ADHD is substance abuse, and stimulants are very rewarding neuobiologically speaking (because they, especially amphetamine, promote dopamine release and persistence in the reward areas near the brainstem, as opposed to non-stimulants like Strattera which does effect dopamine reuptake but only in the prefrontal cortex, the primary area of impairment in ADHD [it does this by exploiting the fact that the NET is used for Dopamine reuptake exclusively in the PFC]), especially when treated like a recreational substance to be taken freely in a dose designed to be fun.
There is a lot of variety in people with ADHD, but I think that perception is more due to how the drugs work when taken medicinally vs recreationally and individual propensity for abuse.
I remember finding a test online for "left-right blindness" that had a similar kinda busted vibe. It was literally something where you look at arrows going up/down/left/right and you have to press a thing to match it.
I wish I could find it again and run it across some cohorts, because it was quite fascinating to feel my brain suffer more on the horizontal arrows.
Am I risking any trouble if I were to open source this test? Based on this writeup?
These platforms are often just digitising a test that is already open access. I think this one is https://pmc.ncbi.nlm.nih.gov/articles/PMC11546344/
https://embrace-autism.com/autism-tests/ also implements a bunch of open access tests.
I find really interesting the description of the ADHD assessments, both on the post and on the comments. It seems like everyone had one or two tests plus some interview at most.
My diagnosis came after I had multiple tests and interviews in a 2 month period, including interviews with my mother and my partner. Sure I was also diagnosed with autism, but the final report given to me was so complete and descriptive of my pains, symptoms and the impact on my day-to-day functioning that it just couldn't be made with a single interview.
Opening up devtools during ADHD test is so ADHD, almost as if he didn't even need the psychiatrist to explain the results :D
I didn't think of this until after haha
That was my first thought. I only wish my type was to put in the work for a blog post instead of just thinking on it and getting overwhelmed with all I need to get done.
Trust, this blog post was in the works for weeks and was actually supposed to have a YouTube video accompanying it that I never finished T_T
That doesn't have to be ADHD, could be the *tism too. The tells are usually somewhat overlapping.
In general, if you are in the industry, save yourself (and your kids) some trouble and get diagnosed before it becomes a problem.
Add: I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
> Add: I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
I have been screened a few times for ADHD and each time was found to obviously have it.
Ritalin does not make me feel calmer. I have been told by those close to me that there are externally visible improvements in my behavior. At doses to reach that effect, it also impacts my sleep quality enough that I don't take it.
Adderall causes mild symptoms of psychosis and mania before it has any theraputic effect.
Dexmethylphenidate (aka Focalin) has identical theraputic effects to ritalin, but slightly reduced side-effects.
I'm still on my journey of finding meds (and dosages) that work but I would highly recommend for anyone who has a inattentive scatterbrain to try lis/dexamphetamine.
Methylphenidates can be quite numbing (zombifying) in my group of ADHD friends but dex seems to have a more consistenly helpful effect. The unfortunate caveat for me is that I personally seem predisposed to pelvic floor/urinary issues, which you'll find anecdotal evidence of being exacerbated by amphetamines (research seems yet to catch up), but aside from that the theraputic effects, particularly in emotional regulation seem so far unmatched.
It's unfortunate we have such a tentative model of how our body and, particularly, our minds work so drug treatments often require a trial and error process.
I have exactly the same problem with pelvic floor and urinary issues when I take adderall, although with continued use and PF therapy it's gotten moderately better (and my dr and I decided that the benefits outweighed the risks and issues).
I found methylphenidate-based drugs to be useless after a few days.
Have you tried pure lis or dexamphetamine? I know dex can be prescribed without the mixture, maybe lis can too. I keep meaning to ask my doctor about it.
The other issue I find is tolerance, though even with this I'm still far more focused than when I'm not taking adderall. It really is amazing how much better it makes me feel. I find no problem with addiction whatsoever -- if I forget to take it, then I just have full blown ADHD, but I'm no worse off. I also find it's more effective if I minimize coffee, but I haven't yet cut coffee entirely. (I find caffeine is vastly more addictive than amphetamines.)
I'm nearing my 40s. In my mid-twenties I was diagnosed and over the next couple of years tried all of the usual ADHD meds and none of them were short of terrible in regard to side effects. I guess I've just learned to live with it in a way that outweighs the side effects I get from the drugs.
I was diagnosed with Shiftwork Disorder at one point in time and was prescribed Modafinil and it was incredible for the most part and had zero side-effects, but my doctor wont prescribe it for ADHD. One down-side to Modafinil is that I could get stuck on an unproductive task and would realize in hindsight that I had just been hyper-attentative to this unimportant task for hours.
Studies show Modafinil isn't effective in ADHD adults. It may have benefit in children with ADHD.
I think many prescribers give ADHD adults a high dose too soon causing side-effects. In my experience, it's best to start with a low dose and slowly increase as necessary. The myth is ADHD responds quickly, but observing hundreds of patients it takes months, not days, for benefit of treatment to develop. There's wisdom in the phrase, "start low and go slow".
Yep. What you find often is that the drug is effective right away, at a 20-30-40% effectiveness level. But over time you learn to take advantage of the benefits more effectively, and get more used to the side effects, so it tends to increase significantly in effectiveness at the same dose over 6-8 weeks much like SSRIs, not because the effects last that long, but because you use the tools to improve the tools.
Have you gone down the rabbit hole of non stimulants?
I have had bad reactions to every stimulant I tried since I developed bipolar 1 in my late teens (had taken them as a child for ADHD).
I had a good response to strattera, but there's a variety of them out there.
I had terrible brain zaps on Strattera and didn't notice anything at all in regard to benefits. Probably because I just could not get through taking it long enough.
> it also impacts my sleep quality enough that I don't take it.
Yeah, it's basically why I don't bother with it. I know it works, but trading one set of problems that I know how deal with for a different set of problems that needs more meds isn't appealing at all.
I had a doc that prescribed me amphetamine. It was glorious for work, being in one of those horrendous open table environments with only a screen in front of you to keep from staring at the person directly across.
I was able to laser focus and jam through things but the side effects were not worth it and I backed off. I've yet to find a magic pill that does that without the side effects.
PSA: depending on your specific needs, guanfacine can be close. Once you get used to it, it can be just... constant +1 to wisdom.
Thank you! It seems worthy of pursuit -- gonna bring that up with my doc.
I have similar stimulant intolerance since I developed bipolar 1 in my late teens (had been diagnosed with ADHD at 7). I was off ADHD meds for several years, and have now tried a few of the nonstimulants.
Strattera was subtle, but I had clearly improved feedback at work, a cleaner apartment, and no side effects.
Qelbree caused a lot of nausea.
Intuniv caused lightheadedness and got me an unnecessary cardiac workup.
Wellbutrin doesn't have as much ADHD efficacy as Strattera (my doc won't let me take both at the same time), but it improved my seasonal depression and motivation significantly. I had some irritability for the first few days after a dose increase, but otherwise the only side effect is reduced hunger and I also stopped asking people for cigarettes or zyns when I'm drunk.
That’s basically how the end of my diagnosis went because aspects of my results were borderline, so she suggested that I just try meds to see. But keep in mind that only one type of ADHD involves being hyper. Some of us are inattentive types where our brain feels like an old 70s pony car engine, and if you pull up to a stoplight you need to keep the motor revving or it will stall. Taking Ritalin for us is the equivalent of keeping the revs up.
Great simile. That really is how it feels.
If you're borderline, talk to the doc about a trial of guanfacine. (note that some people HATE it, for exactly this reason) It's the opposite - if your engine is always redlining, it sets a rate limiter and gives you the chance to look out the window and enjoy the scenery, metaphorically.
And in the most interesting cases, you can find a lot of value in both - stimulants keeps you going, guanfacine gives you perspective and the ability to unclench.
As an ADHD person who was already planning to ask my psychiatrist if we can try different medication at my next appointment, thank you very much! That description sounds exactly like what I want to achieve.
I cannot overstate the degree to which it has been lifechanging, after years of trials of various other things. Honestly it was overwhelming - like a months-long mild psychedelic trip. I never want to go back. I am much, much less of an asshole now, and I say that advisedly. (note: lower assholery indicates nothing in absolute terms - I am probably still quite a bit of one. But less! and gratefully, joyfully so.)
Edit: And this is me trying to restrain myself so I don't look like someone starting a cult...
This is the case for me. I finally got diagnosed last year and prescribed Ritalin this year, and it has been transformative in aiding me in getting out of ruts/stalls.
> ... I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
In ADHD (and most conditions) diagnosis by medication response is not acceptable. Response to drugs is highly variable and fails criteria for acceptable tests. Also drugs can produce side-effects. According to professional standards, it's unethical to expose people to nontrivial risks without good cause.
So this is the cheats with "give everyone ritalin and see how they feel" - it works for most neurotypical folks too. It's just a very small increase compared to the annoyance and side effects, so it's usually not worth it. To extend the car analogy from a sibling comment, putting race fuel in a volvo.
So they can't test by response, because everyone would be like "yeah I can focus better", you have to test with the drug on, and the drug off, to see whether the "horsepower increase" is worth the fuel price. Increasingly strained metaphors are my strength.
Yeah it feels like the diagnosis itself is useless, compared to just straight up trying some of those drugs and see how much you feel better. If none works, then no use in diagnosis.
Still waiting on reverse engineering tiktok vm part 2
https://nullpt.rs/reverse-engineering-tiktok-vm-1
> This performance pattern^H^H^H^H^H^H BLOG POST may indicate attentional difficulties, and taken together with other findings, an increased likelihood for the existence of ADHD.
This is basically what I did to every online based quiz in school. Big respect lol.
this method works more often than not :P
The biggest risk for ADHD treatment is that most diagnosed people are told: "you brain doesn't make enough dopamine" which makes it feel safe for you and why they say non-ADHD people cannot take it.
But for your specific brain it does make enough and it will fight to maintain that via homeostasis (usually by creating more dopamine vacuums/re-uptakes that stick around a long time...there is good science on this).
So you become dependent on the medication and tolerance can occur making your situation worse than it was in the end.
ADHD-as-a-diagnosis is just a clever way to make the government okay with prescribing stimulant medication to "people who it can help" and having someone safely monitor its usage, and to assure the government that we won't end up with too large of percentage of the population taking it.
Don't know what conspiracy theory are u in but I forgot taking my meds this morning and forgot it a couple times every month. I hope I am addicted to it so I don't forget
For real. I bet the people showing up every 90 days on the dot are the easiest addicts/scammers to detect.
"people who it can help"
This is just my story but before ADHD diagnosis and medication I was unemployed, on food stamps, in an abusive relationship, and struggling with alcoholism. After taking medication for a couple years I'm in a healthy relationship, making good money in a stable job, and on the wagon. The medication prescribed helped so much with my impulse control issues that it literally changed my life.
Not going to get into a back/forth due to the pseudo-conspiracy end, just stating that this is significantly inaccurate.
Those are some possible outcomes, yes, but it is not a black/white thing, and that is actually WHY it's important to work with a qualified doctor to monitor medication, effects, dosage and so on, and make adjustments as necessary.
Different medications work very differently as it relates to dopamine, uptake, production, etc. And there are also non-stimulant medications that may be effective for some folks.
Amphetamine used to be legal.
As an example, President JFK received regular injections containing high doses of amphetamines from his personal physician.
Then the risk of abuse and side-effects in the population were observed and it was banned.
Did JFK have ADHD? No, it just helped him with energy levels. Like it would anyone.
There are no conclusive bio-markers for ADHD. Therefore its not possible to say who doesn't have it and should not get stimulant medication.
The only commonality is that there is an impairment. It's not possible to say: this person has difficulty focusing and has ADHD but this person has difficulty focusing but doesn't have ADHD.
The board of psychiatrists who decide what symptoms constitute it just essentially make it up.
The only thing that is real and measurable is the level of impairment to someone's life.
Stimulant medications works, but it would work for anyone regardless of an ADHD cause. ADHD is like a catch-all for people who can't focus that doesn't match any other condition that could be resolved differently.
Stimulant medication definitely carries risks and health impacts. This is black and white.
You seem to have your mind made up, so just gonna say that for anyone else reading this, this is not accurate or scientific information. Lacks an understanding of how the medication works, the differences in kinds of medications. The fact it used to be legal is not relevant. Misrepresents how ADHD is diagnosed, the criteria for it (by professionals), and even to a lesser extent the biomarkers statement.
Everything I have said is explained with citations here: https://pmc.ncbi.nlm.nih.gov/articles/PMC9189308/
I skimmed over that paper, and may do a deeper dive later, although doesn't really seem worth it. I thought it was going to be a scientific study, but it reads more like a essay from two authors with a specific viewpoint trying to convince others, via slanted/biased text, that other text and language is baising an entire industry and population? I find that questionable at best.
And while the authors made a lot of claims, and cited some other studies, they don't really, IMO, prove their point in any scientifically valid way, or even as a solid, well-formed argument. Add in that the authors are sociologists, not neuroscientists or psychiatrists/psychologists, and it makes me question both their claims and understanding of the topic.
I did catch that one of their main points (that you mentioned as well) boils down to not having a physical test or clear biomarker. But that applies to nearly all psychiatric conditions. Saying the absence of those kinds of tests is the same as the absence of a real condition ignores the research that has been done demonstrating functional impairment (including twin studies, some indications of genetic heritability). The paper presents a specific sociological viewpoint, and that isn't the current scientific consensus.
Like I said, probably not gonna convince you, just dropping this for others that might see the essay link and think it might actually provide validity when it does not. That essay does not really make significant arguments against ADHD.
It does present good warnings to be aware of pressures that would distort diagnosis and I do think there is good reason to be cautious about over diagnosing, or diagnosing by unqualified personnel, both of which do happen of course. But the article goes too far beyond that.
Because others can say this much better and with better sources and citation than I can, both directly address many of the criticisms made in the essay shared and the faulty reasoning based on it.
International Consensus Statement on ADHD: https://www.russellbarkley.org/factsheets/Consensus2002.pdf
The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder: https://pubmed.ncbi.nlm.nih.gov/33549739/
I would've liked to read the article but I got distracted.
I like how this can be summarized as a person taking part in an ADHD test before getting off-track and overanalyzing the task without actually doing it.
Good test, though—very effective.
Reminds me of one of the first video games to get FDA approval as a medical device. EndeavorRx I believe it's called. You have to keep the character moving down the path while not paying attention to all the shit the game produces to distract you.
https://www.endeavorrx.com/
seems like lack of focus to me. doesn't mean you have a medical condition.
"Seems like you have a lack of control over when you pee your pants to me. Doesn't mean you have a medical condition."
In the past few years the internet have been busy trying to attribute completely normal human quirks to ADHD, ADD and various levels of autism. We see these "Only people with X will understand this" and it's something stupid like forgetting why you entered a room. I don't know if neurodivergent people increasingly seeks out online "forums" like Reddit and Imgur, but they seem to be populated entirely by people with ADD, autism and depression (and Furries, but that feels less problematic). All are on a mission to convince anyone who stumble into their realm that they too have a disorder.
Understandably people want to help when they see someone struggling with the same things they did, and I'm not suggesting that you don't seek out professionals if you think you might have a disorder, but we need to stop labeling completely normal behaviour as problematic.
Just like people without various disorders can't relate well to those with e.g. ADHD, people with the these disorders also understand neurotypical behaviour way less than they think they do. A large number seems to struggle with separating "normal" quirks of the brains and their diagnoses.
Pre-taking medication, here's what my personal experience trying to focusing looks like:
I have some really interesting, but lengthy text that's really important for me to read for class. No cell phone, cleaned my room, put on specialized focus music, jot down all my random thoughts on a notepad, got myself a cup of coffee and made sure I eliminated all distractions.
I then proceed to read the first two or three sentences before I realized I have been mindlessly scanning the text with my eyes like I'm reading, but instead I am doing the equivalent of watching a movie. I'm 100% zoned out and in la la land.
I realize this, so I stop, refocus, repeat. I realize I did it again, stop, refocus and try reading out loud. I'm annoyed because I'm saying the words out loud but not comprehending it.
I meditate for 30 seconds to calm my mind, try to refocus and repeat. I finally get through it after about 30 minutes.
Here's how my personal experience looks with medication:
I pick up the damn paper, read it and summarize it with notes in 5 minutes.
Correct. People with focus issues do not necessarily have ADHD. That requires meeting a defined set of diagnostic criteria, including that it has an impairing effect on an individual's life.
Also, just because it seems like a simple lack of focus to you externally, that does not mean the person does not have a disorder.
What a lovely mini journey. Turns something possibly stressful into something weird and fun.
There's a well-known issue of "construct validity" in neuroscience.
Oh hilarious and well done Null ptrs.
And brilliant picture.
"ADHD" is really having a moment, isn't it.
This article itself seems to scream ADHD.
But also seems very much like a software dev, so does seem to reinforce the stereo type.
Ahahah the end got me laughing