Ask HN: My 12 year-old nephew just got diagnosed with ADHD, any advice?

Psychotherapy sometimes feels artificial since if what works would feel natural or obvious, well... we wouldn't need therapy, which is a handcrafted intervention (n=1). This is *really* important to remember while you are trying to improve/do therapy. More on this later [1].

A better mental model for reward-based interventions is to think about your inner "reptile brain" as a weighted graph that connects things (stimuli) with emotions and behaviors. Those connections are mostly learned throughout your life (and therefore "artificial"). And your brain is trying to find the happiest (and laziest) path in this graph.

A very motivated person tends to have a great graph that connects stimuli like "answering emails at 9:00 with music" to "happiness" or "hitting the gym" with "muscle soreness" and with "happiness with realization" and "tasting the morning coffee."

If your lazy, hedonistic, dopamine-maximizing brain does not have a path from the behaviors you want to create (e.g., answering emails) to something pleasant, it will be hard to make that a habit.

In a very explicit way, this sometimes looks like a point system. But don't think about the points. You have two very important tasks:

1. Find your "natural" rewards: coffee, watching TV shows, going for a walk, whatever you want to do, sex. And don't forget about internal rewards: self-respect, pride, nice words for yourself. Add to the mix social rewards: share your achievements... Each person is more sensitive to a different set of rewards. Find yours and pick the ones that make sense for your life context.

2. Make those rewards contingent on your goals. For example, I try to answer important emails first thing in the morning, especially those I want to avoid, and after that I go out for a small walk or have some tea.

Over time, you will internalize that conditioned (artificial) emotion for tasks that before felt horrible. Like many are able to feel nice when they have muscle soreness, because it was conditioned over time to something nice: social reward, internal/verbal rewards, techno music, whatever.

Don't forget to be nice to yourself, start simple with small goals, forgive yourself if you don't hit every goal at the beginning.

[1] Understanding this helps a lot in therapy or "self-intervention" because if you don't understand basic behavioral intervention and why it works, sometimes the intervention itself seems childish or stupid, and that hurts the efficacy. There is a huge body of research that shows that if the patient understands the therapy and has a mental model of it, it works like magic because we change from "I am doing stupid things because my therapist is saying them" to "I am nailing this, what a behavioral change I am making. That's great—in a few weeks I will be able to do X."

Second, medicine is helpful, but it's not a panacea. Also, two common ADHD medicines in the US face FDA-imposed shortages, so prepare for many calls to the pharmacy.

Also, ADHD is not just hyperactivity and attention--it impacts emotional regulation, impulse control, task initiation, time management, and other things related to executive functioning.

Finally, ADHD isn't bad. I like to think of it as an insanely strong, overenthusiastic hippopotamus--if you work with it and get to know it better, you will be able to have a hippopotamus friend, which sounds handy, but there's always the risk of it getting a little too excited and breaking stuff.

Updated my email in my bio, and also you don't have an email address in your bio. I see you also are interested on ADHD. I also was diagnosed with adult ADHD relatively recently. I'm in the process of finding what works for me. I'm interested in your supplement-based approach. I mostly overlooked it till now, basing my treatment approach mostly on the last ADDitude survey (https://www.additudemag.com/adhd-treatments-scorecard-medica...)

> Meds like adderall or provigil tend to be demanding on the brain neurochemistry, so supporting the biochemistry becomes an important part of the strategy, rather than continually going back to the doctor to bump up the dose.

Can you explain what you mean by this? Do the meds lead to overconsumption of scarce chemical resources in the brain?

I'd be glad if we could get in touch via email.

I'd like to be a bit positive anyway, because it gives more agency. My own experience is that by knowing how ADHD works, one can use it to focus on where it shines and avoid where it's definitely not great. People aware of their strengthes and weaknesses, whatever they are, are so much more effective.

The strong emotions, the energy from novelty, even the erratic curiosity are powerful capabilities in the right context : - fuel on anger to speak your mind when an inappropriate situation occurs and no one dares - use your energy to Kickstart new projects, and then give them to someone else to finish - emergencies often require to look everywhere before the root cause is found - etc

It would be easier without the emotional roller-coaster and focusing mayhem, but I'm convinced I couldn't do those things so well without ADHD .

To finish, I wish you all the best!