ADHD Didn't Break Me–My Parents Did

> There has been an interesting result recently, which was discussed here [0]. In an online game where participants had to forage for resources, people with attention deficits scored higher, because they preferred exploration to exploitation.

The “scored higher” part of this study is editorialization. The game was developed in a way that exploration produced a higher numeric result so they could measure something as part of the test. The game was an artificial experiment environment and it was designed to “reward” behavior associated with ADHD, so it would have been more surprising if the game did not result in higher scores for people with ADHD.

The layers of editorialization and hypothesizing built on studies like this remind me of the debate over “depressive realism”. Some researchers put out a study showing that people with depression more accurately interpreted something in some specific scenarios which were designed for the study. It was widely misinterpreted by the public and pop culture science writers as showing that depressed people see the world more accurately, and therefore they are an untapped reservoir for seeing the world as it really is. There’s a huge problem with this interpretation because depression produces a lot of cognitive distortions that make people think things are much worse than they really are, so they’re really only more “accurate” when you have them evaluate situations that are worse than they appear. Yet this nuance is lost in the pop culture debate and many people think “depressive realism” means depressed people have a secret advantage.

I think these ideas have become popular as the diagnostic criteria for ADHD and other conditions have widened to include large percentages of the population. In the past the diagnostic criteria for ADHD was such that it was estimated to have low single digit percentage prevalence in the population. Now we’re at a point where Adderall is the 14th most prescribed drug in America ( https://clincalc.com/DrugStats/Top300Drugs.aspx ).

A similar thing has happened with Autism Spectrum diagnoses, where the criteria were once so strict that it was very rare for someone to get a diagnosis. Now I’m hearing fellow parents casually mention that their young children got an Autism Spectrum diagnosis after simply visiting a medical professional (found on internet listings) and suggesting it. Meanwhile my family friends with a severe autistic child are increasingly frustrated that pop culture idea of autism has shifted so far into the population that people are seemingly forgetting that severe autism is actually very debilitating, much like severe ADHD.

> It literally feels like the walls are closing in and there's not enough Adderall that can fix that.

My psychiatrist told me that when using any amphetamine-based medication for ADHD, it's important to see it as a way to reinforce routines and habits, whatever they may be, and not necessarily a fix to ADHD itself but rather as a tool to help my brain.

With that in mind, I was advised to take my medication and immediately start doing the things I usually struggle with. For me, that just meant getting to work on specific tasks or studying specific things. Sticking to this approach made a huge difference in how well the medication worked for me.

Over time, I was able to lower my dose, and now I find it much easier to settle into a routine. While the medication can dull my creativity, I've learned to work around that by adjusting when I take it and planning out my work accordingly.

In the case my workload or life changes I tend to get back to my old dosage for a short period until new routines settle, I'm very fortunate to have a family doctor that understands this and is willing to change dosages when needed.

I'm not sure how this would play out with extended-release versions or if this applies to your situation, but I figured it was worth sharing.

Also curious to know if this approach has worked particularly well for me but not for others, or if you take the same approach already.

Being unable to focus attention is not a beneficial trait in current society. Imagine having to have to take regular medication to control your blood pressure but cannot keep track of your regimen. It requires extra effort to keep the person healthy. Another is tackling difficult and long-term cognitive tasks, which is often necessary to function in society nowadays (I dread filing taxes). This may change in the future (especially with AI) but right now it is the way it is.

There are many traits that are advantageous in one environment and not in another: for example, sickle-cell phenotype became prevalent in regions where malaria was common, because you are likely to survive the infection. But otherwise the individual is likely to suffer from sickle cell anemia. People who have low calorie requirement may survive a famine, but may suffer from obesity in calorie-rich environment.

Many things are hard enough for “normal” person who would not be perceived as having ADHD, but it’s more so for people with it. The expectations are set by the modern society, but the actual challenges for ADHD are naturally present - thus they are classified as disorder. It’s commonly debilitating enough to be recognized as one.

ADHD is ultimately a disability of reduced executive function, and all of the seemingly disconnected symptoms are connected by that common fact. Everyone has challenges with executive function in life - especially if chronically sleep deprived, but the degree of severity varies substantially to the point where people with ADHD are radically different from people without on a lot of axes.

It's quite the opposite of "absolve[ing] people of the responsibility to work on their concentration." Instead the diagnosis shows that this is indeed the reason why people with ADHD have been struggling to meet expectation their whole life, and there are specific actionable things they can do to fix it, that aren't the same thing that work for people without ADHD.

I had a huge amount of guilt and shame that comes from having tried every productivity, organization, and concentration technique to no avail. I felt like I was pushing against an invisible brick wall that nobody else had. I could deeply care about something, focus all of my energy on it, and yet fail to do it for reasons that remained a mystery to me- when peers with less innate ability and less motivation/drive still did it easily. The diagnosis made sense of this, and pointed me to solutions that actually work.

As a parent of a young child with ADHD that was kicked out of 5 schools before getting a diagnosis that led to him thriving... the idea that it is just an excuse to avoid personal responsibility seems absurd. I could (and have) guilted myself into thinking this way about myself, but can't really apply that to an innocent young kid trying their hardest to fit in, and constantly being rejected and abused by adults and peers due to their brain just working so differently.

I tend to not edit drafts as much anymore and just start over, more of a destructive iterative design approach. It makes it harder to plan projects and colleagues don't always like it but my output is high and I tend to be really good at cutting off things early that won't work. Do you feel similarly?