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ADHD drug treatment and risk of negative events and outcomes

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Re: ADHD drug treatment and risk of negative events and outcomes

#501
post #421

Earlier quoted context omitted.

This is a common belief people have, especially those with mild ADHD or those who wish to be dismissive of the disorder. Unfortunately, in reality while there are some very limited advantages, as a whole ADHD is a whole-brain dysfunction where your neurons are literally incapable of maintaining their level of operation as long as in a healthy person, with ALL of your executive functions - all self-regulation, plannin…

I sympathize with this point of view but I disagree. I’m not sure if I’m ADHD, but I’m autistic. I’ve been diagnosed as ADHD in the past, I’m just not sure how useful it is as a diagnosis for me. I have enormous problems with focus and executive functioning. For large portions of my life I’ve been seriously disabled, unable to work or support myself. There are times where I’m unable to talk. And I still don’t see aut…

I'm diagnosed autistic and ADHD.

A lot of my autistic issues are caused by society because they are mostly sensory - bright lights, random noise, synthetic smells.

The social model of disability doesn't cover all my symptoms and issues though, I am very much disabled. Pre diagnosis and medication my rejection sensitive dysphoria would cause me to perceive sleights and fly off the handle very easily.

5000 years ago I would have had a rock to the head.

Re: ADHD drug treatment and risk of negative events and outcomes

#502
post #495

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1. Standardized is absolutely meaningless here. We can develop any set of symptoms, develop a standardized questionnaire, and have millions of people who meet it. 2. CPT measures attention/focus in an entirely made up lab scenario. Attention and focus are not singular numbers, and are deeply tied to the actual emotions, risks, rewards present in a situation, and cannot be so easily measured. I can see the value of a…

You've raised some common and valid criticisms of how ADHD is diagnosed. 1. On standardized scales being "meaningless": The term "standardized" here doesn't just mean a consistent set of questions. It means the scoring is normed against a large, representative population. So when a parent says their child "often" loses things, the scale helps a clinician determine if that "often" is statistically significant compared…

I hold the same criticism for other psychatrist disorders, I am only talking about ADHD because its the one I personally identify with and spent the most time thinking about.

I am not disputing that it's possible to group populations on behavioral traits, long standing emotional states, etc. If you want to say "there are people who feel unmotivated, inattentive in their life and we call that ADHD", fine. However identifying a distinctive cause as a scientific fact is an entirely different matter. I.e, your behavior categorizes you as ADHD by the DSM, we found taking amphetamines often helps people with these complaints is a very different statement than something like "you lose things often BECAUSE you have ADHD"

>but in providing an objective measure of things like attention lapses and impulse control that can supplement the subjective reports.

Stick in me an abstract math class and all my neurons will be firing, put me in accounting and ill fall asleep. How is a simplified messure of attention in a single artificial scenario interesting? These labs are for profit companies trying to make a buck.

>Again, standardized test scoring DOES have the effect of giving a "definition" to the term "Often",

I dont see how this follows. You at best merely have some distribution of how often people feel like they lose things. You have no way of either knowing how often it is people actually lose things or how inattentive they are in conversations, and certainly less so that the patient in front of you is so. I urge you to think about this little more deeply.

Lets take inattentive in conversations for a second. How many conversations does the patient have, with whom? What are the patient's interests versus the type of conversations they have? Are they shy, awkward, or likewise the people around them? How long of not paying attention is considered inattentive? What is the objectively measured norm for all these behaviors? And if you can admit its way too hard to measure, all youre doing is basing your decision on your own and your patients feelings. As a psychiatrist, you have to ask yourself, are you really trying to understand the cause of this patient's inattenttion in conversations, or are you merely looking enough evidence to fit them into a bucket that you already understand? Id have a million questions before I can even answer this question intuitively, nevermind objectively.

And this is besides my greater point here. Per the DSM, it is possible for you to have ADHD and not be found to be inattentive in conversations but often be losing your keys, and for me, vice versa. So were admitting these things can have other factors. For example, I may be losing things simply because my mom never had me clean up after myself and I keep dirty place with too many visual distractions. Maybe I have a job or friends or whatever circumstances that make my life more chaotic. Perhaps going out anywhere makes me nervous so I don't think clearly about grabbing the things I need on the way out. Perhaps Im not as bothered by being inconvenienced so I dont care as much to meticulously think about the things I need.

And you will say "true, but ADHD isnt just losing your keys, its a pattern of related behaviors", and I say what is the belief that these different behaviors aren't independent?

Categorizations can be useful, but by definition are a loss of information. We have learned nothing by attaching a name, except perhaps a feeling that we have something simple we can understand.

Re: ADHD drug treatment and risk of negative events and outcomes

#503

Earlier quoted context omitted.

Before getting onto Vyvanse, I couldn’t drive more than 30 minutes without wanting to stop for a coffee and then needing a red bull to keep going… now I can drive at least a few hours continuous without breaks.

How do you feel after those drives of a few hours? I have driven up to 6 hours at a time, but I'm in hyper-focus mode the whole time and it takes everything I have to stay locked into that focus so I don't die. I think all the time about moving somewhere where I don't need a car. I hate driving and always have. I recently found out I have ADHD. I haven't tried meds yet (but am having my first meeting with someone tom…

Long drives for me used to be a fucking nightmare, especially long highway drives. Anything over 5 hours was basically an impossibility, now with medication it's really a mild inconvenience. I just moved to a new area, and I have a friend 2 hours away in another town. I don't even think about the drive when making plans, I'll happily drive up, hang out for a few hours, then drive back home. I still have limits on how long I want to drive (did 10-11 hour driving days when I was moving cross country, and that sucked), but they're way higher.

Having a car with lane centering cruise control also helps a ton, at least where I live. Not having to micro-manage a car for several hours when you're on a long drive reduces the cognitive load.

Re: ADHD drug treatment and risk of negative events and outcomes

#504

Earlier quoted context omitted.

How do you feel after those drives of a few hours? I have driven up to 6 hours at a time, but I'm in hyper-focus mode the whole time and it takes everything I have to stay locked into that focus so I don't die. I think all the time about moving somewhere where I don't need a car. I hate driving and always have. I recently found out I have ADHD. I haven't tried meds yet (but am having my first meeting with someone tom…

I bought a new-to-me car that supports Comma.ai. It's not full self driving, but it handles the boring parts sitting on the freeway for me. it's the best purchase I've made in recent memory because holy shit sitting there on the freeway forever is the worst.

I got a used tesla a few years ago that came with FSD, and I fully agree. I drove to Vegas for DEFCON a few weeks ago and the ~8 hour drive was kind of just a mild inconvenience.

Re: ADHD drug treatment and risk of negative events and outcomes

#505

Earlier quoted context omitted.

I feel this. It's so very hard to manage one's medicated-ADHD productivity in a way that feels useful but doesn't burn like a white-hot flame. My boss has been supportive and really helped me see the ways in which I was causing myself burnout, encouraging me (as a senior tech IC) to write things down, do more knowledge and skill transfer, and delegate more. That helped me a lot. What I used to think of as "autonomy,"…

> I also had to privately learn how to pace myself, setting realistic, appropriate and prioritized daily goals (nevermind the arm's-long TODO list). Checking myself against those, aiming for better goal-setting each day. Being able to close the laptop when it's done. I never really had a sense of "done" before, I had a lifetime of feeling always-behind. There's this peace, though, that comes with realizing that you _…

> How long did it take you to get to this point? And how do you deal/ identify/ know you are “done”?

It took me around three to four years after starting medication to get to this point.

The "done" part comes out of setting and meeting realistic and prioritized goals. If I've done that part right, then I can feel OK about stepping away. How to set those goals is the harder part.

Tasks with time-constraints have to be identified and dealt with, such as "prep for meeting with product team." Identifying them means looking ahead on the calendar (not always easy for ADHD'ers!), and getting out of ADHD magical thinking about "just needing a few minutes before" to prep sufficiently. That might mean scheduling a half hour block for prep on the calendar. As a bonus, being aware of what's coming up next is always a good thing.

Open-ended tasks and independent work are harder to clarify and prioritize, but I got the greatest reward when I started attempting to describe what I was doing at my team's daily standup meetings. I might be spending weeks on writing some document, which can feel endlessly the same, but I force myself to not have the update everyday be "worked on the document," but rather:

> I researched topic X and spoke to people A, B and C to try and answer this question I had, and learned this thing

or

> finished drafting section X, editing section Y and started on section Z

Then it becomes much easier to keep track of the longer journey through writing that document. In addition, writing the description for other people helps make that easier.

Breaking the description down also helps you notice when you're stuck, because your daily descriptions start to sound the same. If you notice that sameness, but then ask yourself "if I say _____ today, what will I be able to say that's different tomorrow" then automatically you'll start to get more specific, have better updates, pace yourself better, and as a bonus you have an idea of what you'll do the next day.

Using the above tactics, I started to use standups to pace myself and feel better about my work (more "done"), whereas I used to become full of anxiety and guilt for not feeling like I could report "progress" day over day. It was all a mindset shift.

Re: ADHD drug treatment and risk of negative events and outcomes

#506
post #475

Earlier quoted context omitted.

> It seems more like a horoscope to me - everyone can find themselves in the criteria. It’s an observable thing, I’m just not sure I buy its special distinction Do you think the same about conditions like Autism or OCD? People often say they "are a little bit" OCD or autistic, but it's the degree to which those traits are experienced which is the differentiation. There is also no objective test, it's all "soft" scien…

FWIW I don’t think the same about autism and OCD (at least not to the same extent). There are some similar problems with the soft diagnosis, but there is more going on there imo. They both do have problems with variableness (particularly autism), but it’s more distinct from the general public.

My "personal hypothesis" is that the ADHD/Autism/OCD are fundamentally related somehow. The comorbidity between them is much higher than general population incidence, there's large symptom overlap, on a personal level I've found that I relate to and get on along much better with people who have at least one of those conditions, and a good 2/3rds of the people I consider close friends do.

Re: ADHD drug treatment and risk of negative events and outcomes

#507
post #424

Earlier quoted context omitted.

One neurotypical I know who took 20mg of Adderall IR ended up going into a hyperfocused ‘can’t look away from the road’ 12+ hour road trip without stopping and couldn’t sleep for 3 days afterwards. An ADHD’er I know who did the same thing, took a nap instead, and then actually started their taxes. These are not the same thing.

Not doubting you but… how? Adderall leaves your system in like 4 hours. The half life is crazy short and it’s extremely noticeable when it happens. I don’t understand how someone would fail to sleep for 3 days, or even hyper focus for 12 hours, when the drug is going to be completely gone from their system and not affecting them a fraction of the time into that period. Are you sure it wasn’t something else or they di…

Drug responses can be weird. Plus if you’ve been told this will make you manic and hyperfocused, your body will respond accordingly even if biochemically that doesn’t make a lot of sense.

Re: ADHD drug treatment and risk of negative events and outcomes

#508
post #353

Earlier quoted context omitted.

Focus is the same. It's the euphoric high and increased hyperactivity in neurotypicals which is the divergent response.

the euphoric high also happens in those with ADHD but only when they first start taking it. I would assume if you took it recreationally and not consistently you would have the same effect

My problem is I forget to take my Adderall. I've also experienced shortages in my area for 3+ months. When I eventually start back on my meds after a long hiatus, it seems to work just like it did when I stopped.

I could use some more euphoria in my life, sadly Adderall does not provide it (for me.)

Re: ADHD drug treatment and risk of negative events and outcomes

#509

Earlier quoted context omitted.

If that was true there would be a shortage of pain pills

I haven’t once heard of a person addicted to Adderal outside of a DARE class. Opioids however…

I'm currently addicted to Adderall. I also have a prescription for it and I have ADHD, but I'm still absolutely addicted. Without it I would suffer, and I would seek it out through illegal means if I could not get it legally.

Re: ADHD drug treatment and risk of negative events and outcomes

#510

Earlier quoted context omitted.

> the DEA now takes potential abuse of legal drugs much more seriously and adderall (an amphetamine- it's a cousin of meth) is at a high risk of abuse. I know that I process Adderall differently having ADHD, but I still struggle to see how it's used recreationally. I took it somewhat consistently for over a year for ADHD treatment until I missed an appointment and couldn't get around to scheduling another before my p…

My doc says the best diagnostic for whether you have ADHD is to prescribe Adderall and see what happens. Those with ADHD react very, VERY differently to the drug than the rest of the population.

I doubt that very much
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