From project manager (80k+) at a large NYC-BASED structured-cabling company to a billing coordinator position (<40k) at his most recent position. With the starting of each new job, him telling me this time it's going to be different and not end in his firing.

It makes me want to put my head into a pillow and scream because he's an intelligent, sociable and kind person but his mind just sits so juxtaposed from what these companies want. However, I can see his mind move beneath his eyes when we converse, and then subsequently lose focus, so it's pretty apparent if you were to meet him. I can see how that translates to poor job performance.

Unfortunately, due to a heavy-handed prescription dosage of adderall when he was young, he's pretty hesitant about trying a new regimen. I've tried pulling him into it by telling him my newly prescribed Semaglutide (Wegovy) medicine will also be a lifelong medication/issue too so we'll be in the trenches together.

I have also been fired a bunch of times, and people describe interacting with me in the exact same way as you just described it.

Your brother is consistently going for the wrong kind of job, from the sound of it. Operations jobs.

I eventually succeeded when I switched to work that is more strategic and creative.

I got really into language learning, blogging, website building, and then just followed things forward.

I then eventually became head of marketing for two different startups.

And now I run a bootstrapped company that is exploding in growth. We’ll probably do $10m+ next year in revenue.

I pay people to take care of details while constantly explaining to them what my vision is.

I KNOW the feeling when you see people lose faith in you. You can literally see it in their eyes.

And I also - finally - know the opposite feeling. That of admiration and appreciation.

Please show this to your brother.

Taking you at your word, here: being the smartest in the room might be making things harder for you, not easier! If you’re regularly figuring stuff out in the first five minutes of a meeting to then watch others spend 25 (or, god forbid, 55) minutes reaching the same conclusions, you’re going to end up frustrated with meetings no matter what your dopamine chemistry is.

In terms of being the smartest guy in the room.. I know the feeling but in my last role .. pretty much everyone there was highly intelligent. The only person I can think of who (probably) wasn’t would be the office manager.

In the end, while it was a bit of a weird moment to at first to no longer be ‘special’ in that regard, it was a lot more rewarding. (And how nice it is to be in meetings where everyone can keep up!)

Even then - people appreciated my creativity and ability to distill complex ideas into simple explanations.

The challenge has an ADHD person for me has been to recognise exactly where my limitations are and how to put people with the right skillsets into roles to balance me out.

Regarding drugs I tried Vyvanse and didn’t really like it but now am on Ritalin and despite stereotypes, for me it’s been great.

I stunk at routine day to day work.

For me the worst pain possible is boredom. I’ve had kidney stones. Boredom is in same range.

First time I took medication was shocking to find that the pain of boredom was gone. I had no idea that was possible.

The most successful moments in my career have been when I have been at a place long enough to know the domain and being reasonably comfortable in the code base. Because then I have been able to take on those really difficult and urgent tasks. And I don’t get nervous or stressed while doing it :)

I ask because my attention issues are task-dependent, but doctors tend to view even the suggestion of occasional use as a red flag for recreational abuse.

I don't think this is the case - mine recommends 5-6 days a week maximum to avoid building up tolerance, and I believe this is fairly standard advice. And occasional longer breaks are encouraged for the same reason.

Later I got a proper diagnosis for adhd.

Wishing your brother the best.

After 30+ years, I have found the non-amphetamine medications work a lot more consistently and helpfully than the amphetamine ones.

The one downside is that if your brother also ends up on SSRI's, he won't be able to use most of the non-amphetamine medications until he is done with SSRI's.

I've watched a lot of friends go through the same cycle: Initial excitement from an Adderall prescription which gradually gives way to tolerance and a mismatch between reality and their perceptions of Adderall as a miracle pill.

The non-stimulant medications have worked wonders for a lot of people I know.

The catch (and it's a big one) is that they generally don't work immediately. In fact, they can be kind of unenjoyable for the first weeks or months while they begin to work. This is the exact opposite timeline of stimulants, which puts a lot of people off. If you can gradually titrate up and you're willing to give it a multi-month trial before ruling it out, the non-stimulant medications can actually be quite good. Some times better than the stimulants at controlling impulses and improving cognition, even. First-time stimulant users can easily get sidetracked by focusing too much on distractions.

The other catch is that it's hard to objectively evaluate the positive changes when they happen gradually over the course of a month. A lot of Straterra (Atomoxetine) users will think the medication isn't working, but when you ask them to objectively walk through their daily routines and work performance they realize they've improved tremendously. For others, they don't realize the benefits until the quit the medication and lose the positives, at which point they're back for round 2 of titration.

Straterra/others are interesting in that way.

As you say, you don't get the immediate on/off feeling you do with amphetamines, which makes sense because of how it acts, but is a weird thing for those not used to it.

Having had to switch on and off it a few times over 30 years for various medication complexities, as you say, you notice a few days later when it's gone.

Guanfacine is another, I haven't tried it, so I can't give any first hand experience. I think it's used more to help blood pressure & agitation that can come up with adhd

Welbutrin is also commonly used.

I guess if you’re arguing (I know you are not, I am just putting unsolicited info out) in terms of what amphetamines are the worst… methamphetamine, pharmaceutical grade & at the equivalent therapeutical dosage for ADHD symptoms - which is something like 5mg-15mg max, & potentially up to 45mg for the very worst cases of chronic fatigue syndrome - is actually less hard than others on your body from a neurotoxicity standpoint, as well as on your vascular system in general. You can also very easily take naps on it (at those dosages).

It just happens to be highly addictive because of the whole blood brain barrier crossing thing. & then once you get out of that therapeutic dosage into “recreational/abusive” dosages… that is when meth is very bad.

So if you don’t have an addictive personality & can control yourself, prescribed methamphetamine (Desoxyn, not sure if a generic exists) is otherwise the safest treatment for ADHD if expected to be consistently on it for decades/life.

I believe it then goes

DextroAmphetamine

50:50 Racemic Amphetamine (Evekeo may be brand for this in US?)

Adderall (which is 3:1)

From least harm on your body to most harm over time.

My doc & I for the time being found Vyvanse was nearly perfect for me, & essentially perfected it by adding a small (10mg) instant-release DextroAmphetamine (Zenzedi, specifically branded - seems to be the most perfected formulation in the US pharmacy system as of now.) along with it to kickstart things in the morning. There are also times when I’m scripted to just take multiple 10mg IRs a day instead of the entire Vyvanse dosages for other medical reasons & potential need to rest. Mentioning rest: a non-negligible portion of people on an otherwise perfectly working Vyvanse dosage seem to need a mild-moderate sleep aid towards the end of the day. & where you may think that just indicates a lowering of the dosage, that is mostly wrong & ruins the “otherwise perfectly working” aspect.

I only mention all of this unsolicited advice/information as I’ve for far too long now, & with medical practitioners in family, seen anecdote after anecdote of people prescribed Adderall (IR or ER) eventually trying pure DextroAmphetamine IR (previously known as Dexedrine, now Zenzedi, & of course generic) - or ER like Vyvanse - & finding that it works much, much better than Adderall. Typically from a standpoint of less irritability/jitteryness/emotional blunting & more focus & ability to change task to task if needed. For whatever reason though (obviously, industry money slushing around related), Adderall is prescribed at a ridiculously higher rate than pure DextroAmphetamine. There’s also a decent amount of people who’ve only heard the term Adderall & don’t know DextroAmphetamine exists. Finally, that in some rare cases, meth is genuinely the correct drug for treatment. I honestly think if you’re being prescribed an amphetamine, doctors should have to inform you of all amphetamine based medication able to be prescribed for your condition & the potentially pros/cons comparisons - but I am nobody in this world.

Methamphetamine is legally available by prescription in the US, but in many other countries that is not true. Here in Australia, it is technically legal to prescribe, but effectively unavailable, because no pharmaceutical company is authorised to sell it. (It is unclear to me if that is because the government refuses to authorise it, or merely that no company thinks the potential revenue is sufficient to justify the hassle of seeking that authorisation.) Even in the US, from what I hear, many refuse to prescribe it at all, or only do so sparingly, because (apparently) the DEA likes to give methamphetamine prescribers extra "attention".

Methylphenidate (Ritalin/Concerta/etc) is notably absent from your list. I've heard claims (not sure how true they are) that methylphenidate has less neurotoxicity than amphetamines. Related compounds to (racemic) methylphenidate include dexmethylphenidate and serdexmethylphenidate (a prodrug, as lisdexamfetamine/Vyvanse is).

Other drugs I know of that are sometimes used for ADHD include guanfacine, clonidine, modafinil, armodafinil, atomoxetine (Strattera), bupropion (Wellbutrin) and phentermine (usually prescribed as a weight-loss drug, but has been used off-label for ADHD).

I’m in this category. But thankfully 0.5mg melatonin is all it takes to get a good night sleep, and that seems safe enough even as a habit.

I have been pondering for a very long time what the best options may be. I feel as if low dose benzos are a great option, but also that unless you’re somewhat affluent, finding a doc willing to prescribe & help you through amphetamines & benzos would be hard. Likely something like 0.5mg klonopin, small dose temazepam, or same for lorazepam. Likely not alprazolam.

0.3mg melatonin used to help my insomnia before I was ever prescribed amphetamines, but somewhere between when I was not prescribed them, started a low dosage of Amitriptyline for nerve pain, & now - 0.3mg-0.5mg melatonin started to make me wake up extremely agitated & have nightmares no matter what (like clockwork) - & the higher dosage gummies, like 3mg to 10mg, gave me a great variety of extremely realistic dreams.

Also spiked my heartrate by roughly 30bpm (aka a lot)

I’m glad that melatonin works for you because it’s quite convenient (well, I think having to take any pills is inconvenient, but I digress) - & also glad you can agree with the perfect dosage aspect/idea.

I have ran into middle of their career-ish psychiatrists who simply say it’s an absolute bullshit, but then mostly the entire generation of younger psychs, younger PharmD’s, a & large amount of internet psych anecdata agreeing. Conveniently, those middle aged psychs didn’t start their career when Vyvanse was even a thing, & all of the younger I mention have always known of it…

I just don’t understand why some docs outright refuse to believe such benign information/lived experiences from their patients, & presume their patient is lying to their face before they’d ever agree with them.

For those wondering of my excessively long posts… currently not on any amphetamines while dealing with other acute medical issues, but most definitely in a situation in which I have great need to distract myself. Long posts help with that, though maybe I should resign to saving them in my notes instead of hitting “reply” :P

I got the idea to augment with melatonin from a Slate Star Codex post. Since the author is a board certified psychiatrist, I decided to trust this info. Google should get you the original article, but here's my memory of it: melatonin is safe, little to no side effects, and should be taken by anyone as a first line attempt to fix sleep issues.

Melatonin is ridiculously safe. It basically has no detrimental effects in large doses. As a result, nutrition companies are in a war to make ever bigger over-the-counter doses because those sell better. But unfortunately while 5mg isn't toxic, it also makes me sleep 10 hrs and wake up groggy. As a result it's hard to find over the counter melatonin that is in the real dosage I want, 0.3 - 0.5 mg. However I found that Costco sells kids melatonin gummies with a 1 mg dosage, which is the smallest you can find on the market without paying extra. I just cut/bite the gummies in half to take approx 0.5mg a night. It's perfect, and I'm sorry it didn't work for you :(

The one thing that doesn't replicate for me from the SSC post is that he suggested taking melatonin 7(!) hours before sleep. I find I get tired upon taking melatonin immediately, and to take it early just screws ups my circadian rhythm.

Regarding the dream thing... Here's the weird thing: I have aphantasia when awake, and typically don't dream. But when I take melatonin I not only sleep better, but have vivid dreams that I remember upon waking. I guess I'm fortunate these don't turn into nightmares, generally. I guess I'm saying I can confirm your experience that melatonin leads to active dreaming, but maybe the nightmares are caused by something else? That is to say the melatonin is working to get you quality REM sleep, but some other interaction or issue is agitating you to make those dreams unbearable. Maybe worth talking to a doc about what can fix persistent nightmares.

Interestingly, adderall not having an all day effect is something I like about it. I take an XR in the morning and have a smaller IR in the afternoon. It gives me the flexibility to not take one or the other if I'm not feeling up for it.

> Melatonin is ridiculously safe. It basically has no detrimental effects in large doses. As a result, nutrition companies are in a war to make ever bigger over-the-counter doses because those sell better. But unfortunately while 5mg isn't toxic, it also makes me sleep 10 hrs and wake up groggy. As a result it's hard to find over the counter melatonin that is in the real dosage I want, 0.3 - 0.5 mg.

My sleep doc has advised ~0.5mg a couple hours before going to sleep. As I've come to understand it, taking it too soon before sleep is what causes the grogginess.

> However I found that Costco sells kids melatonin gummies with a 1 mg dosage, which is the smallest you can find on the market without paying extra. I just cut/bite the gummies in half to take approx 0.5mg a night. It's perfect, and I'm sorry it didn't work for you :(

I found some 1mg flavored chewable tablets that're easy to split in half. I've found the same brand at my grocery store and on amazon

It’s definitely a much more subtle effect vs actual medication.

[1]https://promixnutrition.com/products/flow-state

Depends on the country. In Europe, it's not so easy. In the UK, the last I checked, it was contraindicated for long-term use, meaning it could be used for smoking cessation but not for long-term ADHD treatment.

> similar to amphetamines

Wellbutrin has a very different mechanism of action, and a different effectiveness profile. I wouldn't say it's "similar to amphetamines" in any clinical sense.

It is not a typical treatment, but a psychiatrist in the UK does have the discretion to prescribe Bupropion off-label.

In my own n=1 experience, as a fourth option, only after unsatisfactory trials of more traditional stimulants and Atomoxetine.

For me it was like rediscovering caffeine for the first time, which lasted about six months altogether. Then the positive effects waned and it became a self-inflicted case of acid reflux.

Would never describe it as being similar to amphetamines. The most praise I can give it is as "an antidepressant that kinda sorta works."

Can get with a prescription or found easily online. Would highly recommend it.

They actually have more side effects than amphetamines do, though Strattera works well for me as long as you absolutely always take it with food. (Otherwise it feels like you're getting kicked in the stomach.)

Even if he won't take the meds, he could still benefit from one of the many ADHD workbooks that are out there. I was initially skeptical, but I finally bought one[0] and worked through it, and I found it to be really helpful. I had always thought of my ADHD as one problem (I just can't attention!), but the workbook breaks it down into distinct sub-problems, one of which (poor mental flexibility) I honestly hadn't even recognized as a problem until I read the book. For me, breaking down the problem has made it easier to deal with.

Another thing that might help him out is journaling. I am still occasionally able to go weeks without a conscious awareness that ADHD is wreaking havoc in my life--but not when I'm journaling. By setting aside a little time each night to A) reflect on my values and B) take stock of the day, the feedback loop goes from days/weeks down to 24 hours, which makes it much, much easier to prevent my disease from having a negative impact on me and my loved ones.

Sorry for all the unsolicited advice. You sound like a good brother, and I figured this might help. Godspeed.

[0]https://www.amazon.com/Thriving-Adult-ADHD-Strengthen-Functi...

https://www.youtube.com/watch?v=qa5v1a2H-xs

It's hard for me to believe that there exists persons that won't / don't identify with that description, and thus the cause of my executive dysfunction isn't ADHD, but just a failure to cultivate habits of discipline.

As one of those persons (tested 98th percentile on SAT in 8th grade, for example, and was in gifted or advanced classes until I just got bored of "extra work"), I think it is important to really consider this and reflect on whether or not something like ADHD could be at play and getting in the way of life goals. The rejection sensitivity dysphoria mentioned in the article, while it is not a diagnosed condition (won't find it in the DSM), does describe one of the states of mind of a lot of people with undiagnosed ADHD because of a lot of negative conditioning for many years, being told they just didn't have enough willpower to do things "right".

“a failure to cultivate habits of discipline” is an _outcome of ADHD_. Executive dysfunction is preventing the cultivation of habits, not to say it’s impossible but they’re usually connected.

A useful trick here is to accomodate the lacking parts of the ADHD brain, with external consequences and external timekeeping.

External accountability and consequences such as a gym buddy (who you don’t want to let down), or needing to get your work done to get paid (so you can eat).

And external timekeeping is critical because we are time-blind [0]. Whether it’s a calendar, setting reminders, etc.

“People with ADHD know what to do, but they can’t do what they know.”

[0] https://m.youtube.com/watch?v=JowPOqRmxNs

I used to be in the habit of trying to do things manually, trying to remember things without google assistant, navigating without GPS, not buying "Unnecessary" things like smarthome devices.

My first line of fixing mistakes was... nothing. I just assumed I would get better at things I do every day over time and no longer make the mistakes. Until I realized I would make a new type of mistake for the first time, then make it again the next day.

It almost seems like when I practice things the wrong action gets reinforced just as much as the correct action and I sometimes actively get worse with practice unless I'm carefully watching every step so there are no errors.

Now the fridge has a sensor so I don't leave it open, and I assume that the future doesn't exist, only computers are capable of remembering something at a future date.

I doubt I'll ever be able to do the stuff that really matters, the things that can't be done with plans and gadgets, like driving or useful levels of math, but onsite maintenance engineering is not a problem for me.

Then again, I'm pretty sure I have dyspraxia, not ADHD, I don't get distracted easily or have multiple thoughts running at once or anything like that.

Washington, December 24, 1848

Dear Johnston: Your request for eighty dollars, I do not think it best, to comply with now. At the various times when I have helped you a little, you have said to me ``We can get along very well now'' but in a very short time I find you in the same difficulty again. Now this can only happen by some defect in your conduct. What that defect is I think I know. You are not lazy, and still you are an idler. I doubt whether since I saw you, you have done a good whole day's work in any one day. You do not very much dislike to work; and still you do not work much, merely because it does not seem to you that you could get much for it. This habit of uselessly wasting time, is the whole difficulty; and it is vastly important to you, and still more so to your children that you should break this habit. It is more important to them, because they have longer to live, and can keep out of an idle habit before they are in it; easier than they can get out after they are in.

You are now in need of some ready money; and what I propose is, that you shall go to work, ``tooth and nails'' for some body who will give you money [for] it. Let father and your boys take charge of things at home---prepare for a crop, and make the crop; and you go to work for the best money wages, or in discharge of any debt you owe, that you can get. And to secure you a fair reward for your labor, I now promise you, that for every dollar you will, between this and the first of next May, get for your own labor, either in money, or in your own indebtedness, I will then give you one other dollar. By this, if you hire yourself at ten dolla[rs] a month, from me you will get ten more, making twenty dollars a month for your work. In this, I do not mean you shall go off to St. Louis, or the lead mines, or the gold mines, in Calif[ornia,] but I [mean for you to go at it for the best wages you] can get close to home [in] Coles county. Now if you will do this, you will soon be out of debt, and what is better, you will have a habit that will keep you from getting in debt again. But if I should now clear you out, next year you will be just as deep in as ever. You say you would almost give your place in Heaven for $70 or $80. Then you value your place in Heaven very cheaply for I am sure you can with the offer I make you get the seventy or eighty dollars for four or five months work. You say if I furnish you the money you will deed me the land, and, if you dont pay the money back, you will deliver possession. Nonsense! If you cant now live with the land, how will you then live without it? You have always been [kind] to me, and I do not now mean to be unkind to you. On the contrary, if you will but follow my advice, you will find it worth more than eight times eighty dollars to you.

Affectionately Your brother A. LINCOLN

After a lot of work in therapy and many different types and dosages of medications, I'm in a better spot. I've turned what was a problem into something I'm proud of.

Through putting my foot in my mouth so many times, I've grown an ability to say the hard, uncomfortable things. Building a lot of empathy and mental processes has helped me be able to approach conversations and situations head on with (some amount of) grace. I'm a better manager because of it.

However, humor is a requirement for working with me, it's a way I've diverted the impulsive thoughts into something less abrasive. I often wish I didn't make so many remarks or jokes but on balance it's not too bad.

Which is usually a requirement to be hired in my team.

I vastly prefer direct, humorous, and respectful coworkers like you over perfectly controlled machines.

An underrated employee with a superpower every org needs.

So far I've had "nice to meet you" calls with six or seven of the people on this team. And nearly half of them mentioned "by the way, I have ADHD, just so you know."

And since I share so many characteristics with these individuals, now _I'm_ wondering if I have ADHD. Certainly the never-ending Instagram ads want me to think so. Or is this becoming a blanket term for "I'm easily excited and a bit weird"?

Personally, I went almost my whole life with mild depression and didn't even know it - I just thought depression happened to other people, and that what I felt was normal. Then when a doctor gave me the questionnaire during a routine checkup and put me on SSRIs, it was basically life-changing.

So I wonder if this is another case of that?

The problem is that most jobs and almost all schooling is flat out incompatible with being an easily distractible person. I think it's just a phenotype that doesn't work well in the traditional professional environment.

And yes, Adderall will help you focus on boring shit.

[Source: I'm clinically diagnosed with ADHD)

Or I would have hobbies or activities I would want to do. But would end up in the same cycle.

Then at the end of my weekend I would feel down because I spent the entire past two days constantly task switching with zero enjoyment.

But on Adderall I am able to sit down and enjoy the first game / hobby I pick.

I found an exceptional game last weekend that I played through. I laughed, I cried, it was fantastic. I spent a lot of my free time on it, and beat it.

This weekend I was just a little disappointed I couldn’t wipe my brain and play that game again.

I don’t think that’s depression, it’s just being unwilling to put up with a game or activity being boring.

It's also a game you probably should go into not knowing hardly anything about it ahead of time. I've already accidentally spoiled myself on a few things looking for help getting past a couple parts that I wish I didn't know about ahead of time.

What's the game you played that you wish you could wipe your memory of and play it again?

It’s also fun because the source code is all in Python and just sitting there in the folders, which has made me interested in making something similar. Now to just write an interesting branching story…

Since I enjoyed it so much I’ve been branching out and trying games I wouldn’t have considered before, and just downloaded Vampire Coteries of New York.

And ADHD people in my experience aren't worse at activities that do require what I would call simple willpower. Things like race cycling or endurance running, where persisting through discomfort and even pain are necessary.

Give me a challenge, AND all the tools to conquer it, and I can get it done. Give me a lab environment with the servers and scripting tools I need to automate something, and I'll put it all together.

Hamstring me by not giving me the tools I need, make the barrier to accomplishment too much, or give me really boring work without some kind of clear path, and I lock up.

I can play Factorio for 12 hours a day when I get my yearly mood for it. When I am assigned a cool automation task with the tools available to BUILD it, I can run with it. Too bad my current job, a multi-billion dollar software company, can't spare me a few VM licenses without me jumping through hoops.

Oh, and Adderall can help, but it makes me so anxious and even more impulsive once I'm done with work.

I'd like to point out that, at least in the first two cases, the workplace is hoping you will lock up and the system is functioning as intended. This isn't a shortcoming on your part.

If you still feel compelled to be productive in those instances then a fun game is to dig into your employer's policy/security/IT hoops in order to identify the hidden workarounds in which you can get stuff done.

I'm really happy that ADHD has had such a limited impact on your life experience. However I think your statement is an unfair oversimplification & reads like a dismissal, whether you meant it to read that way or not. Very minor distinction, but phrasing it as 'most of MY ADHD' would have been much better.

The biggest hurdle for me, is management's expectation that I be passably as competent at staying on top of multiple async communication threads, and being on time for things.

Even if I say up front that "I will try and likely fail at following up with things that require me to check back in on things that may or may not have changed in a while, or remembering to respond to people." They eventually end up saying "I'm able to be in n meetings a week and manage k jira boards concurrently, surely you should be able to do x"

Nope. DM me or tag me if something needs a new look.

So no, it’s not only with boring task. I’d love to. My life would be far easier.

Heck I can have hyper focus on boring task because it’s relaxing.

So no. It’s not only will with boring task :(

My phone works almost in a pull-only manner - not many things are allowed to cause push notifications there. I can't imagine being able to get through my life with so many things constantly begging for my attention. I have to use ad-blockers and disable JS by default to browse the Web and keep some sanity. Neurotypicals don't seem to mind.

I never considered my self suffering from it, my quirks were individual parts of my character!

But now I highly suspect I have it.

I lose focus all the time. For example, Going from doing laundry, to gathering dishes, and bringing out trash without finishing one of them. Or I can't read long articles with topics that are important for me but don't tickle one of my interests. I've started reading countless books for only 20-30 pages.

Also, it feels impossible to plan for/estimate longer time periods and I'm constantly bouncing my knee or stimm in another way.

I started freelancing because I couldn't get to work at the same time every day and even now I just work 5-10h a week, because my lack of motivation for repeating tasks.

I thought, well it's biological, I can't have it, my relatives are all normal... But wait, my mother did impulse purchases all the time, was switching jobs constantly and even retired with 50, because of that.

Whelp, guess I should get a psychiatrist soon...

Anyways definitely seek a specialist, there are many options and even if it's not ADHD they've got access to a lot of really great resources to cope with what you do struggle with.

This is one of the reasons why I will refuse a job title that is greater than senior engineer. I know in my heart of hearts that being a staff or lead engineer will be bad for everyone. I'm not even particularly stellar as a senior engineer, but I can at least sustain it.

Reaching this point can be astonishing to the undiagnosed ADHD programmer. For the first handful of years into their career, their shortcomings were either dismissed as inexperience or covered for by coping mechanisms. In my experience, the coping mechanisms start to buckle once you're a senior level programmer.

Get a diagnosis ASAP if you suspect you have ADHD. Medication and other things can definitely help. I also think there's nothing wrong in figuring out just how much mental capacity you have to give to your job and not exceeding it, even if that means rejecting prestige.

It's frustrating and makes me often give up. I work in Ops, so it's not a day to day thing for me to write any code. Thankfully with all of the fires and different things to work on in Ops I think it's a very good fit for an ADHD person.

Ops I think can be great for this personality type. But it really depends on the exact ops job, and the person in question. Some ops jobs are more flexible than others, and I think flexibility is really what matters the most. I was an extremely productive sysadmin when I did that as my dayjob, but if you asked me to show up during any block of 8 contiguous hours we were going to have a bad time. If I could randomly show up at 3am to hack out that task I just remembered it was a great fit, since you'd get far more work out of me overall.

Debuggers or things like Sentry and Honeycomb. Basically everything that gives me runtime insights to the software.

Using static types and tests to ensure every dumb change I make gets caught somewhere.

Yes, I'm rejecting well paying jobs constantly because I couldn't bear to be employed and working 40h a week again.

We think differently, and tend to value others with similar "differences". The trick is avoiding an ADHD/Aspie monoculture. You need some people around to do the important, but less shiny stuff.

Can't concentrate on boring things - surely that's normal? It feels like they're casting the ADHD net wider and wider and from reading the internet I'm starting to question whether my behavior fits into the ADHD category. And part of me wants it to so that I have a label that explains and excuses me.

But how do you separate it from this boring hyper-specialized world of bullshit jobs? As someone said it's no measure of health to be well-adjusted to a sick society. I love Doug Stanhope's take on it: https://www.youtube.com/watch?v=kKyMvjPJdtM

Neurotypical people can get stuff done even if it's of no interest to them or if they find it boring because it has to get done regardless. I've certainly had the experience of assigning something to an intern or trainee that's super boring and they just knock it out, even though they could care less about the subject of task itself.

People with ADHD have lots of difficulty with tasks or subjects that are not of interest to them, which leads to procrastination. They often wait until the last minute (often it's those people who say "I'm good under pressure"); if the consequences are serious enough, that causes them to focus on getting the task done. Pulling an all-nighter to get that report done doesn't scale and it means something else important isn't being attended to.

Dr. Andrew Huberman (Stanford neuroscientist) has an excellent podcast about ADHD [1].

[1]: https://hubermanlab.com/adhd-and-how-anyone-can-improve-thei...

It not only doesn't scale - you develop a resistance. Because you managed to pull it off with that all-nighter, next time you won't leave it for the last 12 hours, but the last 8 hours instead. If you still manage to do it, then next time you won't be able to get to it until it's 6 hours till the deadline. And at some point you start to fail. At the beginning it's not a big deal, as you were always delivering and everybody fails sometimes - but that only makes you even more resistant and eventually, it becomes the norm. You fail hard.

Of course this is simplified a lot - it's not "next time", it may happen over the course of several years, get better and worse periodically, etc. But that's the trend anyway.

It's not that I think "Well, this is boring, I won't read it!"

It's like I want to really read it, suddenly I'm on Twitter, Reddit, 9gag, IG, etc.

It happens in a matter of seconds to minutes and I don't even remember how I opened an app/website.

I can dampen this effect a bit by blocking websites and uninstalling apps, but then I zone out in my mind and don't remember what I read.

I'm not saying ADHD isn't real, just that environment-induced distractions aren't it.

The idea being, social media and the like became so bad in the last 10 years, that there is no functional difference between inherited ADHD and acquired ADHD. The only difference is that the acquired one might be curable.

However, at that point it becomes hard to do anything else before finishing that book...

Normal people can concentrate if you pay them money to concentrate. ADHD people can't concentrate with such incentives, they are people who require intrinsic motivation to concentrate and money/other rewards aren't enough.

I dropped out of high school after moving from private to public, since it was utterly worthless and a waste of my time. I logically knew I could just stick it out another 2 years and party, but I literally could not force myself to wake up to do it. I contemplated suicide over this, so it's not something I was taking lightly at the time or not caring about. I ended up just taking the GED one day on a whim.

Then I went on to have a somewhat successful career. It took me years to realize/internalize I'm not just lazy - something is different about me. Very few folks in my peer group could keep up with my work ethic once I found things I was interested in. For me this doesn't mean I only do the "fun stuff" - it means I need to see results of my effort, and those results need to be meaningful. I also need to work on things with a definitive "end" to them - not a never-ending project that won't see a single real-world result for years.

I describe it to folks that I am literally allergic to busy-work. You could offer me a million dollars to do some busy-work task for a month and I already know I'd fail at it before I started.

If the consequences or rewards are large and immediate enough you can kind of "push through" it - but if it's some concept of a future consequence or reward the brain simply decides it does not care.

This is all pretty difficult to nail down I think because I'm simply describing what other folks have certainly felt to some degree. The difference is I don't know many folks who will trade weeks of mental anguish and lots of money to avoid doing a 30 minute task.

That said, lazy often looks pretty damn similar and it's easy to have an excuse on hand.

You nailed it here - anticipation for results is one of the greatest motivations I can have. If it's not there, things get really hard. I don't think it can be sufficient on its own, but it sure needs to be there.

That said - some kinds of what's essentially busy-work can be pretty rewarding in this regard too. There were periods where I caught myself doing plenty of non-creative and rather trivial distro packaging at work just because it was providing me with a quick feedback loop. It wasn't interesting or challenging, but a meaningful chunk of work could be completed before I got bored and seeing it done was rewarding enough to keep going.

It's easy - most people can just decide that they're going to do the work they need to do even if they loath it. They won't be happy, but they'll do it. They may even actually be happy if they're compensated enough.

Other people cry into their pillow hating themselves because they can't manage to do simple things they have to do just because they aren't interesting enough, even though they try hard and may wreck their lives by not doing them.

Not if it happens 24/7 across work, hobbies, and remembering to go to bed on time. (This is about struggling at work with ADHD, but it's more often possible to succeed at work and neglect everything else.)

And "bullshit jobs" are a fake concept. Just because a guy wrote a book saying he doesn't understand a job doesn't mean it's not useful to someone.

Every single one of those books hit a point where they stopped being something I could read. I don't know why. The subject still interests me and there's more to learn. I know I should finish them, I consciously want to finish them. And every time I think about sitting down to finish them, my mind will come up with a thousand other things for me to do instead. And it's not just all "interesting" vs "not interesting". My mind will decide that cleaning the dishes, filling up the car or sorting through and deleting all the emails older than 7 years is something more important than finishing any of those books. I assure you the topics of those books are vastly more interesting to me than any of those chores. But for some reason my lizard brain has ranked reading and finishing those books below even the chores.

I finished one such book in the last 10 years of my career, and I only did that because I made finishing it part of a annual goal / metric. And even then it took until the last month of the year and I had to dedicate a fixed time every single day where I forced myself to sit down and read a fixed number of pages no matter what.

That's more than just "can't concentrate on boring things". Those topics aren't boring. Reading isn't boring. The chores my head will convince me to do before reading those books are more boring. And yet those books will remain unread, at least for years, and if past performance is indicative of future behavior, for the rest of my life, because it's impossible for me to sustain the amount of focus and sheer determination it would take to finish those books they way I finished one. Unless and until my brain moves them up the "importance" list, they will forever remain yet another thing I've started and never finished.

And it's not just a "maybe you just find reading non-fiction really boring", it happens with other forms of media content. John Winans (John's Basement on YouTube) has a series he's been doing on building a Z80 computer from the board design up. Massively interesting stuff to me, a subject that I've always found fascinating, having grown up after the home brew computer generation and never having gone into hardware even though I really want to know more about it. The original video dropped over a year ago, and at first I was following with each new video and then one day my head decided this was no longer a priority. He's made 54 videos so far and I've made it through 22 of them. I have a tab with the playlist open. That tab has been open since last year, and the last one I watched was 2 months ago, before that it had been another 3 months and 3 more before that. When I finished the last video, I wondered why it had taken me so long, I was really enjoying it. And then I have't been able to get my head to want to start the next one. I've watched multiples of hours since of other videos. I've had days when I was bored or sick and just watching whatever dumb content caught my eye. The list was there there the whole time, and I never could get myself to keep going. Again, I can't explain why, there's nothing boring about the videos, they're certainly more engaging than a lot of content I've watched since I watched the last one. But the list sits there, more videos get added, and the longer I go, the more the act of watching the video feels like an insurmountable boring chore that will take everything I have to sit down and do, even if I know I'll enjoy the content the entire time.

I've mentioned here before I started ADHD meds for myself after the pandemic started. That was the fist time in decades of living that I had ever been able to think about something I wanted to get done, decide I was going to do it and then do it without going through a process of fighting myself into it. It's probably the only reason I've watched the 3-4 videos I did manage after my brain decided they weren't a priority any more.

And all of that self struggle and fighting is for things that I don't consciously think are dull or boring. It's worse for things I do. Imagine a task that you have to physically and mentally psych yourself up for. Maybe it's going to the doctor for a physical, maybe it's visiting family on holidays because they're party green and you're party yellow, maybe you're trying to get in shape and it's going to gym or waking up at 5 AM to go for a run. Call this your big hurdle. Now think of all the things in your daily life that are "boring". Making food, washing dishes, putting them away, washing laundry, putting that away, filling out TPS reports, documenting changes, making appointments, cleaning rooms, paying bills. Imagine that the same effort and energy you have to put into your hurdle also has to go into any mundane "boring" task that isn't in the top 3 things you'd rather be doing right this moment. That's so much more than "can't concentrate on boring things", and so much more exhausting.

I'm undiagnosed, but have already made an appointment after reading a similar topic on reddit earlier this month [1]

[1]: https://www.reddit.com/r/getdisciplined/comments/z1usgt/advi...

Or if you think about your thoughts calmly, at a distance, what pops up?

When you try to imagine let's say a chess board and the pieces on it, does it look clear to you? Or do you have difficulties controlling your internal visualization?

(if anyone also with ADHD wants to answer, feel free)

When I try to phantasize something to calm myself down for sleep, I often end up thinking about something embarrassing or hurtful from the past. I can't control it, it just happens and when I notice it, I alread ruminates some time about it and don't know how I got there.

But besides that, I don't have problems to visualize things in my mind. I just have to do it consciously, most of the time I think in concepts.

However, I’m not sure if this is an experience exclusive to ADHD.

Is this a generational thing? I mean, are these people in their early 20s? I'm in my 30s and would never say anything about my mental health in a phone call with a stranger unless my boss is bringing up this subject with me on a one-on-one.

That said, I still haven't brought it up with anyone at work because of the stigma around it. It's tiring pretending it's not a problem for me though.

I think you're right that it's a generational thing. More people know what it is, are less judgemental, or know they have it themselves. Also, a lot of people don't see it as about mental health in the same way e.g. depression or BPD is. (Unsure if that's what you were implying though!)

Statistically that seems rather unlikely, so I wonder if people are being over-diagnosed?

Over the years it's turning out my entire since-college friend group have some sort of mental health disorder that's been missed for 30 years.

If I found a team with a couple other ADHD folks that seemed to be thriving that company would be top of my list for sure.

Some industries and workplaces are better suited for ADHD sufferers as well. My ADHD got in the way in most of my other jobs before I became a developer, where it's actually sort of an asset. Perhaps OPs job attracts a certain type.

Probably because ADHD people have trouble getting along with neurotypicals

In our defense, normies suck.

I have a very small circle of friends and they're all kinda... special. So for me such behaviour feels normal.

Society forces everybody to interact socially. In a society where everybody is expected to date anybody, forcing somebody to date is still abhorrent.

No, the premise you require in order for me to be wrong is that society forces this on everyone, but I live with a woman who has crippling anxiety to the point of being on disability for it and I can tell you that's emphatically untrue. Even SSI related meetings happen over the phone because of her disability.

Those with ADHD have many challenges that other people don't have, but asking the whole of society to suddenly be able to understand them better is like asking all women to be start preferring short men. It just is, and those with these challenges will have to learn how to deal with them (and you see posters on HN all the time talking about how they've done just that). For those for which it's truly debilitating, we need to make sure they don't fall through the cracks (and for the most part we do this).

It's as much a part of reality as the person with 2 missing thumbs having more difficulty grasping things than someone with both thumbs.

Yes, society changed to help people as much as possible. With changes your living-mate can interact with society as well as possible. Sure, the missing thumbs are disabling, but somebody insisting on hand-written instead of typed notes is an asshole. At some point, people who ignore a disability or disorder because of general ignorance or worse are the problem.

I mean, I get it. Every time I point out other groups have challenges too, you're going to attempt to explain why those challenges are not relevant to this conversation.

And when you're done with this conversation, you'll be in the same spot you were before.

That might be a lot percentage-wise, but it's also a really small number of people to draw conclusions from, isn't it?

I mean, if you look at early 20th century jobs most similar to office jobs today, they look from the outside, and are depicted by contemporary media, as crushingly dull—but, they had the benefit of also being highly repetitive, stack of papers to go through, do the thing you do, put it in the outbox, move to the next stack. Now everything's every bit as dull, but we're also expected to juggle a much broader set of not-terribly-similar tasks, often taking on little bits of what used to be the jobs of entire, dedicated humans before computerization "freed" companies to smear those tasks across their entire workforce. That seems like a recipe for failure for someone with ADHD-brain.

"Overdiagnosis is defined here as occurring when a person is clinically diagnosed with a condition, but the net effect of the diagnosis is unfavorable. Misdiagnosis (when a child is incorrectly labeled with an ADHD diagnosis instead of an alternative condition) and false-positive diagnosis (when a subsequent clinical encounter reveals a wrong initial diagnosis) are not the focus of this article."

Unfavorable here is:

- medication can have side effects

- it might be used as an excuse to stop trying/caring

- there's a social stigma

2) Your second link provides no evidence of drug-seeking behaviour. It only claims that it's possibly to get a high score on an ADHD checklist with fake answers. It makes no claim that people without ADHD actually seek an ADHD diagnosis to get prescription stimulants.

Note that I'm not claiming they aren't, just that this article doesn't support that claim.

3) The third link is just an article on time with the headline that 1 in 4 adults who seek treatment are faking it. I can't find any reference to this number in the article body, nor a link to the paper.

I think this is the paper: https://www.researchgate.net/publication/46282569_Effectiven...

Color me surprised: this one does actually support the claim that 22% are exaggerating symptoms. There are of course some limitations to this study. And it makes no claim that those that are exaggerating symptoms are doing so to seek medication (again, I'm not claiming otherwise).

The good news is that there are methods to identify these patients. And given that this study is from 2010, I hope that those are in use to aid with (mis)diagnosis today.

Mitchdoogle, do you have any other evidence to support your claim of overdiagnosing and drug-seeking? In the future, please take the time to read through the articles you link. And please take the time to read the last paper before you reply.

... So if, let's say, the existing treatments for some disease are bad and often make the problem worse, then the people designing this terminology consider the problem to be "the disease is diagnosed too often" rather than "doctors treat this disease badly"? And the solution to be "avoid diagnosing this" instead of "change the way doctors treat or don't treat it once it's diagnosed"? I mean, that's what the term seems to imply.

Wiki agrees with you... and with me:

> Overdiagnosis occurs when a disease is diagnosed correctly, but the diagnosis is irrelevant. A correct diagnosis may be irrelevant because treatment for the disease is not available, not needed, or not wanted. Some people contend that the term "overdiagnosis" is inappropriate, and that "overtreatment" is more representative of the phenomenon.

And many of us (and many, many published articles) suspect big pharma of making docs drug pushers.

So many fingers pointing in all directions!

>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042533/

That's for children and adolescents just fyi

I was incredibly lucky, once I got into software dev, that my untreated ADHD often manifested in hyperfocus, so I could deliver large amounts of business value in bursts, that meant my other foibles were tolerable.

Of course, my spending 20 hours of a day hacking on something for a week was very hard on my family, but at least I stay employed.

I much prefer being medicated. The symptoms are still there, but manageable. I still need lists to ensure I don't forget things, but at least with medication I a) remember I have a list and b) remember to use it.

So many times previously, people would say "Just write a list, how hard is that?"

It was quite hard.

1. Remember to keep a list

2. Remember to update the list

3. Remember to check the list

4. Start a new list because I can't remember if / why I care about anything on the old list

(Personally, I've never started a list but I can imagine how it would go.)

On balance, this shift in my attitude means I definitely use more simple organizational tools more often than I did in the past, and that has certainly helped my productivity.

  * Christmas / birthday ideas
  * House TODO
  * Project ideas
  * Car maintenance

I'm always writing emails, and I notice that I've got things in my drafts folder, so it reminds me to keep it updated.

That said, gaining those skill and having treatment feels like a superpower

Treatment - whether medication or otherwise - will help you to focus, but it won't magically teach you organization, time management, note-taking, active listening, etc.

The explosion of resources for ADHD adults has made it a lot easier to understand ourselves and how we work, but that information hasn't necessarily made it out to the neurotypical world.

I have always shied away from seeking an adult ADHD diagnosis, partly because of prideful denial (not wanting to acknowledge that there might be something wrong with me), and partly because I have no faith in the NHS giving a shit, since I am an otherwise health and successful 30-something.

I take daily ritalin - outside of the first few days (which were dramatic) I haven't had a life altering experience on the drugs, and tbh it doesn't change much whether or not I take it. However, having a diagnoses changes the way I approach things in life - it's helpful to know why my brain works the way it does, and how to work around it and with it. I don't think you need a formal diagnoses for this though.

It's extremely helpful to take a big dose just before a long meeting, to be fair. Where previously I'd struggle to even make it through, I can now be engaged.

Your description of ritalin is similar to what I found when I took my experiments further and tried modafinil for about 18 months. It was just about effective enough to justify the (legal but awkward) way of obtaining it. Speaking to a doctor would of course be the sensible next step if I wasn't so bloody stubborn.

> not wanting to acknowledge that there might be something wrong with me

I had a similar mindset about a diagnosis. Here is why I changed my mind:

The purpose of the diagnosis is to guide a course of actions that may improve your life and that of the people around you. It is the opposite of an excuse because getting help is good for you and others. You need never disclose to anyone that a diagnosis affects you but it can be helpful for others to understand some characteristics about you.

ADHD (and many conditions) isn't something wrong with anyone. It is a term for a cluster of cognitive/behavior differences in the area known as "executive function." [0] These difference can be thought of like height or eyesight in that they can be [dis]advantageous or not and they can be compensated for or not.

The choice to go on the road of self discovery is your own. As far as I can tell there is nothing to lose and much to gain.

0. https://en.wikipedia.org/wiki/Executive_functions

But I'm still glad I sought help, even if it didn't fix the underlying self-doubt and self-derision.

None of it worked. Medication, so far, has been life changing.

I consulted a therapist for many months (which I also hoped would help with this) and she confirmed that I should seek out medication.

I don't want to promote any specific company, but I had a really good experience with one of the newest online medical startups (check reddit for recommendations). I was able to make an appointment, talk to a doctor twice in two days, and get my prescription and medication within 48 hours of signing up... I'm lucky to be in the US right now (I'm not a citizen, just working here legally). Out of pocket (i.e. without any insurance) it cost me roughly speaking $250 all in all which is extremely reasonable...

And that's why you see a professional. If you don't, you'll never know. It's hard, it's embarrassing, and ultimately, it can be redeeming to know that no, you're not just lazy.

In the US it's even easier. There is a profit motive in the US to get people onto lifetime medication, and many websites for online diagnosis and delivery. If you have private insurance, it's easy - just self refer to a psychiatrist, list your ADHD symptoms, get a prescription. There's even an Adderall shortage in the US right now - demand is outstripping supply. Adult ADHD seems to be rising dramatically in western countries.

My thoughts are that a lot of people, esp. intelligent ones, will have a lot of symptoms of adult ADHD. It might even be something normal in people near the top of the IQ bell curve - so especially common in tech workers. I think that what you have, and others, could be diagnosed as mild ADHD, maybe moderate. It's nothing at all like severe ADHD - which would make it literally impossible for you to have a career or get a degree without medication. These are the cases generally diagnosed in children because it's so obvious.

So... what to do? You can get a private diagnosis and get medication. It will probably help you a lot, at least initially - you'll be able to crank out 8 hours of boring ass work no problem. Over the long term, you will suffer some side effects - worse sleep, tolerance builds up, and your ADHD symptoms will likely get much worse if you stop medication.

I have mixed feelings about it all. I also identify w/ a lot of the ADHD symptoms (and I've been trying to get an NHS diagnosis for ages, and am going to seek out a private one next year). But with good sleep, exercise, and various other techniques, I think I can manage a successful job/career without needing meds. I found WFH really hard though, but in the office I can manage. It's really hard to know where I am on the "normal" curve though - I don't know anyone who doesn't suffer from procrastination to a degree, or struggles with boring tasks, who themselves are not on medication.

I think the thing you might overlook with this statement (truncated slightly) is that sometime people are able to mask their symptoms, especially those who are highly intelligent and who may fall into an "inattentive" diagnosis, rather than the "hyperactive" side. I agree there are different levels that the affect can have on folks, however there is a difference between the boredom/procrastination/etc. struggles with someone who has ADHD and someone who doesn't. It's isn't just something that "everyone deals with to some extent or another". And proper diagnosis techniques will also sort for false positives, to eliminate folks who are actually "just bored", for example.

That said, this is something that studies have shown very much needs to be addressed not only from a medication aspect - sometimes it is definitely necessary and in many cases all the behavior techniques in the world won't make up for the chemical imbalances. But it should also be addressed from a behavior standpoint, via CBT or other therapy as well as other wellness techniques you mention, like good nurtition, sleep, exercise. From the studies I've read, the best results come from a combination of the two, not from ignoring or promoting one over the other.

Nothing like this should happen. They will improve your sleep and your symptoms will get better over time without medication.

If you get tolerance, take magnesium and NAC.

Stims? Definitely not in the long term IMO - I am fully with the parent comment here.

I agree that if you don’t plan on taking medication there is no need to seek a diagnosis. Unless you want to get involved in ADHD support groups and stuff, where you’d (imo rightfully) draw some errant looks if you admitted you’d never been diagnosed with it.

For me the medication is life changingly effective so I’m very glad I got formally diagnosed at 25

- Help via CBT and other thereputical techniques.

- Knowledge of what's imposter syndrome and what's a real issue you're facing.

- Allowances (the legally required ADA type) at work.

I get the concern about the NHS (private support options are available too if that’s an option for you) but I would definitely try to move past any stigma concerns - no one cares (in a good way) :) personally I don’t think it’s a big deal and that shouldn’t get in your way of pursuing answers if that’s the right path for you to take.

Short answer: yes, there's lots of evidence of genetic factors. One reason this isn't better understood is that a close relative can have undiagnosed ADHD, so people don't see the family ties. And also because it's stigmatized in some families, it's like a "don't ask, don't tell" situation.

I mentioned a great podcast by Dr. Andrew Huberman, a Stanford neuroscientist earlier in the thread that mentions how the genetics of ADHD works [1]:

[1]: https://news.ycombinator.com/item?id=33960655

Doesn't mean there isn't also some nuture involved also, likely not the "over-stimulation" argument you make, but more likely the "if you have it, more likely to recognize it in your children" type of thing.

From the following link

> Decades of research show that genes play an vital role in the etiology of attention deficit hyperactivity disorder (ADHD) and its comorbidity with other disorders. Family, twin, and adoption studies show that ADHD runs in families. ADHD’s high heritability of 74% motivated the search for ADHD susceptibility genes. Genetic linkage studies show that the effects of DNA risk variants on ADHD must, individually, be very small. Genome-wide association studies (GWAS) have implicated several genetic loci at the genome-wide level of statistical significance. These studies also show that about a third of ADHD’s heritability is due to a polygenic component comprising many common variants each having small effects.

> Family, twin, and adoption studies provide a firm foundation for asserting that genes are involved in the etiology of ADHD.

> Adoption studies suggest that the familial factors of ADHD are attributable to genetic factors rather than shared environmental factors

> A similar heritability estimate of around 80% was seen in a study of MZ and DZ twins, full siblings, and maternal and paternal half-siblings

> There can be no doubt that DNA variants in genes or regulatory regions increase the risk for ADHD. In rare cases, a single genetic defect may lead to ADHD in the absence of other DNA variants. We do not know how many of these rare variants exist or if such variants require environmental triggers for ADHD to emerge. It is equally clear that no common DNA variants are necessary and sufficient causes of ADHD.

It doesn't preclude environmental factors either:

> The convincing evidence for genes as risk factors for ADHD does not exclude the environment as a source of etiology. The fact that twin estimates of heritability are less than 100% asserts quite strongly that environmental factors must be involved. ADHD’s heritability is high, and that estimate encompasses gene by environment interaction.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477889/

ADHD is supposed to be a diagnosis of last resort that they give after eliminating all other possibilities. It's useful to know the root cause of whatever problems you may be having.

Some studies and some individuals report benefiting from certain nutritional supplements if you get a diagnosis and want to treat it without medication per se.

He also has some health issues and can't pay attention when he's under the weather.

There can be lots of reasons someone has trouble concentrating at times.

If you have to deal with NHS for ADHD, them giving a shit is the least of your problems. Getting an appointment with a dedicated specialist is the hardest thing. Currently the waiting times are 6 months to 2 years.

However, I eventually discovered that I could improve my executive functioning skills by getting ten hours of sleep a night and engaging in intense exercise. These changes have made a huge difference for me and have greatly improved my ability to manage my ADHD. I'm glad that I was able to find alternative methods that work for me.

I've been on several different stimulant medications for ADHD. They all make me anxious, even the one I'm taking now.

Adderall: Grinding teeth, anxiety, didn't like feeling euphoric ("good" for no reason), stomach pain

Vyvance: Same as above

Focalin: Better than both above. This is what I'm currently on. It works for me well but it still comes with some side effects. I have stomach pain pretty consistently after taking my dose, and I have anxiety throughout the day.

It's unfortunate. I absolutely need these meds to keep my life in order, but they honestly suck pretty bad.

In particular: atomoxetine (Strattera), bupropion (Wellbutrin), guanfacine (Tenex), and — if everything else fails — tricyclics such as nortriptyline (Pamelor/Nortrilen).

Now when I take any stimulant after a couple hours I start to feel dehydrated and light headed. If I continue using for a couple days I am unable focus on anything except a couple intrusive thoughts.

Different medications work for different people, so please don't ignore ADHD treatment! It's a powerful tool, just be careful not to cut yourself like I did.

Definitely would recommend anyone who has serious suspicions about themselves to get checked out, especially if you found academics intuitively trivial through the 'typical' diagnosis years of ~8-14.

I've been programming for a long time, but I only got neuropsych testing about 10 years ago. I was unambiguously diagnosed with ADHD, and I've been on stimulants ever since.

Despite all that personal experience, I still found that her ADHD videos connected a lot of dots for me. The videos also give some practical advice that's working well for me.

[0] https://www.youtube.com/@DrTraceyMarks

The memory issues were probably some combo of poor sleep / stress / aging. But the testing did reveal massive ADHD as well as (probable) mild Asperger syndrome.

Interestingly, this was after I'd already earned my PhD. It's a little sad to think how much better my career might have gone, and how much faster I could have finished grad school, if I'd known about the ADHD.

I really used to beat myself up over the whole "wasted potential" feeling I'd get. Especially so after my teachers were fifty-fifty "you have great potential, apply yourself" and "you're a jackass, you won't amount to anything".

I always wonder how things could have been different. If I might've got into some irl engineering instead of software, or just advanced in my career faster, etc.

My biggest hope is that my sporadic deep dives into different subjects will eventually lead to a good idea to invest in, or some oss i can get sponsored to save me from the despair of competing/comparing against my neurotypical peers with degrees.

As mentioned in the article, a large component of the struggle is executive functioning, but there are tools like Double [0] that aim to provide a way to get around that struggle by pairing people up to do the same task together. It's actually a really neat concept that extends beyond ADHD![1]

[0] https://doubleapp.xyz

[1] https://en.wikipedia.org/wiki/Social_facilitation

I was diagnosed fairly young (some time <10 years old), because my mother is a pediatrician, did research into my behavior, saw signs, and had me diagnosed by a doctor. For most of my life up until my late teens, I was on a regular regimen of stimulant ADHD medications (in addition to the other structure imposed on my life by middle+high school and living at home). I did very well and got into a top public university.

Once I left for college though, my life fell apart. I had no one to make sure I was on a schedule and taking my meds. I basically quit taking my meds, struggled to attend class & do assignments, and nearly flunked out of school a couple times.

I loathed myself. I thought "what good am I, if I can't function without the pills?" This was a toxic mindset, but I stuck to it through college and for a few years after. I think the only thing that saved me from total ruin was the fact that I found tech work so engaging that it never felt like a chore to me, and I was able to succeed despite my false start.

Being off the meds forced me to develop a lot of coping mechanisms I never learned as a kid. I externalized a lot of my executive function into reminders, calendars, and habits. I cut away all unnecessary tedium in my life. I became addicted to coffee, because (surprise!) stimulants helped my symptoms & dealing with life in the workforce.

About a year ago though, I decided to start on meds again. They aren't a silver bullet for me of course (the real silver bullet all along was having my mom's structure and support in my life), but they help a lot and I can notice the difference. It's so much easier to deal with necessary tedium when I have the meds in my toolbox again. I don't feel the need to be on them 24/7 (probably a good thing), but it's nice to know I can take them and not feel shame about it anymore.

It's really, really frustrating knowing help exists but I can't get it, be it therapy or medication. It actually makes me angry, I read stories of people whose lives have gotten so much better, but around every corner all I find are brick walls.

I tested high-IQ, I did amazing in secondary school, but college and the workforce have been rough. I don't usually stay at a job for more than 2-4 years before the executive functioning problems accumulate to a degree that results in termination, and I've been negative on myself my entire life, told I was lazy, told I was immature or a baby (I'm 50 years old!), etc. etc.

I have a 17 month old son and I'm looking for steadier employment as I've been freelancing for years now (partly to get away from the inevitable judgment of the usual boss) but the pay is spotty. My partner is anxious about my future earning potential given we have a kid now (let's just say "this has impacted our relationship"), and I absolutely cannot stand the flakiness and the rejection and the constantly being measured by someone else's ruler that is part of job application (I had this problem whenever I dated, too). Years ago I noticed that I could not emotionally tolerate applying to more than 1 job a week because the rejections just withered me... "rejection sensitivity dysphoria" is a thing I apparently have. (I couldn't take more than 1 rejection a night from a woman when I was out and about as a single person, either... This might explain why I only found my partner at 39, and possibly why I was basically sexually addicted (sorry, "on and off again") to a prior partner prior to that despite that person being bad for me in numerous other capacities (those dopamine hits are everything!).)

Do you think video gaming is simultaneously more appealing to this type but also makes it worse?

And also, at what point is this more of an excuse than an explanation?

Given that you should not generally disclose your health issues to bosses, how would you even find accommodating work (in, say, technology) with this "limitation"?

I've always felt like doing uninteresting things felt like wading through 3 feet of water, but I assumed everyone felt that, and that I was just lazy.

The biggest realization I had was that I have been using negative feelings/emotions in order to get stuff done for years. On the outside I looked like a productive, healthy person, on the inside I was beating myself down all day every day, and that behavior didn't lead to a great relationship with myself.

Now that I'm on medication, my brain actually rewards me for doing boring stuff. I see a dish in the sink and I want to rinse it and put it away because it feels good.

tldr; Just because you lead a successful, healthy life, your own perception on how hard life needs to be may still be skewed, and treatment for those who have been diagnosed with ADHD can really up your quality of life

Yeah, those years of negative self-talk, there's a lot of learning to be kind to yourself that comes with a diagnosis.

My biggest killer is meetings. Especially the boring, pointless kinds that have nothing to do with my actual work (like the one I'm sitting in right now where they collected everyone in the product team to ~look forward to 2023 and what your role in all that is!~ (please shoot me)) that drag on for what feels like eternity, slowly sucking away any and all excitement about the day out of my life.

It transports me back to primary school, where you were stuck in a room with no escape for a large chunk of your day. If I had absolute power, the one thing I'd do for those like me with ADHD would be to make meetings over 10 minutes illegal and punishable by a Ludovico Technique style torture method, let's see how they like it!

I’m definitely guilty of this.

Keeping track of that logistical stuff is a nightmare and is directly incompatible for most with ADHD. And then as the ADHD worker progresses in their career, they no longer get a secretary who would have offloaded these incompatible tasks for them previously. This new setup distracts ADHD workers from focusing on what they’re good at. It then becomes a terrible look to a neurotypical (NT) person when an ADHD person forgets a meeting or a little request that isn’t part of their core work. To an NT individual, forgetting to do these little things is baffling, but it’s a part of having ADHD.

Add in an environment where people want to have meetings all the time and instant messaging services constantly pinging your computer, and I can see how the modern workplace is a very tough situation for an ADHD worker to demonstrate that they’re going above and beyond when their workflow is not catered to. I do think the shift to working from home from the previous open office layouts is very much in favor to those with ADHD, so it’s not all bad.

Perhaps one day there won’t be such a stigma against neurodiversity where those who are neurodivergent (ND) have to hide it and mask during the entire working day. If we reach that point, we’ll be able to put ND individuals in environments that let them achieve their full potentials and thrive in situations where NT individuals cannot.

[0] https://www.bls.gov/ooh/office-and-administrative-support/se...

While the surrounding conversations can be distracting to a degree, it's significantly better than the distraction that is slack notifications. A conversation among other members of my team happening around me is something I can either tune out entirely, listen with half an ear or wind down what I'm doing and start paying attention to all based on what I hear while I'm doing something else. But slack (and other remote communication systems) require me to stop everything I'm doing and switch my attention exclusively to sorting through conversations that are or have already happened. And when someone pings me for attention in person, I can ask them to give me a moment to finish up without actually taking my attention away from what I'm doing to see who and what I'm being pinged about in the first place.

Additionally, my experience is that remote work tends to increase the likelihood of meetings being scheduled at odd hours like 10:30AM or 3PM. For whatever reason being in person people seem more likely to try and schedule at the beginning or end of a morning or afternoon block (e.g. 8AM, 11AM, 1PM or 4PM). That sort of scheduling is much better for me because something in the middle will effectively cause me to lose a bunch of time right before or right after since it takes so long to "spin up" into a task, and once there I run a high risk of me losing track of time.

Obviously MMV but the modern office seems to work well for how I experience ADHD. That said, I don't think I would have done well in say 70's era IBM offices, and did terrible at a GE office way back at the beginning of my career which was effectively a set straight out of Office Space.

[1]: https://add.org/the-body-double/

https://www.youtube.com/watch?v=6T9LQ5kqOqo&list=PLzBixSjmbc...

ADHD has caused me a life of chaos. Aside from the "fitting in to corporate requirements" I just have absolutely no chance of stability. Chaos, risk, impulsivity, drugs, drink ... all these things are required to keep dopamine levels at a functional baseline.

Get me coding or debugging an interesting problem, and i'll neglect to eat or sleep to get the job done.

I'm so thankful my brain finds coding (some of it) stimulating enough to earn a living from it. Without coding, i'd be dead or in prison.

For me, the bigger struggle came late-college/post-college when I had to manage boring and diverse real-life tasks, like acquiring the right documentation to go to the DMV for a new license. I paid crazy numbers of late fees and came close to some serious real-world consequences here. Getting treatment, reading Delivered from Distraction, and leaning on friends/partners made a really big difference. I'm now in my 40s and life things are very safe, stable, and happy (though I'm still constantly distracted).

I guess I'm writing this (from a throwaway) to say - don't feel like your problems are invalid just because you coped ok until your 20s!

Of course, that's in an ideal world. In reality you'll be forced to take part in hour-long-plus meetings to decide the simplest of decisions (or just blather on needless about decisions that were already made and written down, ughhhh)