[prometheus76]

It's the classic situation of someone without ADHD telling us "just focus!" or "you just need to write things down!" or "you're just lazy".

I have ADHD, and I also do not have a sense of smell (lost it in a TBI when I was a teenager). I tell people, "you take for granted what it's like to have a sense of smell. It affects every moment of your day, catching your interest and directing your attention all the time. Imagine not having a sense of smell. Imagine not smelling dinner or smelling your wife or smelling your baby. Imagine not smelling flowers or not smelling a gas leak. So much of what you take for granted comes from your sense of smell. Having ADHD is like that. You take executive function for granted, and can't imagine what it's like to not have that. When you say 'just write things down!' it's like saying 'just smell harder!'"

[bookofjoe]

Memories of my ex-wife admonishing me, while in the throes of a deep, disabling episode of clinical depression, to "Snap out of it!"

[bloopernova]

I'm sorry that happened to you. The phrase that made my then wife an ex-wife for me was "you're not supposed to be fixing yourself you're supposed to be fixing our marriage!"

Led me (with therapy and time) to realize what I meant to her; I was an accessory.

[camillomiller]

Oh wow, glad for you she’s ex now

[brnt]

Wut, wild for her to not see how those two are so interlinked that separating them is considered old fashioned nowadays by therapists.

[d0100]

Ironically, "snapping out of it" is the best way I can deal with it

No other reasoning with myself works better than just "snapping out"

[adadadadadad]

“Today is the day” and sometimes it just is.

It’s nice to tell yourself a story as to why this is the ideal moment to have a reset.

[Swizec]

The thing that worked for me was getting so bored of being depressed that one day my mind went “Okay fine, you’re right, nothing matters. If nothing matters, then me feeling this way doesn’t matter either. I’ll just go do the things regardless of how I feel”

Been 20 years now. Works fine. The depression has been starved of attention, only comes back when I’m hungry.

[adadadadadad]

Sounds like the latter...

> Nihilism is often associated with feelings of despair, pessimism, and apathy, as it challenges traditional beliefs and values. However, some argue that it can also lead to a sense of freedom and liberation, as it allows individuals to create their own meaning and values without being bound by pre-existing structures.

It is counter-intuitive to the traditional: find meaning and purpose dogma.

[Swizec]

Years later, I read Viktor Frankl and his approach really resonated with me. He adds the nuance that you need meaning, but you can create your own out of anything.

[bookofjoe]

Yes. Being depressed is SO boring. So is being in a psychiatric hospital because of deep depression (I've done that twice, in 1977 after a near-miss suicide attempt (pills) and in 1991 when I became anxiously non-functional and frightened).

Though I've never been in jail or prison, I suspect boredom is a dominant condition there too.

[selcuka]

Sure, but that's something that only works when you say it to yourself and believe that it will work. It worsens the situation when it comes from someone else.

[verisimi]

"Snap out of it!"

lol

Sorry. I actually relate to this!

[Arrath]

Same. And all the comparisons akin to "Hey what are you sad about? You don't live in a third world country struggling from meal to meal!"

Very helpful, thank you.

[darkwater]

I'm not a medical expert or anything but I guess there is a good chunk of population who just procrastinates or can struggle with focus without having ADHD? Or is there always a 1:1 relationship?

[snazz]

A lot of people (myself included) procrastinate on something because it's emotionally uncomfortable, without necessarily having ADHD. For example, when I was much younger, I'd procrastinate on math homework specifically, not because I struggled with focus, but because it was difficult to admit to myself that I didn't know how to do it and would need to practice. Subjects that came more naturally to me (English, science) didn't give me a "fear of failure" response in the same way.

[equalsione]

Growing up, my parents didn't have encouragement or patience in their emotional toolkit. You were expected to do everything perfectly - homework, writing a letter, any kind of planning, even sweeping the floor or washing dishes - and if you struggled in any way you were berated at length.

Many decades later even mundane things can be a battle - ringing a doctor to ask for an appointment, or a provider to query a bill, filling in forms and so on. Most of my procrastination stems from my experiences back them. It is easier in my mind to defer action than to risk the imagined verbal abuse. I'd imagine a fair share of non-ADHD related organisational issues can be traced to similar experiences.

Just like you can't out-train a bad diet, you can't out-live a shitty childhood.

[haswell]

Really sorry you went through this. Your experience reminds me of mine, which left me to contend with a lifetime of challenges.

> Just like you can't out-train a bad diet, you can't out-live a shitty childhood.

I think I’d challenge this slightly. Out training a bad diet probably doesn’t work, but is better than a bad diet with no training. And when you fix your diet, the training can start working wonders.

My childhood left deep and unhealthy imprints, but I’m no longer in that environment. I think you can out-live a shitty childhood, by changing your diet so to speak. This is grueling work, painful, slow, and often frustrating. But replacing old patterns can really transform living in the same way changing a bad diet can transform the process of training.

Over time I’ve come to believe strongly that the only thing harder than dealing with the past is not dealing with it. And over time, this gradually transforms the present. I very much prefer the late 30s version of me to all of the preceding iterations.

Best of luck on your own journey. Send me an email if you ever want to chat. (Not selling anything, just someone who cares about this topic a lot).

[StefanBatory]

That is something I share too, I had similar experience.

Faced with hard task, I ended up not even trying - penalty for failure was the same as one for not doing something.

[adadadadadad]

That sums up a lot of workplace disfunction. Proactively pushing new ideas and then getting blamed for failure, not applauded for them attempt. It’s why corporates can’t innovate internally.

[haswell]

The book "Learned Optimism" was a life changing read for me coming from this kind of background. It includes exercises that start to rewire your brain. Highly recommended.

[StefanBatory]

Thanks, I'll check it out.

[T_MacThrowFace]

But with the upside that it is technically unknown whether or not you actually could have pulled it off if you tried, and if every once in a while you manage to perform the impossible, that covers for 100 failures.

People who don't care about their children don't care about this, of course. You have failed them simply by being a child.

"Why didn't you just have better parents you stupid little brat, didn't anybody teach you anything you absolute dumbass lazy #%!£ moron?"

"I'm sorry, mom"

[StefanBatory]

It did mess up with my ego heavily. Because once in a while I would actually manage to push through anxiety and do something, and I'd succeed.

Unfortunately it made me quite narcistic, as I ended up with belief that I could always succeed, if only I gave in some effort - but as I never tried to do that in practice, I ended up at the top of Dunning-Kruger curve. High ego, no skills.

[helboi4]

How do you overcome this? I've avoided things due to emotional discomfort my whole life and I don't think I can ever do better at this point. I find that it requires conscious effort to learn to do things that are required as standard for most adults.

[snazz]

With math specifically I had a good teacher in high school who made us practice in class together. He'd get everyone to sit around a table and he'd give handheld whiteboards to every fourth or fifth person (depending on the number of basic steps in the problem), and then the person with the whiteboard would do the first step and pass it to the person on their right. That experience stuck with me because just forcing me to get started (with help available) was enough to quickly clear up anything I was avoiding getting started on at home.

I still avoid doing things because they're emotionally uncomfortable occasionally, so I haven't really found a general solution. But it's gotten better over time and it's less of an issue when I'm more invested in something.

[prometheus76]

I have found the advice in this Andrew Huberman video to be helpful. Long version: [1] Useful clip from that longer video: [2]

TL;DR: motivation is a muscle that can be developed as long as your efforts to do so are voluntary. In other words, do the hardest thing that you can actually do, even if it is just pick up one piece of trash and put it in the garbage. Or wash one dish. The list of possibilities is endless. The idea is to face your discomfort, and as you do so repeatedly, your ability to do so increases.

[1] https://www.youtube.com/watch?v=8OHYynw7Yh4 [2] https://www.youtube.com/watch?v=BoutTY8XHSc

[StuffMaster]

+1 for Andrew Huberman

Controlling Your Dopamine For Motivation, Focus & Satisfaction:

https://www.youtube.com/watch?v=QmOF0crdyRU

ADHD & How Anyone Can Improve Their Focus:

https://www.youtube.com/watch?v=hFL6qRIJZ_Y

[WhitneyLand]

Makes perfect sense. Kind of interesting the opposite can bite too: Math came naturally to me, but after seeing some high standardized test scores adults paraded them around and made a big deal of it, so it became stressful to do without perfect outcomes. For my own kids I just refused to allow a lot of that stuff like IQ testing, etc.

[darkwater]

Yep, that's my experience as well. Or because it's just something I don't like to do that much or that doesn't give me some good hormone to my brain in exchange after doing it.

[WhitneyLand]

Extreme forms of procrastination do not mean that someone has ADHD by definition. It can be rooted in anxiety, stress, depression, other mental health conditions. It can be lack of motivation, or simply the habits and behaviors one has developed over time.

I’d really like to know in addition to personal anecdotes of successfully overcoming it, what on average turns out to be most effective?

[pjc50]

ADHD, like a lot of things relating to the brain, is not a binary condition; it's just the diagnosis that's binary.

[annie_muss]

The real measure is the level of harm. That's it.

My ADHD meant I couldn't hold down a job or relationship. You lose your job enough times and the depression that follows is inevitable.

That said, I can imagine a Dustin where I had stumbled into a different career, a different family situation. Then my ADHD might not have caused enough problems to be a disorder.

[adadadadadad]

I sometimes wonder if it’s just a sign of being in the wrong career.

A lot of people chase the money in an area of general interest. But the actual tasks they are being paid for might simply not be what they are suited for.

If always think to myself if only brainstorming, ideation and online shopping were a career haha.

[Modified3019]

ADHD is definitely a major cause, but another big one which is much more complex to talk about is “avoidant” type behaviors that are a result of trauma/neglect/abuse early in life.

There is correlation that occurs among diagnoses of ADHD, Autism, CPTSD, and other “mental issues”, such that by the time one becomes noticeable as having pathological effect, then it’s likely to be able to identify at least a few more issues acting in a comorbid manner.

[adadadadadad]

Avoidant behaviors can also just be a result of getting older. Everyday is the youngest you will ever be and gradually doors close off to you which can induce panic and anxiety.

Starting a task towards a longer term goal brings to the forefront of how little time you have left.

[brnt]

People love to label things, and parents overlabelling ADHD has been a common warning among anyone working with kids now.

In broader context I think we are now finally starting to pay attention to the fact every single human is subtly or not so subtly different, and we haven't even scratched the surface of mapping all those particularities and so we put people into categories we know, not necessarily where the actually belong.

It's great were slowly letting go of 'normalising' ourselves, but we're going to have to learn entirely news vocabularies to says describe who we then are. Also, by thinking about yourself you define yourself, so if you think differently you define differently. I.e. we are fluid, to a certain extent.

[prometheus76]

I was diagnosed with anxiety and ADHD about 8 years ago, and since then, I have mainly worked on my anxiety. My anxiety has diminished drastically, and I have found that my ADHD symptoms are now manageable without medication (although I still struggle some days). For me, ADHD led to failing in my daily duties as a kid, which led to higher and higher levels of anxiety, which really exacerbated my ADHD symptoms. Now that I have learned how to control my anxiety, and with the resulting calming of my nervous system, the ADHD isn't nearly as problematic.

TL;DR: anxiety and ADHD are often intertwined and they spiral each other out of control, so what looks like ADHD is sometimes much worse because of anxiety.

[dartos]

It’s likely that a lot more people have ADHD than we think, but I don’t think everyone who procrastinates does so bc of ADHD

[adadadadadad]

If you read the diagnostic criteria that is used, it’s so broad it could easily apply to most of the world’s population…as long as they declare they have trouble focusing.

[projektfu]

I disagree. I think that 6 months or more of 5/9 symptoms of inattentiveness or 5/9 symptoms of hyperactivity, persistently, does not represent most of the world. (And excluding: "The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions." 6/9 symptoms are required to diagnose children) [0]

Indeed, surveys show that it's probably under 10% [1]. Mind you, these are surveys of symptoms, not surveys of diagnoses.

0. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/

1. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...

[adadadadadad]

If you look into how the criteria is chosen its very arbitrary. And this descriptive diagnosis where you pick from list A and B is extremely bizarre from a common sense standpoint. And there is no brain imaging or genetic markers available.

> The number of criteria required for a diagnosis of ADHD has been set arbitrarily in DSM-5. No scientific justification has been presented nor method used for deciding how many criteria should be required

> https://www.frontiersin.org/articles/10.3389/fsoc.2022.81476...

and...

> For the case of ADHD specifically, this is translated to: “if an individual has attention deficit hyperactivity disorder it is because he is inattentive, disorganized and hyperactive-impulsive, and if an individual is inattentive, disorganized and hyperactive-impulsive it is because he has ADHD.

> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9871920/

It's important to be aware that each percentage point is hundreds of millions of dollars.

[_yb2s]

The set of symptoms are not arbitrary, but are connected logically, by each being the result of a deficit in some type of executive function. ADHD is broadly a disability of executive function.

Executive function is historically entirely a psychological concept, although there is starting to be some biological understanding which came later (e.g. which brain regions are involved, etc.).

[renaudg]

> The number of criteria required for a diagnosis of ADHD has been set arbitrarily in DSM-5. No scientific justification has been presented nor method used for deciding how many criteria should be required.

Erm.. welcome to psychiatry ?

There is nothing bizarre (or unique to ADHD) about picking from a list of precise, agreed-upon criteria to form a mental health diagnosis. It's how the entire field works, and it's actually a huge step forward from the times when each therapist made up their own definitions.

In the absence of definite imaging or genetic markers for most illnesses, building consensus on criteria and thresholds in a reference manual (the DSM) is the next best possible way to end up with objective, useful and standardized definitions.

Not having a blood test for an illness doesn't mean it isn't real.

> It's important to be aware that each percentage point is hundreds of millions of dollars.

You don't need to resort to conspiracy theories once you understand the above.

[corobo]

Many people probably do have the same brain wiring, or maybe it's a low level of background dopamine, or whatever it turns out to be once science figures it out.

The reason most of the worlds population isn't diagnosed[0] is that second D: Disorder.

No disorder, no problem, no diagnosis.

[0] outside of lack of access to mental health resources, not knowing what they're looking for so never getting referred to a place to diagnose it, not believing in treating mental health issues, self-medicating, avoiding stigma, etc

[hirvi74]

I liken it to forgetfulness in old age.

A majority of elderly people see a decline in memory as they age. Not every elderly person who is forgetful necessarily has dementia.

[cloverich]

This is true about most diagnostic criteria, which is why medical students think they have all the illnesses before they get experience with people who actually have them. Its just very difficult to use words with sufficient precision to capture the bits that are, somehow, more obvious once experienced.

[dartos]

Yeah it’s hard to write specific criteria for some mental disorders.

They’re not all uniform in presentation or affect.

It’d really be up to the therapist.

Thankfully, it doesn’t seem like most of the ADHD meds usually have long lasting adverse effects.

[adadadadadad]

The brain does adapt to adhd meds and there are studies showing this.

The thing I don’t like about adhd is that the premise is the brain doesn’t produce enough dopamine so we return it to normal levels…but the brain always seeks homeostasis so it will adapt by producing more dopamine reuptake cells. There are no conclusive imaging studies or genetic markers for it.

The meds certainly do work but if you ask someone to explain their condition to you they have all have the same simplified and erroneous explanation as to why they can handle addictive meds and the general population cannot.

I think it’s pretty much a general smart drug but with high risk of addiction.

[slowmovintarget]

Deep breath in... Many people who suffer from ADHD actually have undiagnosed allergies.

My father was told he had ADHD late in life... he had allergies. I had problems with focus and being scatterbrained... on days the tree pollen was up. Kiddo was starting to get easily distracted and unable to focus on schoolwork... It was an allergy to the hard wheat used in U.S. bread making and preservatives.

You [edit: most people] don't just "have ADHD." That's like diagnosing someone with a headache disorder. There's an underlying cause that requires more work to dig out.

[Jommi]

No that's not true. ADHD is a real thing that exists. You shominimize that.

Now are there other disorders/illnesses/allergies that affect concentration definition.

A lot of people have deviated septum or allergies that make nasal bresthing incredibly hard without effort. Of course this has a major effect on concentration.

Other examples surely exist. But please don't minimize real debilitating ADHD.

[_yb2s]

I don't think they are in any way minimizing ADHD. ADHD is diagnosed by symptoms, and has a large number of different possible underlying causes, most of which are not well understood. When ADHD is caused or worsened by an allergy, that in no way makes it not real ADHD, but can make it easier to treat, if the allergy is identified!

It's known that ADHD is highly heritable and has some specific genetic mutations weakly associated with it, but it can also be caused by traumatic brain injury, toxin exposure, some food dyes and preservatives, and allergies. It's very likely that many of the heritable genetic factors themselves have interactions with external environmental factors, and can therefore be treated with environmental manipulation, if we can understand it better.

[T_MacThrowFace]

If you ever get diagnosed as having ADHD though, then every doctor will forever pretend that they know for a 100% fact that your ADHD is caused by mutated dopamine receptors, while having done no testing of course; why would they when you have already been diagnosed

[_yb2s]

That is pretty silly, and a misunderstanding of the research. All of the mutations in dopamine transport associated with ADHD are pretty weakly associated, and still very common in the non-ADHD population.

[slowmovintarget]

I'm not talking about difficulty breathing. I'm talking about a systemic inflammatory response from allergies that includes neurological symptoms like an inability to focus, problems with reading comprehension, and uncontrolled daydreaming or "tuning out." Every time I got my allergy shots, my concentration was shot for the day, and it had zero to do with my nasal passages.

I'm not minimizing the problems of those who suffer from ADHD. I'm hoping that they work with their doctors to see if there's more going on.

[LoganDark]

ADHD is a spectrum, so it can have different severities. Some people simply find it more difficult to function well whereas some people find it absolutely and utterly impossible.

[_yb2s]

What spectrum means in this context is that it's a multi-dimensional problem- different levels of severity across a large number of different dimensions. Executive function is typically broken up into a large number of different functions, and people have different levels of each, so a person that functions well in one context might do poorly in another, and vice versa.

[LoganDark]

> What spectrum means in this context is that it's a multi-dimensional problem

I used "spectrum" to mean that ADHD is not always severe enough to cause outright disability, but the underlying problems can still be present to a lower degree.

The parent mentioned "procrastinates or can struggle with focus without having ADHD" (emphasis mine) and I wanted to point out that some of those people may also have some very mild form of ADHD.

[_yb2s]

I don't disagree with your point, but you are misusing the term and misunderstanding what it means when it is applied to neurodevelopmental disorders like autism and ADHD.

[LoganDark]

ADHD the diagnosis is a set of symptoms. These individual symptoms may be present to varying degrees in different people. The fact that it varies means that ADHD is a spectrum. That's not misuse or misunderstanding, and it agrees with your original comment. I'm simply clarifying what I meant because it's not just "everyone has different specialties". It's that specific problems that can contribute to ADHD can be present in people even if they don't have the entirety of ADHD. There is no genetic boolean that decides if one will have ADHD or not.

While, sure, everyone does have different specialties, they could also have some traces of ADHD that aren't severe enough to give them all the symptoms but still manage to hurt their performance in certain areas.

Also, I said nothing of autism. Please don't extrapolate

[T_MacThrowFace]

Aren't you guys talking about an academic and somewhat theoretical definition of the term "spectrum"?

In reality, it means

"But doctor, how can you attach this very serious and stigmatizing diagnosis to my child while skipping half the tests in the official criteria and fudging the numbers to reach some threshold number?"

"Oh don't worry, it's a spectrum, you see"

...

"But doctor, what you just entered into my medical records is not what I told you at all, how can you be sure you're making the correct diagnosis if you're not really listening to what I'm saying, and when you're completely misrepresenting my situation?"

"Well, it's a spectrum you see"

[LoganDark]

I'm using "spectrum" to mean that mild and severe cases of ADHD exist, as well as everything in between.

For example, ADHD controls my life and I was never diagnosed with it until I figured out the symptoms myself, because nobody could ever see me struggling with it - there is no fighting it for me. However for some others, their ADHD is trivially controllable via medicine or habit-forming.

[hirvi74]

> ADHD is a spectrum

When analyzing people what is not a spectrum? Every human attribute can be placed on a spectrum. Even other diseases, disorders, etc.. A broken bone can be a hairline crack or shattered into pieces.

[LoganDark]

Someone can have a mild form of ADHD without it being severe enough to cause executive dysfunction outright. That's what I mean by spectrum

[hirvi74]

Ok, now I understand. The term I have always heard is "subclincial."

[LoganDark]

Huh, that's a good term. Thank you

[hirvi74]

It's a square vs. rectangle kind of thing.

[hirvi74]

I'm doubly screwed.

Like you said

> "It's the classic situation of someone without ADHD telling us "just focus!" or "you just need to write things down!" or "you're just lazy".

Of course, this advice was never helpful and did not work. However, I was properly diagnosed, went to medication route, coupled it with therapy, and I'm still not better. Now, the medication and all that is definitely better than nothing, and I still rely on the relief I get. But the benefit of modern medicine for me is like taking a low dosage of painkillers for 3rd degree burns.

[adadadadadad]

Be cautious, the meds can make it worse in the long run as your brain seeks homeostasis and now demands even more dopamine than before to motivate.

[hirvi74]

I swear you are on to something. I have been on them for 9 years, and I am basically fried and useless. It's as if I had never been treated at all, if not worse than that. I feel like I am in a constant state of burnout, without actually being burned out, so to speak.

[adadadadadad]

You will find that a lot of negative ADHD med discussion is censored. Even on HN if you question the science or legitimacy of an ADHD diagnosis you will have posts removed. It's a pretty deep rabbit hole to go down if you are game, and there are massive financial incentives to increasing diagnosis rates.

If you drink too much coffee it loses its effect. This is the same but with a much stronger and extremely addictive drug.

Some readings:

ADHD in the DSM-5-TR: What has changed and what has not - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9871920/

The scientific integrity of ADHD: A critical examination of the underpinning theoretical constructs- https://www.frontiersin.org/journals/psychiatry/articles/10....

Tolerance to Stimulant Medication for Attention Deficit Hyperactivity Disorder: Literature Review and Case Report https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9332474/

ADHD is sold as a neurodevelopmental disorder which means you had it since birth, where they hypothesize that your brain doesn't make enough dopamine so you can't focus, so they simply return it to "normal" levels with meds. This is used to justify why normal people can't have it, and also why ADHD people won't simply develop tolerance and get addicted. But there is no "normal" across people. Your brain ships with a system that does everything it can to maintain its levels of dopamine, aka homeostasis.

There is no conclusive brain imaging evidence of it being a result of a brain defect. It could just as well be environmental or masquerading as social media addiction, or any other afflictions caused by rapid societal change. So you potentially mess up everyone's brains and get them hooked on pills for a lifetime. It would take a long time to re-adjust back to normal dopamine levels, so most people won't go through this process because it will be years of finding it harder than it originally was to focus.

[rodly]

I mean ADHD medication is essentially meth. At first it works, and then you need a little bit more to get the same effect.

I was diagnosed with ADHD at 19 years of age (quite a while ago) and it took me 9 months to realize the medication was a net-negative for me.

I encourage you to seek other forms of treatment that aren't medication-based. What works for me is a lot of exercise, good sleep, healthy diet and limiting "easy" dopaminergic activities like scrolling random content or watching random YouTube videos.

Good luck.

[helboi4]

I just had my new therapist yesterday telling me

"doesn't it feel good to be consistent and achieve things" and I'm like yeah no shit.

"so you need to be consistent with something" yeah that's my problem dawg.

"what's the feeling you get when you want to quit?" it just happens that my life falls apart or I get really into sth else. does nobody else just lose track of all the bricks required to do things sometimes?

"it will eventually not become effort to do these things" no sir I can tell you from experience that it NEVER becomes natural for me to be organised and motivated. It takes substantial effort for me just to use a diary, which apparently is what is supposed to make me organised. Sometimes it becomes easiER because I have a streak of good habits, but it can fall apart at any moment because it's all a precarious conscious effort.

"that's because you've never stuck to anything long enough" i've stuck to different things for different lengths of time, at what point are you suggesting this actually starts working?

God I hate therapists. I sure do hope I actually have ADHD. Otherwise I'm fucked.

[alpaca128]

It sounds like your therapist is in the wrong profession.

I've interacted with four different ones so far, and while the value I got out of them varied greatly I think none of them would ever say BS like that.

> I sure do hope I actually have ADHD

I hope whoever tests you is not like the ADHD "specialist" I had to deal with. Knowingly swapped symptoms and cause in the final report for whatever reason, and made terrible jokes that indicated he either doesn't know the basics I could read on Wikipedia or just already made up his mind beforehand. Absolutely fantastic when it comes to disorders subtle enough that you even question yourself sometimes.

[hirvi74]

> It sounds like your therapist is in the wrong profession.

It's like all professions. Most have no business being there. And if Pareto was right, then 20% of the therapist make up for the other 80%.

[helboi4]

Honestly I've had a few and I've had much much worse. Especially as someone LGBT they can be downright offensive and oblivious.

[SleepilyLimping]

It's always uncomfortable with a new therapist because they lack the context to know what you're going through, for how long, and the factors that are affecting it. I've seen mine for over a decade at this point, and when I talk to people about their potential growing pains when they're seeking out help, a lot of it is a reminder that you have to create that context/history with them over time.

It seems like yours is more comfortable making suppositions without the historical context, which sucks to hear and is pretty exhausting.

[helboi4]

Yeah, most therapists have pissed me off because its infuriating having to teach a so called expert how to understand you at a premium price. I find it ludicrous that they'd be able to tell me anything about myself that I don't know or that my friends couldn't point out to me, because I'm not exactly someone who struggles to analyse myself. I'm not unfamiliar with journalling, I have read tons of stuf about psychology and I'm not afraid to confront these things. I have therefore quit all therapy I've tried after a couple months tops because I can't justify paying to see how it goes. However, I am trying it again now because I am paying nothing now because of insurance. So even if I'm skeptical I lose nothing. So hopefully I'll get to the point of them having enough context to be helpful and can assess it properly this time.

[alpaca128]

> I can't justify paying to see how it goes

YMMV but the best therapist I've met so far already felt more understanding and productive in the first hour than others in months, I think if it's going nowhere after a couple sessions that might not change any time soon.

[prometheus76]

Find someone that understands ADHD (even better if they have it too). This is just more gaslighting from people who can't comprehend that other people might not be wired the same.

[notjoemama]

As the non-ADHD spouse I definitely understand this but it leaves us both scratching our heads when problem solving ADHD related things. I simply can’t comprehend what it’s like and nothing that works for me works for her. Mostly I just try to focus on myself and my needs (which has limits in our relationship). I can’t offer anyone advice except sometimes loving someone else is a choice you make for you, especially when it’s inadvertently (often but not always) one sided.

[adadadadadad]

They need deadlines where they feel shame if they fail. And they will do anything to avoid having them. To provide the necessary structure and disciplining as a partner is next to impossible in a relationship of equals.

They need some external force to exert pressure, which is usually a strict boss and job, but usually they will just leave their job if the income is not needed.

A lot of ADHD advice promotes being more empathetic and forgiving, but ultimately they need a much stricter regime than the rest.

[troad]

Is this take based on any medical evidence?

I note you're casting your take as contrary to a 'lot of ADHD advice', but it's not clear to me whether you're implying that (a) a lot of popular ADHD advice is scientifically unsound and your advice is more in line with the science, or whether you're saying that (b) both the ADHD advice and the science it is based on is wrong, but your take is right.

Edit: Saw some of your other posts and am reasonably confident (b) is the correct hypothesis.

[adadadadadad]

"ADHD" is pseudo-science in my opinion. The impairment to life is certainly real. But the cause is unproven, and for ADHD and the medication, it must be present since birth...a brain defect...but we live in an incredibly distracting environment due to social media and all the societal change coupled with that.

> For the case of ADHD specifically, this is translated to: “if an individual has attention deficit hyperactivity disorder it is because he is inattentive, disorganized and hyperactive-impulsive, and if an individual is inattentive, disorganized and hyperactive-impulsive it is because he has ADHD.

> ADHD in the DSM-5-TR: What has changed and what has not - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9871920/

--

My take on this situation is based on common sense and personal experience.

I would be interested to read the science that counters this if you have it.

ADHD people tend to leave things to the last minute. But the reason they start in the first place is because of the deadline's existence and strictness - the physical reaction of stress when they finally consider the consequences. If you acknowledge they leave things to the last minute and account for that by making deadlines less strict and more forgiving, then the motivating and focusing power of the deadline decreases and they can just make excuses and don't find the deadline motivating enough to start.

The key is maintaining the motivational power of the deadline.

The smaller the deadline, usually the less motivating power it has and the less consequences it has to missing it. It's all a delicate psychological dance, but at some point the person needs to push up against a negative emotion now and then...which our modern culture seems to want to entirely eliminate.

Its the age old: why do I only have intense motivation to do the task the night before its due...next time I just need to start earlier...without realizing its the power of the night before that is the key to it all.

[riehwvfbk]

Well, yeah: the lack of motivation is the problem. But here's the thing: just like a depressed person can't just "snap out of it", someone with ADHD cannot just make themselves get the motivation. Why? Because we can't remember that we need to. ADHD is primarily a working memory impairment.

All brains have an autopilot mode, and an ADHD brain on autopilot thinks thousands of thoughts at once. When I am not medicated I can be cooking, having an imaginary conversation about politics, planning the weekend, and listening to a song playing in my head - all at the same time, and doing all of the above badly. When I am medicated I do the same thing, but after 10 or so minutes a thought pops into my head: hey, you are distracted, focus! Without meds this thought may take an hour or two to arrive.

A deadline seems to raise the baseline of executive brain activity for a similar effect to the medication, but it's not guaranteed. Now try explaining to a boss who doesn't believe that ADHD is a thing why your performance is inconsistent. Don't you care about deadlines? I do, but I can forget that a deadline is a thing that exists in this universe.

OK, you'll say, just build routines. Discipline. Of course - I couldn't survive without routines. The trouble is: I forget I have a routine when my brain is in that fuzzy state. I can get to work, not know what my tasks are for the day, and start daydreaming. Why not just look at JIRA? Because in that state I don't remember that such as thing as JIRA exists in this universe. I actually have an alarm in my phone that tells me to check JIRA around the time I get to the office. I rarely forget, but when I do - the failure is epic.

[adadadadadad]

I haven't really heard about ADHD framed as a working memory impairment.

Because it does seem like an easy workaround via religiously following pomodoro - every 25 mins a reminder that you should look at your task list. It's hard to argue that someone can manage to ignore an alarm ringing every 25 minutes.

I thought of it more as you actually do know what you should be doing, but there is something a lot more interesting and novel that you prefer to be doing and the thought of reverting back to the task you should be doing without exploring this novel one feels like complete torture.

[adadadadadad]

Give this a read: https://www.frontiersin.org/articles/10.3389/fsoc.2022.81476...

> Quasi-Scientific Basis of ADHD in DSM-5

[slater]

> "ADHD" is pseudo-science in my opinion.

Cool opinion!

> The impairment to life is certainly real

Ditto!

> But the cause is unproven

It's very much not so.

[littlelady]

I cannot overstate how odious I find opinion. Yes, people with ADHD need structure and accountability. But they don't need more shame or punishment.

Shame is malignant. It is an unproductive feeling that hinders people from seeking out accommodations that would help them.

This idea of punitively shaming people with ADHD is doubly asinine, because people with ADHD often suffer from rejection sensitivity dysphoria[1], which already can make them sensitive to embarrassment and prone to having low self-esteem. Emotional dysregulation[2], another "fun" part of having ADHD makes it hard to recover from the experienced rejection.

Some research is more focused on self-regulating aspects of ADHD, as opposed to relying solely on medication[3]. This source is focused on pediatrics, but self-regulating therapies exists for adults, e.g. DBT.

[1]: https://my.clevelandclinic.org/health/diseases/24099-rejecti...

[2]: https://my.clevelandclinic.org/health/symptoms/25065-emotion...

[3]: https://www.cdc.uci.edu/research/

[adadadadadad]

> I cannot overstate how odious I find opinion.

Yet...

> RSD isn’t an officially recognized medical condition. It’s also a condition for which there’s limited scientific research available.

> https://my.clevelandclinic.org/health/diseases/24099-rejecti...

---

> This idea of punitively shaming people...

It's more about ensuring they appreciate the severity of the deadline.

If I tell a non-ADHD person to try their best to meet the deadline, they might get it done or might not and need a little extra time.

If I tell an ADHD person to try their best to meet the deadline, they might have not started at all, and end up falling far behind, or start making excuses because they are captivated by another task.

There are so many times where fear of repercussions from an imminently looming deadline gave me the initial momentum to put everything else aside and channel my focus to deliver.

But every time this happens you want to say "I just need more time because I started late because of ADHD"...and if the boss says "sure that's okay, take your time"...the motivation dissipates and you are back to tasks piling up.

I can only conclude that ADHD people need a shorter leash regarding scope and stricter deadlines, and not a comforting presence to reduce the pressure.

I am very open to hearing criticism of this approach.

But I think it's actually cruel to not be tough with someone and let their performance drop to a point they have to be fired which is the inevitable consequence. If someone cannot deliver then they cannot be kept around. If someone has 6 months to prove themselves...do you think with less deadlines and less strict deadlines they will have more chance of success? I think it just adds more risk and stress to themselves.

[littlelady]

RSD is a term used to explain a behavior. It doesn't have to be a medical diagnosis for it to be something people experience.

> It's more about ensuring they appreciate the severity of the deadline.

People with ADHD are aware that there are consequences for missing deadlines, so aware they've coined the phrase "ADHD Tax"[1]. Shaming doesn't motivate people, especially people who have issues with motivation in the first place[2]. It just causes them to withdrawal.

> If I tell an ADHD person to try their best to meet the deadline, they might have not started at all, and end up falling far behind, or start making excuses because they are captivated by another task.

Telling someone to "try their best" doesn't actually address the problem their having.

Folks with ADHD aren't always just distracted. There are a number of factors at play with ADHD: poor memory (e.g. often "out of sight, out of mind"), poor organizational skills, and often time-blindness make it hard for people with ADHD to structure their lives. All of these things fall under "executive function"-- which is impaired in people with ADHD[3]. Ex: someone with ADHD might spend a week working on some random detail that doesn't matter, because they think it's important.

Deadline extensions are only one type of accommodation, but imo they don't really address what the person is struggling with.

There a multitude of other accommodations. This may include letting an employee wear headphones, or having a "do not disturb" sign (that is actually respected), or partnering with an employee with especially good organizational skills. Allowing them to block out a few hours of the day where they will not respond to phone calls or emails, etc...

For projects: assistance with breaking down tasks and setting priorities paired with frequent deadlines can combat overwhelm and help with consistency. There are lots of ideas out there, here's a particularly helpful list[4]. Do not micromanage-- you'll make it worse.

> I can only conclude that ADHD people need a shorter leash regarding scope and stricter deadlines, and not a comforting presence to reduce the pressure.

The most helpful accommodations will depend on the individual, but now you have lots of ideas. Of course, they hinge on the employee feeling comfortable enough with you to actually discuss what they need.

[1]: https://www.additudemag.com/adhd-tax-financial-wellness-mone...

[2]: https://www.psychologytoday.com/us/blog/longing-nostalgia/20...

[3]: https://www.additudemag.com/7-executive-function-deficits-li...

[4]: https://add.org/adhd-workplace-accommodations-guide/

[adadadadadad]

> assistance with breaking down tasks and setting priorities paired with frequent deadlines

Pretty much what I am arguing for.

Deadlines have to matter.

> someone with ADHD might spend a week working on some random detail that doesn't matter, because they think it's important.

No one is like "oh, thanks, it was just a matter of working on this thing, my bad, I lost track of time". It's a totally arduous process to abandon this task you are enjoying and drag yourself kicking and screaming to work on what you should be working on...which will be pain inducing. You need a way to get through this pain.

[havblue]

I think for me I can think of several examples when my desire to avoid another broken relationship was what motivated me to do whatever it is that they care about before they get angry about it. For example I used to be bad about doing dishes and left them in the sink for too long, to the frustration of roommates. There was something in my brain at the time that dragged me to my room to be alone. I eventually forced myself to just do the work and the pathways for doing that chore formed. I "couldn't" do it at the time for some reason but I "can" now.

While I can relate that it isn't simply about laziness, I think people getting angry can simply be their way of saying that they aren't your psychologist and they expect you to do your share regardless of your mental state.

[brnt]

In defense of whoever said it to you: I find that writing things down goes a long way for me. Even just the act of it, without ever reading it back.

[selcuka]

> So much of what you take for granted comes from your sense of smell.

I briefly lost my sense of smell after having COVID, and I almost gave my kid spoiled milk, so yeah, it is actually a crucial sense.

[doubled112]

> you just need to write things down

That's fine and all, but where did I write it down again?

I lost my sense of smell for a few weeks with covid, and I actually can relate now. It's a very, very strange thing to be without. It doesn't seem that important until it's missing, but now I can't imagine life without it.

[jprd]

"...you are so smart, if only you would apply yourself!"

[hirvi74]

Maybe that is a true sign of intelligence? Smart enough to know it's all a waste of time and effort.