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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.

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"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.

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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.

[riehwvfbk]

The working memory impairment idea comes up a lot. I don't know that it's necessarily "scientifically correct" but it feels subjectively true to me, and thinking about it this way seems to help.

Here's the thing: I know what's important, I know that hard work is one of my core values, etc. I just don't remember any of this when stressed and the brain goes for the shiniest thing that gives immediate gratification and gets stuck there.

A too-perfect-to-be-true manager could maybe notice daydreaming and just say, hey, focus. That would be enough to snap out of the fugue state. Unfortunately, manager types tend to be the "tough love" people and they assume things about morals and values. Avoiding this is what people mean when they say ADHD people need more compassion.

Essentially, people with ADHD have figured out how to act in order to trigger the "they have the right beliefs" thoughts in people like you. It takes a lot of effort, and because it's not automatic sometimes we get exhausted and fail. That's when you see the inconsistency.

Imagine being in a wheelchair, needing an elevator to get to the second floor, and then being berated for not wanting to go up there badly enough when you can't make it when the elevator is broken.

[troad]

I've actually found these takes quite interesting, though I wouldn't say I am in agreement.

You might find some of Freddie de Boer's writing on disability interesting, such as this piece [1], this one [2], and others.

[1] https://freddiedeboer.substack.com/p/your-mental-illness-bel...

[2] https://freddiedeboer.substack.com/p/the-gentrification-of-d...

[SomeoneFromCA]

Are you a conservative or a republican? you sound like one. I am not being passive-agressive, just making a point that political beliefs have strong influence on attitude towards mental disorders.

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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/

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> 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...

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> 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/

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> 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.

[littlelady]

Your response demonstrates you didn't engage with my response. ADHD is not a character flaw, it is a disability.

1. More deadlines for smaller chunks does not imply that the deadlines are stricter; it's about preventing overwhelm and helping with time-blindness.

2. Focusing on the wrong thing is not (always) about "enjoyment", so much as it's about being overwhelmed, bored, under/overstimulated, or being unsure of what one "should" be working on.

3. Your wording, particularly "kicking and screaming" reveals your disdain for people with ADHD. You are not "very open suggestions" on accommodations as you claim to be.

Here's a list of books about ADHD: https://www.additudemag.com/slideshows/adhd-book-recommendat...

Here's an article, if you can't be bothered to read a book about it: https://www.webmd.com/add-adhd/adhd-wish-you-knew

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> Your wording, particularly "kicking and screaming"

I am describing myself.