[throwaway98031]

> Isn't "Do they respond to ADHD medication?" our only test?

No, absolutely not. It's a common internet myth that response to ADHD medication is indicative of ADHD. In reality, nearly anyone who takes ADHD medication acutely will experience increased focus and productivity (again, acutely) due to the acute (pre-tolerance build-up) effects of the drugs. Additionally, new users experience a short-lived euphoria that convinces many people that they need a stimulant to feel "normal," when in fact they're just experiencing the initial euphoric effects of the drug. Be warned that the euphoria fades and, more importantly, does not return without abusing dosing schedules.

ADHD marketing materials combined with pop-psychiatry have stretched the definition of ADHD to encompass nearly anyone. It's trivial to find low-grade internet forums in which users believe that anything and everything is a symptom of ADHD. You can even find a large number of people who believe that something called "hyperfocus" (being able to focus very intently on one thing for a long period of time) is a symptom of ADHD, believe it or not. Of course, the term "hyperfocus" does not appear in ADHD medical literature or any ADHD studies.

ADHD is a complex disorder, and the modern world can (and does) drive people in to ADHD-like states with all of the distractions available to us. The single best approach to dealing with this is to pursue constant discipline and self-monitoring, in order to train yourself back to a healthier mental process. ADHD medications can help people implement those disciplines and healthy processes, but they don't actually substitute for proper habits. It's not uncommon for people to pop Adderall expecting their ADHD to disappear, only to be drawn in to extended video game or web-browsing sessions that are in no way productive.

So my advice would be to make efforts to structure your life in ways to minimize distractions and hold yourself accountable for your results. Realize that everyone is distracted in modern life, but that's not necessarily indicative of a disease. Stimulant medications are not to be taken lightly, and you're best avoiding them long-term if possible.

[afarrell]

To be clear: I'm getting that from a psychiatrist and a psychologist that I've seen. Of course they would have an economic incentive to over-diagnose.

Do you happen to know what one actually does in order to "pursue constant discipline and self-monitoring"? Mindfulness meditation is not really that effective, but I might have been doing it wrong. Running in the morning seems to have had some effect but I can't yet tell. The only things that have been effective have been applying external constraints by:

- Getting married to someone willing to yell at me for getting distracted.

- Installing http://selfcontrolapp.com/ and putting it on before I go to bed.

- Putting my smartphone near a co-worker's desk when I get in in the morning.

- Making sure my monitor faces out towards the common area so someone could look over my shoulder.

- Keeping a lab notebook so that I can remember the state in my head if I do get distracted.

- During meetings, pushing people to be very clear on what problem we are trying to solve.

It works okay. I am a fairly productive engineer as long as I am on a team where I can succeed at that last bit. But I've never been able to get rid of the internal urge to check my email or HN or Twitter. Or worse, to look things up about, for example, the role that the Harlem Hellfighters and other WWI vets played in the Civil Rights movement of the 1920's and 30's. So whenever I have a weekend to myself to work on projects in my spare time, I don't get anything done and I haven't known how to even make progress toward fixing that.

[ktsmith]

> Of course they would have an economic incentive to over-diagnose.

Why would your Dr have an economic incentive to over-diagnose? I was diagnosed a year ago with ADHD and I have tried every self-discipline technique you can think of without success. The quantified self just becomes an effort in futility and depression when you see where you are wasting time, actively try to correct it and still fail. I saw my Dr every six weeks initially when trying out medications. I see my Dr. every three months now instead of six months so that I can have my prescription renewed as she can only issue three one month non-refillable prescriptions but that's a tiny amount of additional money my Dr. is getting. I suppose if the Dr. is diagnosing this on a large scale the volume adds up but it just doesn't seem worth it. Especially with the changes to schedule II drugs and their prescription/distribution in the U.S.

I've been medicated for the last year and it's been a life changing experience. My own day sounds similar to what you describe below as far as the distractions go. I cut down to two monitors instead of three as I was using the third for just email and other communication tools. I now hide those on a virtual desktop. I do occasionally miss the third when I have a code window on one, and an output/debugging window on the other when having all three full screen would be easier but that's about it. I only let communication apps send me notifications once an hour instead of in real time which helps. I also have scheduled blocks where the notifications are blocked on my phone and computer except for specific people which is a new feature of Android 5 that I really like (Priority notifications). The medication has helped me build a routine and stick with it, and I'm hoping that when I decide I'm ready to try going off of it full time I will be better able to continue that trend. I don't believe for a minute that I will be able to eliminate all of it completely but I hope that I will be better prepared to handle it.

[ktsmith]

> Of course, the term "hyperfocus" does not appear in ADHD medical literature or any ADHD studies.

Hyperfocus has been used generically to refer to one of the negative effects of a lack of self-control and self-regulation in the executive ability of ADHD individuals. This has been the case for at least the last 15 years. Both inattentiveness and excessive focus are thought to be caused by a lack of dopamine which the stimulant drugs counteract.

> The single best approach to dealing with this is to pursue constant discipline and self-monitoring, in order to train yourself back to a healthier mental process.

There is no single best approach. Different approaches will work for different people. I can only speak for myself but no amount of pursuing discipline and self-monitoring on its own worked for me. Rescuetime, getting things done, pomodoros, daily self evaluation... didn't make an iota of difference before I went to my Dr and got a diagnosis. The combination of Vyvanse and these techniques has made a difference, though I've eliminated the pomodoros as it just flat out doesn't work for me.

> So my advice would be to make efforts to structure your life in ways to minimize distractions and hold yourself accountable for your results.

Easier said than done. Structure is incredibly important but, at least for me, anything can be a distraction. The soft blue glow of the led on my monitors power button is a distraction. The difference in textures of the keys on the keyboard is a distraction, getting suddenly lost in thought or mentally stepping through what I need to do instead of doing it is a problem.

Figuring out what works best for you as an individual is important. I actually work much better with noise in the background so long as it's fairly consistent. Electronic or classical music is pretty good for this for me but at times can be too repetitive and then that becomes a distraction. Music with lyrics is generally better for me so long as the volume isn't too high and I'm already familiar with the songs. This also usually ties directly into the constant motion of my legs. I've been a leg bouncer for my entire life, especially when I need to do something intense like test taking in school or working on a complex algorithm at work.

The addition of medication to my daily life has allowed me to cut out some of the inputs I was giving too much attention to. When I'm locked in on something and someone interrupts me I actually hear them now rather than what would previously look like I was just flat out ignoring them. That ability to not switch tasks when I want to, and switch tasks voluntarily when I need to was absolutely life changing for me. I don't take my medication all of the time, in part to cut down on the tolerance and in part because I'd prefer not to take it forever. Having been on it has helped me be more aware of what I'm doing and catch myself in certain bad habits I've formed; however, if I'm locked into something and my wife walks up and starts talking I won't notice and there doesn't seem to be any amount of structure or discipline that will change things like that. The positive is that we are both aware of what is going on, she knows how to break me out of it better, a light touch, and it no longer is a source of arguments.

> Realize that everyone is distracted in modern life, but that's not necessarily indicative of a disease. Stimulant medications are not to be taken lightly, and you're best avoiding them long-term if possible.

I agree that stimulant medicine isn't something to mess around with or view as a quick solution to get more done. I also don't think it's fair or even good to try to say that everyone is distracted or it's just part of modern life. ADHD is probably over diagnosed because people are looking for a quick fix and going to their Drs with a list of things to say in order to get drugs. Just like with painkillers. If someone is going to their Dr and honestly thinks they may have ADHD or are getting a child evaluated I would find a different Dr if their first recommendation is medication, or if the Dr comes to that conclusion very quickly. I also wouldn't necessarily try to scare people away from trying them if there's a legitimate problem. I wish I had been diagnosed as a child or that I had the sense to talk to my Dr sooner.