Launch HN: Inflow (YC S21) – Self-help app for people with ADHD | Hacker News Reader

Launch HN: Inflow (YC S21) – Self-help app for people with ADHD

Hey! We’re Seb, Levi, and George, co-founders of Inflow. We have built a self-help app for adults and adolescents to better manage ADHD.

Accessing treatment for ADHD is expensive, slow, and can be difficult for ADHD people to organize due to struggles with executive functioning. Inflow makes accessing many of the benefits of in-person ADHD therapy significantly more accessible and affordable.

Based on the principles of cognitive behavioral therapy, our app enables people to better understand ADHD and how it impacts them. It also gives people practical tools and helps them to develop the skills needed to better manage ADHD. This is combined with a welcoming community to share experiences and learnings.

Half of our team is neurodiverse and our co-founder Dr George Sachs, as well as having ADHD, has over 10 years of experience treating people with ADHD through CBT. Consequently, we are aware of the impact of ADHD on day-to-day life and how underserved the ADHD community has been in terms of accessible and affordable support. Levi also previously worked for Babylon Health to develop products for chronic condition management and saw how technology could enable access to care.

The core of the app is a CBT-based program that provides short, daily exercises as well as tools to develop helpful habits and skills. The program is broken down into different modules each focusing on specific areas ADHDers may find challenging such as time management, organization and impulsivity. Our community lets people connect with and learn from a range of other diverse individuals with ADHD in a safe and stigma-free environment. We offer daily live events with specialist ADHD psychologists and coaches including topic deep dives, Q&A, coworking sessions and group meditations.

Other features include prioritization tools, which let you set daily goals to prioritize your most important tasks, and guided journaling—prompts and triggers to help you better understand yourself and your behaviors. We’re just getting started and have a range of exciting new features in the works including routine building tools, accountability check-ins with a real coach, progress tracking, group-based challenges, and more.

The average cost of an in-person ADHD CBT session in the US is $200-300 ($10k-$16k/year). This is compared to Inflow’s cost of $95.99/year. Of course, no app is a direct replacement for in-person therapy but it offers a far more accessible and cost effective solution which allows many more people to get the help that they need.

You can download our app here: https://inflow.app.link/0FXmBEAWjkb. We offer a one-week free trial followed by a monthly or yearly subscription.

If you’ve been trying to or previously had difficulty accessing treatment for ADHD we’d love to learn about your experiences. If you do try the app, please let us know any improvements or additional features you’d like to have. Thank you!

View on HN

Many of the reviews of the Android app are quite critical of the trial and payment model, for example:

> CAUTION: After the free trial period (7 days), they will charge for an annual subscription ($102.95 US). This is OPT OUT, not opt in. In other reviews they say they will offer a refund (I will update when/if I get one) but for an app for people with executive function issues, an opt out format seems shady. Either way, I won't be purchasing this for my loved one with the opt out format for payment.

> They exploit the same vulnerability of the patients, they aim to cure! They take you in confidence and then charge you after the trial ends. ADHD folks forget things all the time and it's a challenge for them. An email reminder is not going to cut it. We have thousands of emails in our inbox. This is profiteering from the mental disability of others. Stay away. A pro-rata charge is a fairer policy for ADHD folks. Any ADHD book will be more useful for what is presented in this app anyway.

> Requires payment to be set up to use free trial... Seems a bit predatory on a mental health app for ADHD brains... We tend to forget things like canceling memberships. And of course they only tell you once you have wasted time making an account. SMH

> Why do you need a credit card to do a 7 day free trial? Why don't you take my card number if I want to continue after the 7 days? What if I forget to cancel, and forget to request refund? I see what you did there

Sounds like they're all making some very relevant points about the app payment model potentially exploiting the ADHD deficit in executive functioning, and the tendency of people with ADHD to unintentionally forget things like subscriptions and bill payments. How do you respond to these critiques?

Thanks for highlighting this - we're trying to figure out what the best model is for our community. A lot of other apps follow a similar model, we allow people to cancel anytime and have refunded everyone that has forgotten to cancel. Some people also like having the subscription because it is a pay per use model rather than putting everyone under the same one-off bundle. We're working on extending the free trial / moving to a freemium model. Would love any suggestions on how to improve this.

Thanks, I appreciate your response on this, but I'd be interested in your thoughts on the following two points specifically:

- Why have you chosen to make users opt out of a subscription when the free trial ends, rather than letting them opt in?

- Why is the annual payment option pushed so hard, in favour of the monthly payment option?

I'm reiterating this because promoting an opt-in, monthly payment model (thus giving more opportunities for any unintentional ongoing payments to be noticed by the payer) seems to me to be the kindest approach to subscriptions for users with ADHD, and a model that would be most empathetic to their condition.

Thanks for the follow-up questions.

We're actually working on several different sign-ups flows at the moment including opt-in post free trial, longer free trial, web sign-up and one-off purchase vs subscription. It is not our intention to push annual significantly over monthly - we wanted to give a significant discount to yearly subscribers but perhaps the difference between the two is too large. The previously mentioned issue with scrolling is due to to a bug with small screen sizes on Android which we're working to fix.

Thanks, it's good to know that you're considering alternatives.

As you have a number of people with ADHD working on your app, I would be curious to know if any of them raised concerns about these specifics of your subscription model, during planning and development of the app?

> we allow people to cancel anytime and have refunded everyone that has forgotten to cancel

Probably not, because your users are people who will forget to cancel and then forget to tell you about that.

> Some people also like having the subscription because it is a pay per use model

What does this mean? It sounds like users are complaining that if they download the app and don't use it it charges them $100.

> Would love any suggestions on how to improve this.

Howabout when the free trial ends, at that time the user has to approve a charge before continuing to use the app.

Just gonna jump on the bandwagon here and say that, as somebody who suffers from ADHD, with all due respect, that is 100% USDA certified horseshit.

At the very least, bill monthly and make the trial not auto-renew at full price. And, since the target market is people with executive dysfunction, I'd love to see your team go the extra mile and default to pushing notifications the week before and day before a user's subscription renews, giving them ample time to cancel if it doesn't fit their budget this month.

As someone who has ADHD and suffers a lot from forgetting to cancel subscriptions etc this would be really really good. I used to set several calendar reminders each quarter. One to sit down and work out what subscriptions I have. Another one to sit down and work out what subscriptions I have. One to cancel subscriptions. Another one to sit down and actually cancel them. A third one to work out if I’ve cancelled them…

Now I have a bunch of automations set up that ping me and say “you’ve got this subscription… are you actually using it?”

It took me a fair bit of effort to engineer but it’s saved me a whole load of money.

Yep. ADHD here and I won't touch anything that auto-renews.

Generally supportive of you guys but want to pick even more.

> A lot of other apps follow a similar model, we allow people to cancel anytime and have refunded everyone that has forgotten to cancel.

Many ADHD people also forget or are too embarrassed to do that.

Life hack that works for some: at least on iOS and in my region one can subscribe, immediately unsubscribe and continue to use a product during its free trial period without risking getting trapped.

This hack works on Android, too. At least I was able to do that with Audible.

I think the easiest solution is to stop providing access after the free trial until they opt-in to a subscription. That way there’s no surprise charge if they forget.

This seems reasonable.

Go ahead and collect the payment info before giving them access to the free trial, let them use the thing for free for X days, then when the free trial is up, block their access and ask them whether or not they'd like to pay for the subscription. It could literally just be one big button that says "accept." Then ideally, ask them again before each recurring charge.

Some people here are proposing an absurd amount of friction - one highly upvoted post suggested that the app should require users to re-enter their payment info before every charge. What if this app is great? What if I actually want to give them my money? Making me type in my credit card info repeatedly is nightmarishly bad UX.

Reducing friction is a good thing, even here. The important bit is just getting the user's clear consent by making it opt-in instead of opt-out.

Charging for monthly instead of yearly after trial ends is something you can push to production in half an hour. Don't try to weasel out in front of technical audience. Liar.

Users do have a choice between monthly and yearly.

Harsh but fair.

I don't know the founders and have not tried the product, but I'm building a business in the consumer subscription space so I'll post a few things that might clarify why they could end up with this model even with good intentions. I'll also add that I don't know much about the science/behavior of folks with ADHD, so I won't try to talk about that piece at all.

First, the app stores are pretty prescriptive about how you handle introductory trials on subscriptions (especially Apple), which means you are usually stuck with "start trial + opt-out" as the only viable model if you're billing through the App Store.

Second, behavioral/commitment theory often shows that for apps or really any behavior change that requires some effort, a longer time commitment/investment gets people to actually invest the effort they need to actually get value out of the product. If you let people pay for a month, they won't actually put in any effort and then at the end of the month they'll be like "I'm not getting any value here" and they'll just cancel. They won't put in the effort to build the habits. So most wellness apps/products (from meditation/fitness apps to gym memberships) end up with some sort of free trial period, followed by an annual commitment (and if there's a monthly option, it's at a steep hike from the annual one).

Finally, when you're early on in the life of your startup, you're mostly trying to get to product-market fit and see whether people are willing to use / pay for what you've built. You just choose a pricing period/plan that makes sense, focus on the product, then when you get the product where you want, you go back and experiment with finding the ideal pricing plan for you and your users.

That said, it's clear in this case that this model may not be great for the target audience (in fact, even for neurotypicals, canceling subscriptions and such is still a challenge to manage). And obviously the app creators could have put more thought into it.

We ended up with an opt-out free trial plan as per Apple's rules on iOS, with a monthly plan where the yearly plan is a 25% discount if you choose it, and several reminders before the trial converts to paid. We also allow users to do a standard opt-in plan if they're not signing up through iOS (ie only need to put credit card after trial expires). We offer refunds where we can for people who got billed but didn't intend to, but Apple has to process those refunds too.

Please do not confuse people liking subscription and people that forget about the day when the trial ends and get charged (a non-trivial sum of over $100) against their wishes. People that like subscription certainly can use subscription, and giving them such an option is a smart move. A sneaky and underhanded move is to charge those that did not explicitly express the desire to have the subscription, but just forgot to cancel in time. Refunding after people vocally complain is fixing half of the problem. Not doing opt-out charging would be the other half.

I know many providers do not dare to give up on opt-out trials, since it brings them money. It is scary to trust your future clients - maybe they won't buy after all? But if you don't trust them, why would they trust you?

The best model for your community is free and open source.

Your current model of opt-in subscriptions makes it clear you're looking for the best model for your bank account

How do you propose that they feed and house themselves? Has someone got a GitHub repo for that?

They can get a real job instead of making products that prey on people with ADHD.

There's no job shortage, so don't make excuses for them

If we didn't build and charge for our app then we can't continue working on it and improving. We enable many people to get support they wouldn't be able to otherwise and significantly broaden accessibility compared to medication and in-person therapy. We're not a non-profit but we do need to improve our model.

My point is about the unbelievably privileged attitude of "you should make products for me free of charge, or else you're the greedy one". Not whether this specific product should exist, which is a different point from how it should be funded.

I can assure you that absolutely no-one "likes" being charged a full years subscription in advance.

We're working on extending the free trial / moving to a freemium model.

Please. You aren't spaceX "working on" your next engine, or AMD "working on" the next processor architecture. All you have to do to end the unethical behavior is flip a few bits in a database. Don't pretend it's some kind of grand technical challenge.

You're luring in people who are trying to improve their mental health and tricking them out of their money. The product isn't even technically innovative. No idea why YC is compromising its brand like this.

While criticism can be good when constructive, I think these comments are a bit dramatic and make way too many assumptions.

I would expect that it's more financially lucrative to have a happy userbase, which translates to a good reputation and thus larger user-base, rather rip-off a few who will eventually give bad reviews and create a bad reputation. To me the current pricing model sounds more like a bad decision rather than anything else. But in any case, if I didn't like it I would just not use it, rather than throwing accusations around on malicious intentions without having any evidence.

PS: I am not even remotely affiliated with the creators of that app

> To me the current pricing model sounds more like a bad decision rather than anything else.

I'd ordinarily be willing to believe that, but I can't stop thinking: this is a service with a very specific target market - people with a condition whose defining characteristic is being vulnerable to be exploited through the exact payment model that Inflow has chosen. To accept this as a honest mistake is to believe that they never thought about their target audience at all, which is inconsistent with their claims of having people with deep understanding of the condition on board.

> But in any case, if I didn't like it I would just not use it, rather than throwing accusations around on malicious intentions without having any evidence.

Startups are getting way too much mileage from Hanlon's razor.

Quite possibly. But still, what happened to personal responsibility? Having ADHD does it mean I have no judgement at all. If I evaluated the risk of forgetting is too high, I could choose not to subscribe in the first place. Or if I still think this app is important enough, I could make sure I find another way to be reminded to cancel.

What I mainly question is the demand culture, that a lot of users have towards developers - even towards people voluntarily put their time to do opensource work.

If you worked towards the higher standard, of trying to avoid even the potential appearance of inappropriate action, you would never do what they did.

Deep down do you believe that they would have changed if not for this public outcry?

Make it free for 30 days THEN throw up a pay screen. You're a funded startup what's the issue here?

Agreed, and that's what I would expect too. In fact, if the app works as they claim to be, users would rush to subscribe after the 30 day trial. Yet, criticism doesn't necessarily need to be accompanied with unjustified accusations and demands. I find this attitude to be a very common pattern nowadays. Criticism can be constructive and to the point without any of these.

it might sound really strange, but remembering to cancel something like this is incredibly hard for me as someone with ADHD. I pay for so many things, sometimes multiple times before I can work up the energy (and memory) to take care of something like this.

"but for an app for people with executive function issues, an opt out format seems shady" is so dead on. What an enormous red flag.

Might as well come right out and say that they understand ADHD and plan to use its drawbacks to make money from people. Considering how desperate a lot of people are for treatment, this sounds like a great monetary investment for people with no conscience.

This may be a bit harsh. I'm a bit salty as navigating the process to get treatment for ADHD is a continual reminder that most services are tilted towards providing services to already well-functioning people. I probably will try it, after all you did just remind me to cancel my free Prime membership, even though it was right there in bold on my day planner a week ago.

Argg! I also have a thing I forgot to cancel last month! Did you get your Prime one done? I'm doing mine right now.

Edit: done! Thanks.

I did it right away, half asleep. The post absolutely reminded me to. The app worked! lol

Plus my dislike of Amazon is rather motivating.

As someone with ADHD, I can confirm this model is super predatory.

I cancel all my credit cards every year just to get rid of all opt-in charges on regular basis

Billing an entire annual subscription up front, as opposed to monthly, seems especially questionable. What if the therapy doesn't work? What if it's so badly implemented that it can't work? You're still out a hundred bucks just the same, and that's just in the first year.

edit: There is also a monthly subscription option, in the Apple app store at least. It's $22 a month - so over twice as much as the annual. This does not give me to think the product here is less sketchy. And the Psy.D founder, Sachs, is a pretty blatant self-promoter of the sort endemic to the ADD/ADHD "coaching" space, if unusually well qualified by that standard: https://sachscenter.com/adult-child-psychiatrist-psychologis...

Perhaps it's less of a surprise than I initially found it that the account posting this Launch HN has thus far had nothing further to say.

also edit: Sachs is a Psy.D, not an MD. Granted, this does entitle him to "Dr." as a term of address, just as would a doctorate in physics, ancient history, or underwater basket-weaving. But, just as with any of those, it doesn't qualify him as a doctor in the generally understood sense. Again, this gives one reasonably to question, and the questions thus raised are ones for which well-prepared founders may reasonably be expected to provide compelling answers.

I just downloaded the Android app to check, and it's a similar ratio as you describe for the Apple app store: £19.99 per month if paid monthly, but £7.17 per month (as £85.99 per year) if paid annually.

And on my phone at least, the monthly payment option is also hidden behind a scroll down action: https://i.imgur.com/rV0bMTH.jpg, with the yearly subscription already selected by default.

It would seem they're pushing quite strongly this annual payment option.

> £19.99 per month if paid monthly, but £7.17 per month (as £85.99 per year) if paid annually.

As someone who's worked on pricing models, this speaks either to very little thought to pricing or a monumental churn issue.

A hefty discount for an annual subscription is generally something like 20%, and companies with good retention only offer ~10%.

Discounting over 50% if someone chooses annual either tells me (1) this company is low on funding and desperately needs the immediate cash flow, or (2) this company can't retain customers and is really lacking product-market fit.

Old YC would have absolutely helped the founders straighten this out, but it seems YC is now just a big cash grab and rolodex in the form of Bookface.

It's really remarkable.

I'm not too proud to admit that I spent a long time not really taking ADD/ADHD all that seriously. That was before I fell in love with someone who has ADD. Seeing on a daily basis the effect it has on him, and the extent to which, even with effective treatment, it remains a serious obstacle in terms of executive function and followthrough even for things he plainly cares a lot about - to say nothing of subscription fees, which even people without these disorders find easy enough to forget that tools for managing them constitute an entire genre in their own right...

Well, I'm really looking forward to seeing what the founders have to say for themselves here, if anything, and wondering what reasons they could give me not to warn my boyfriend off their product in the strongest of terms.

Hey, as an adhd person that really gets frustrated when people don't take adhd seriously -- thanks for changing your stance.

it generally only gets portrayed in the media based on how other people experience people with adhd -- never the actual experience of the person with adhd.

i hope that changes in the future, so more people can have a similar exposure to it that you've had as a loved one.

Thanks for the feedback - this is due to screen size on Android and we're current working on fixing issues impacting smaller screen sizes at the moment.

Perhaps there is room for the following:

(Please dont kill me for the off-the-cuff idea:)

A per-login / frequency of use model;

You agree to a MAXIMUM of $100/year as WELL AS a max per month that may be charged (== to $100/12 max) -- but the idea is that if you skip a month or some amount of time you are not charged....

The usage is based on certain amount of time-in-app or somesuch....

you get the idea.

---

Anyway, as someone who has debilitating ADHD I really want to use this... but whilst not working, I can't pre-commit $100 to something that I may have too bad a case of ADHD to adopt on a regular.

I think that's a good insight, not least in that a model like that incentivizes real utility in the product. Granted, it could also incentivize dark-pattern stickiness, but there's still the seed of something worth considering here.

Granted IAP isn't that flexible, or not to my knowledge, at least. But Stripe is right there, too.

This is a good idea but we do also have limitations from the App/Play Store - definitely something we'd been keen to explore though. In the meantime, we've refunded everybody who has requested one.

That reminds me of a quip by Rachael in an episode of Friends when her and Ross [Ph.D] are at the hospital - "Now remember Ross, there are real doctors here"

> Sachs is a Psy.D, not an MD. Granted, this does entitle him to "Dr." as a term of address, just as would a doctorate in physics, ancient history, or underwater basket-weaving. But, just as with any of those, it doesn't qualify him as a doctor in the generally understood sense.

Indeed, I've had better help from a LCSW than a Psy.D, and I never called the social worker "Dr."

A LCSW is not a doctor in the US but a psychologist is.

Also, as someone without ADHD, I can also say this model is predatory. Nobody should have to remember to put in a request to not be charged after a trial.

You're not wrong - but it's maybe not great to distract from the predatory nature of targeting people that are at high risk of being exploited from this model.

It's bad all around, but it's extra bad for people with adhd -- and considering it's an adhd app, it really puts it on a different level of predatory that's worth focusing on.

Canceling a credit card does not cancel your obligation to pay a vendor unless you also terminate your plan with them. Some of them will try to collect, especially if you had a contract.

Sometimes I go through my bill and find opt-in services so I can call in charge backs against them before I cancel.

They can pry that money out of my cold dead hands. And I've yet to have anything sent to collections

I tried this to get out of my gym membership and they sent the bill to collections. Luckily I called them and they didn't make me pay it. They did ban me from the gym however

If you aren't doing so already, you should look into if your card has virtual cards. Capital One for example does. I think it would make your current process easier.

It looks like Capital One does this via a Chrome extension, which you have to install (and which can presumably look over your shoulder to see all of the shopping websites you visit). I might consider installing this, deactivating it by default, and then only enabling it when I want to make a purchase. But I was hoping there would be a simple number generator in the mobile app. I guess that would be too easy!

I use Privacy[1] for this and would highly recommend the service to anybody using a bank that doesn't have an easy and convenient way to issue disposable card numbers (most US banks).

1. https://privacy.com/

There are nowadays plenty of e-banking solutions which provide you with virtual cards, which you can create and destroy on the fly and at 0 cost. It is really wonderful for this kind of scenario. Vivid is the one I've been using, I couldnt be happier with it. Theres also N26 allowing this, and Im not sure but, Skrill, Transferwise, Revolut,...

Try Privacy.com that should help you manage your subscriptions a lot better.

This is so shady and I "could" understand it coming from a random startup... but by a startup backed by YC? And that it gets it own Launch HN thread (while others startups had to do it in the batch posts?). This is no the first time in the last months that something like this happened, unfortunately.

YC (in)famously backed InstallMonetizer in W12.

https://news.ycombinator.com/item?id=5092711

why do you think YCombinator isn't willing to exploit people? They're a VC accelerator, of course they are. Just because the profit motive doesn't always lead to immoral behaviour, doesn't mean that profit-motivated people aren't going to pursue immoral behaviour if it's profitable.

It's a little surprising to see YC start to risk the brand this way, though, and as others have noted in this thread, not for the first time recently - Skip the Interview, in particular, being of note in this connection, after having shut down the same day it launched due to a complete, and frankly rather easily predictable, failure of product-market fit.

Right now, and in the past, "YC-backed" has consistently been a very solid selling point, both for following rounds and in recruitment. Maybe it's just a transient bobble, and I strongly hope that proves true. Still, at this rate, I'm starting to wonder a little what "YC-backed" might come to mean a few years hence, and whether it'll still be worth the same.

The low-hanging fruit have been picked over. The easy wins of SaaS and consumer web tech have been won already, but they still have an obligation to generate the same levels of profit (have you ever seen a company gracefully shrink with its industry, especially a financialised company?), so they will start to both go for niches, and go for exploitation. Growth is always most rapid at the introduction of a new industry, and if you're a hypercapitalist (as VCs tend to be) you're going to be under pressure to see continued profit levels long after the industry can sustain them healthily.

I mean, reading the description, it's hard not to get a little concerned: "a start up that's going to try to make money off of folks with ADHD" isn't a great starting place.

I think this is sort of a broader start-up problem. Some things shouldn't be monetized (period, but for the sake of the audience, I'll add: at least not as aggressively as is required for a start-up).

It’s shameful for YC to invest in this and blast it onto the front page of HN. Unethical and gross. I wish this site was community driven and not used as an avenue for YC to promote their awful investments.

Here's a counter argument: "a company making money off of folks with ____" describes the entirety of the Biomed industry. Every medical device is sold with the intention of helping people with medical issues, but they can't be free. The cost of development and production has to be covered by somebody (be that by the government, medical insurance, or private party). If it wasn't, the company making the device wouldn't have developed it in the first place.

That industry is also regulated and monitored to ensure that the interventions coming out of it are generally safe and effective. Is the same true here?

> Every medical device is sold with the intention of helping people with medical issues, but they can't be free.

Close, but a slight correction here:

Every medical device is sold with the intention of maximising profit, but they can't do nothing or people wouldn't buy them.

That more accurately portrays the priority.

So true.

I don't see anything wrong with it. Surely a lot of people with ADHD would be happy to pay for an app that helps them overcome their problem, and the monetary price most likely exceeds the benefit (assuming the method used by this app works as advertised). In fact the price is much cheaper than a regular visit to a therapist. The problem I see here is the current subscription model. If people are happy with the trial, and see results, they would be happy to subscribe for a monthly fee along with their Netflixes and Spotifys.

If it actually works, an app like this could be worth 10x the price.

Getting rid of all the time waste, all the stress of AD is worth a lot.

Sure, but then isn't this just a "disability tax"? (I'm aware that the word disability is antiquated and not perfect here, but for the sake of being concise, this is what I wrote).

The need for this app is a problem. Insurance should cover the cost of treatment (and insurance should be affordable and available; for transparency: I'm pro medicare for all, here in the US).

Start ups have a bad habit of taking a systemic problem and trying to monetize a solution to it. In reality, the effort being put into this should be put, instead, toward making systemic changes that would make this app unneccessary.

Most of the folks on this thread seem to be objecting to the opt-out nature of their subscription service. I agree with them.

On the other hand, you seem to be objecting to the very nature of money being charged for this app or any other healthcare service?

It's gross, and I do not love this aspect of capitalism. I agree with you to that extent.

But -- again, without ditching capitalism entirely -- what's the alternative? These folks are providing a service and that costs money. Aside from ditching capitalism entirely, what alternative is there to "charging $X to fix Y?" Literally anything amounts to a chronic or acute disability tax. The cost of asprin is a headache tax. And so on.

The best capitalism has been able to do is roll these sorts of healthcare costs into insurance premiums, so we can share the cost collectively to an extent. Unfortunately I doubt an app like this is covered by any plan.

The only other solution (within capitalism) I can imagine is if the creators of this app ran their company as a non-profit org. I have considered that in the past for a venture or two. But, the money would still need to come from somewhere.

You're right, I take a more aggressive stance on this sort of thing than others might. I'm also known to say "if you can't afford to pay your workers a living wage you can't afford to do business" of many retail/service environments.

"But I need to make money, too" isn't an excuse. It wants to be, but it is not. I would agree that the biggest offender is the predatory model, but I would say that the way to do this _correctly_ is to do it free/OSS with a patreon. Let folks who use it pay what they think it's worth.

The problem is that the incentive systems don't align. Someone elsewhere mentioned that this seemed to build dependency in its users (an anti-pattern in therapeutics (and elsewhere, but let's be specific to therapeutics for now)). With something like Patreon, the incentives are much closer aligned: the app _has_ to do good in order to well, because otherwise nobody will pay for it.

Again, they (the developers) could also put their time & energy into enacting systemic change.

This is a solution to the main problem, which is healthcare being a steaming puddle of diarrhea and medication being gatekept by the industry and the government... for your own safety, of course.

A poor solution imo (at least for any serious cases), but at least someone is trying something.

Given that executive dysfunction is one facet of ADHD/ADD, having opt-out is definitely preying on the users. Avoid.

Noom, a popular diet/weight-loss app, works on the same principle. I've used it. To start the free trial you need to prepare the payment mechanism. Then after X amount of days, the paid service automatically kicks in. I wasn't super-excited to discover I'd just committed a lot of money before I was ready or even fully committed to the app/service.

I suspect this is going to be the new trend for future apps, since it almost certainly delivers a higher number of paid users than other methods do.

It's fair to criticize this, but it's worth noting that this is how subscriptions work in Google / Apple app stores. You really can't do anything else.

I have ADHD, so wearing my consumer hat for a moment, I guess I just don’t really care.

It’s their problem to figure out how to present their product to me in a compelling way that I am willing to pay for. I don’t open my wallet just because I feel bad for starving founders.

Yes that's true. But when we're talking about this on Hacker News, it's interesting to talk about the why. Especially when the why is "Google and Apple make more money this way".

Why do you think you can’t do anything else? There’s different trial methods. Shorter subscription periods. OPT-in models.

There are no free trial subscriptions with opt-in "continue paying" as far as I know. I mean, why would Apple and Google build that? They make more money with trial + automatic billing.

I once built such a trial option myself. You could start a free trial (just within the app, no "native trial" involved) and then sign up for the paid plan with native in-app purchases once it ran out.

It got rejected by Apple. They insisted I use the native app store trial which is opt-out.

Of course they support an opt-in model, they can't really choose to not support it. The "free trial" can just be the app giving you all the features for a week, and then the app can prompt you to sign up (opt-in) for a subscription with Apple/Google when that ends. No CC number until after the trial ends.

EDIT: I'm wrong, comment next to mine says Apple has rejected this. Maybe Google wouldn't though?

>> After the free trial period (7 days), they will charge for an annual subscription ($102.95 US). This is OPT OUT, not opt in.

This is the norm right. I don't know ANY app that is OPT IN after the initial trial period is done. This is the Industry Standard.

Industry Standard isn't marketed specifically to people with ADHD at the exclusion of everyone else. At the point where a product is targeted at people who struggle with this, and it's still not putting thought into how they'll react, something has gone very wrong.

Industry standards for media often don't included content warnings. However, if someone posts on HN that they're building a streaming service designed primarily for people with trauma, and they don't include content warnings in front of their shows, you'd probably have some questions -- because you expect them to know their audience. To me, this launch suggests that the founders either haven't spent much time thinking about how their process actually will work with their target audience or (much worse) that they did think about it and still decided that it would be OK.

It's just really tone-deaf to have a launch HN that spends all this time talking about how the intake process for people with ADHD is thoughtless or needlessly difficult, when their app's funding model is making the same mistakes and lacking the same affordances.

yeah, this really undermines the credibility of the app. I really hope that they address this.

I managed to put together a system to keep track of renewals, and still make sure to pre-cancel them so they won't renew without me meaning to. Too many services will take your money and shut you down if you cancel renewal before the end, and I won't touch any that do. They need to be very clear on how they handle this, or it's a hard pass for me.

I would encourage everyone who feels strongly about this to feel empowered to use the App Store reporting system, or the Better Business Bureau complaint system to report exploit and manipulation by business.

https://www.bbb.org/file-a-complaint

Are you working on a competing product in the mental health space? You're clearly not a prospective patient and you don't have loved ones who you were evaluating this for. Your careful scrutiny exposes you.

FWIW this is how several diet apps work as well. Short initial free trial, followed by auto-charge lump sum subscription of 6-12mo.

Not my favorite model, but also probably not intentionally predatory towards a specific group of people.

From a business point of view it makes some sense. It extracts maximum money from customers in a niche that is inherently flakey (dieting, self-help, etc.). People often start off strong for a few weeks/months and flake out. Forcing a longer up-front commitment helps their bottom line, and possibly helps some customers stick with it since they already spent the money.

I'm not trying to defend it, but I do think it's a bit much to say it's intentionally predatory. From my view it's just app economy capitalism at work.

The massive difference that you are overlooking, however, is the fact that ADHD Brains are neurologically and/or biochemically incapable of defense against this.

That inner voice telling you what to do or what not to do? ADHD brains have... well, let's just say "something else".. in its place.

> That inner voice telling you what to do or what not to do? ADHD brains have... well, let's just say "something else".. in its place.

Pretty much every description I’ve heard from people diagnosed with ADHD features the same kind of internal voice as neurotypical people describe; the “something else” seems to be between that voice and action, not in place of it.

I'm diagnosed with severe combined type ADHD (top tier, best of both worlds) which could have something to do with this, but I can't say I have ever thought of this voice and action/driver as separate things.

My natural, pre-treatment, and unmedicated sub-/semi-conscious behaviour is not at all like that of a typical person.

“Predatory” and “working for other apps” aren’t mutually exclusive.

Thanks for the warning. I'll stick to my prescription.

Presumably for the same reason opt-in is a problem too.

maybe it's good to start putting service payments on blockchain to enable easier accounting, and not require ongoing payments.

This is totally wrong. The economics of monthly billing are awful, and completely unworkable for a new startup. You have to do annual.

Cost of Install: $7.00, for something this specific Trial Start Rate: 20%, if paywalled like this app is Cost Per Trial: $35 Conversion to Trial: 40% Cost Per Subscriber: $87.50

If they charge you $10/month, they can't get into the black on a new customer for 9 months. They have to eat support costs that whole time. It just doesn't work, when you're starting out. You must charge annual.

Medical licensing cartels charge $500-800 PER MONTH. These guys are trying to charge $100 PER YEAR.

This is an order of magnitude more effective.

Said another way: if someone is too poor for this, they're fucked. They're definitely too poor for any other treatment option. On the other hand, this will open up treatment to people who can't pay the medical cartels.

That's amazing, iterative progress.

Let's give props to these guys for making epic iterative progress, not shit on them because they're not working for free.

> On the other hand, this will open up treatment to people who can't pay the medical cartels.

This is making the big assumption that a generalized set of self-directed exercises with no one-on-one personalized customization or checkins is an adequate substitute for real medical care.

I am skeptical that it is an adequate substitute. And if someone is hungry and you sell them a picture of a cheeseburger, that isn't epic iterative progress, it's just exploitative and immoral. I don't see any strong evidence that their app is actually going to work.

People with ADHD aren't famously great at consistently self-motivating themselves to do daily tasks. What are the odds that this isn't just another $100 charge for them that they can feel guilty about at 2:00 in the morning? If the founders want to argue that this is more (or even just comparably) effective than actual therapy and medication when it can't even be used as a diagnostic tool, then they need much stronger evidence than they're showing.

And I don't think that's a problem that can be solved by iteration. If they weren't marketing their product as a substitute for therapy I wouldn't be as critical (although I would still think their pricing model was thoughtless). To market themselves as if they're doing something extraordinary when, from everything I can tell from their product pages, they aren't -- that's predatory.

Self-directed exercises from a startup are not a substitute for real CBT; if they were then insurance would pay for them.

None of what you’re saying makes sense. If the product is amazing people will continue paying and attrition will be low, annual or not.

Basically the model here is like a gym, where people buy things that they don’t use as much as the price implies or is simply ineffective.

Given that the customers are executive function impaired, seems shady.

> or is simply ineffective

And 7 days is really too short to notice a sustained effect.

This is a good point. There are a lot of reasons you might get a small boost of productivity after starting a new therapy approach.

7 days isn't enough time for the vast majority of people to know whether the app is doing anything at all for them.

"Spend a week playing with something new and interesting that you might just hyperfocus on, and then impulsively pay us for a year's access because this time you won't lose interest in two months" feels laser-targeted to prey on ADHD behaviors.

Indeed, but the same could be said about therapy, or anything really. Therapists don’t charge you a year up front as far as I know.

The problem isn’t the cost, it’s the way folks with ADHD are being charged.

The whole point here is to help folks who are having trouble remembering to do things. Regardless of the economics, the optics here make this seem like exploitation.

Making this opt-in avoids a dark pattern. Folks with ADHD are often impulsive and strike while the iron is hot—if this has value people will opt-in.

Why are we holding this new startup to a standard we don't hold anyone else? 6 months from now when they have their economics figured out, cool, they can run that test.

Generally, giving users a toggle to get reminded when a trial is about to run out will INCREASE conversion rates.

That depends on the business, and is part of a pretty standard set of experiments you run post-launch.

With your comments you're part HN is descending into a circular firing squad of virtue signaling. These guys shipped something that could help a lot of people, over time they can improve their onboarding flow, lower cost.

Is the most remarkable thing about a really cool CBT tool for ADHD really that they have a standard trial flow?

> Why are we holding this new startup to a standard we don't hold anyone else?

Most startups aren't offering medical care. Call it "virtue signaling" if you like that those which do come in for a likewise unusual degree of scrutiny, but do you think you're likely to convince anyone that way?

I won't quibble with your analysis of the unit economics involved, but I will say that's not on point - this isn't a question of CAC/LTV but rather one of perception and image. My impression of Launch HN posts is that they are intended in part to elicit this sort of analysis, and by that metric this one has succeeded quite well. It seems like these founders didn't know they had this problem to solve, and now - if they're paying attention, which I assume they are - they do know. In what way is that other than a win?

You’re missing my point—it’s a bad look regardless of the economics.

You can have a great business model, you can have a good product, but if you can’t operate without alienating the people you want to sell to you’re probably dead in the water.

> Is the most remarkable thing about a really cool CBT tool for ADHD really that they have a standard trial flow?

I don't know - the problem is that, as an adhd person, once I learn about their bad trial flow, I'm not continuing to learn anything else about it.

That's their problem, not mine.

I find it strange that you keep talking past the point people are making. The problem is opt-out, and nobody is holding this company to a different standard. People hate opt-out, and in this case it looks particularly predatory.

Your comments come off as entirely unempathetic. Not everything is about bottom line capitalism.

I'm entirely and completely unemphatic. I think these are loser concerns for when a startup first launches.

These guys are moving the needle making improvements in a forward direction, and a big part of this thread is shitting on their launch, hyper-focusing on things they'll be able to change.

Launch HN threads used to be about asking thoughtful questions, having a back and forth where people learn about new spaces, and encouraging people launching their startups.

This whole thread is concern trolling of the worst kind, to eyes.

I'll bow out since clearly the bulk of the thread disagrees.

Appreciate the feedback and we're working on potential solutions to this. We do refund everybody who requests one and send reminder emails and notification within 2 days of the free trial ending.

This is a non-answer making it sound like this is some complex problem you're grappling with. Do the ethical thing and make it opt-in. Stop relying on distracted forgetful people to be so distracted and forgetful that they give you money.

What about folks who don't request a refund but don't use your product (as seems to be the issue that's getting discussed here)?

Fantastic to hear this--as the OP mentioned, having ADHD makes it hard to follow up on stuff like this.

The original announcement mentioned you folks have a neuro-diverse team, which I applaud and respect. I hope you really take advantage of this to dog-food your own product and on/offboarding processes to catch stuff like this going forward.

Keep at it! I'd love to see you succeed with this product.

Thank you so much - really appreciate <3

As someone with ADHD, I’ve stayed away from this product because it is a subscription service.

I will sign up for subscription services fully well intentioned and then proceed to not use the service and forget to cancel it in time. I know myself well enough now to stay away from any product offering a subscription. There is no real “managing” it, it’s just a fact of life for me and something I live around.

An app targeting ADHD minds and not offering alternative payment options is arguably more predatory than the average free-to-play mobile app, as the founders of this app presumably know about the difficulties that ADHD cause and are either willingly ignoring it or actively exploiting it.

Even if it’s a honest accident, it leaves a bad enough taste in my mouth to stay far away.

Thanks for the feedback. We're working on some potential solutions to this and in the meantime we refund everybody who requests one.

> Thanks for the feedback. We're working on some potential solutions to this and in the meantime we refund everybody who requests one.

A proper solution is to not charge in the meantime. I know its an aggressive stance, but the dissonance with the exploit and pricing model is strong. You should feel wrong exploiting people claiming you'll fix it later.

Wanna get paid? Find a way to do that without exploit. You'll find a potential solution a lot faster if the money stops rolling in until you do.

Either way, this is a terrible sign for your focus and compassion as business that toes the line with claiming to be a therapy or treatment for a medical condition. How can anyone believe you truly do the right thing and care? I don't think apps care about me, but an app like this that presents itself as an alternative to therapy I expect to be an exception.

For an app that _for_ folks who aren't neurootypical, accessibility should be priority #1. That it's not does not inspire confidence and suggests that you're going for an "exit" strategy, which might be great for VCs, but not for users, and without users, I wouldn't expect a lot of VC backing.

> suggests that you're going for an "exit" strategy

I'm not sure what you're trying to say here? An exit strategy isn't, like, a particular type of business model that some businesses use. It's just a word for the founders' strategy with respect to exiting the business.

So, what I mean by "exit" strategy is that they're more interested in going public or being bought out than in providing long-term good (and sustainability). There's a different set of incentives in wanting to exit (high valuation, market competition, etc.) than there is with being a long-term viable, sustainable business (building a reputation, being effective, etc.). The former are a lot more common in SV (it seems to me), but the majority of businesses that survived the 90's and 00's are examples of the latter.

Real therapists operate without an exit strategy. A good therapist isn't building dependence in their clients.

An exit strategy just refers to the founders' plan, whatever that may be, for exiting the company. Most people can't meaningfully work on one thing forever, but there's no reason why you can't exit a company and leave it in good hands, with a viable long-term plan. In fact, most founders will be incentivised to do exactly that.

It seems like you're suggesting that the only way to run a company responsibly is to intend to personally be at the helm until you drop dead, like Zuckerberg. That just feels unrealistic, and like a totally bizarre and excessive criticism, when there's lots of other legitimate stuff to criticise about this company.

Of course it is. It carries an important implication that, to put it charitably, the owners will focus on growing and selling their company, at the expense of value provided to the users. This tends to make a startup, depending on the backbone of its founders and pressure from the investors, something between a suboptimal compromise from users' POV, and a legal pump&dump scheme.

This should've been a day one offering. This alone will make me pass on this app.

Such as?

- Opt in free trial without putting in card details - Longer free trial - One-off purchase vs subscription - Web sign-up

In addition to these we also send email and notification reminders before the free trial ends and refund everybody who requests one.

Consider also “we only charge you at the end of the month if you actually used it” or so. Can be a much more difficult revenue model but user trust is way higher when you make that sort of commitment and if you are indeed struggling with getting user trust, it could be a lifesaver.

This is the only honest way to do automatic payments, and I think it should be a legal requirement for streaming services, gyms, and anything else that charges recurring fees and has the means to track usage. I would even be ok with "we'll charge you for this month, but since you didn't use it we will suspend your service and stop billing you"

I don't know of any services that do this though. So I assume they are all dishonest.

I like that suggestion, I'd be much more likely to sign up for something that used that charging model.

oh, this would be very good for the adhd mind.

even with a monthly subscription, it's really easy to completely forget about a service and move on from it entirely without cancelling it

I don't think that longer trial will help here. Rather it will worsen the problem.

Why not offer the service with a paywall? And I don't mean the awful website kind.

I mean: someone signs up - regardless of whether you want to call it a subscription - and every month on renewal, they get a notice to confirm renewal (or have to re-enter payment, though I suspect that's probably _too_ much friction).

Is that a great way to retain revenue? Probably not. But it's way better for press than what I saw when I opened this thread and was immediately turned off. It's definitely the kind of consumer-first model that I'd love to see more of, certainly from a company/app whose target is helping people...

I just got a notification for my 1-year-anniversary for subscribing to blender university.

I've never logged in.

Have you tried Privacy.com ? Even for people with no ADHD the subscription trap is very real but there are technological solutions.

Are there any hidden traps in the free plan? I know they have incentive to onboard as many free users as possible since they get part of the card fee when you use it, but people get greedy even with an opportunity to make essentially free, effortless, and ethical money.

Only ever used the free plan. I don’t think it’s meaningfully different. Only problem is that some apps like ClassPass will decline.

I made an account and moved some things over. Completely painless. I've seen it suggested a lot but I always assumed there was a monthly fee, so I never bothered. The 12 new cards a month on the free plan is already far more than I could realistically use.

I have but unfortunately it’s not available in my country. Would be a great product if it was available more internationally.

Disclaimer: I really appreciate the mission statement here. As someone who suspects they are impacted by some sort of undiagnosed ADD/ADHD, it's really great to know I'm not alone in these thoughts and that there are people trying to make solutions for it.

That said, while everyone is up in arms about the payment model here, I'm more concerned with the nature of the app's content.

What I was expecting to be an interactive, attention-grabbing set of modules turned out to be a whole bunch of audio recordings and generic goal-setting form fields. I almost laughed when I was creating my first goal, because in the introduction video by the cofounder he makes a point to explain that, "Like many of you, I've invested in planners and organizers hoping that they would magically help me become more productive." Can someone from the team please explain how this app's first iteration is not simply the modern & digital version of planners and organizers? Which features will be able to help users with which ADHD side-effects?

To be frank, I had high hopes when I started this free trial, only to realize that it smells a bit like a newer version of the self-help tapes people would fall asleep to in the '80s.

> turned out to be a whole bunch of audio recordings and generic goal-setting form fields. I almost laughed when I was creating my first goal, because in the introduction video by the cofounder he makes a point to explain that, "Like many of you, I've invested in planners and organizers hoping that they would magically help me become more productive."

This is a huge red flag for any self-help app.

Therapists should never try to build a dependency upon the therapist, yet it appears this app is structured to do just that: Convince users that external tools won't work for them, then capture their activity inside of an app with an expensive annual fee.

The purpose of therapy should be to give users the tools to support themselves. For example, showing users how to use traditional organizers in ways that are more compatible with their conditions and building a system of reminders and automatic habits to support that goal.

The incentive structure of this app is inherently in conflict with the traditional goal of therapy: Self-sufficiency.

Thank you for feedback - really helpful!

In terms of our current features, we have: - Short daily learning exercises that tackle a range of ADHD topics - Challenges to support the development and tracking of habits to help manage ADHD - A community of like-minded individuals - Live weekly events with psychologists & coaches where you can get any of your questions answered, or participate in group meditation and coworking sessions.

We are also working on some new interactive features such as accountability buddies, accountability coaching, group-based challenges and routine building tools.

Why do those cost money? Sounds to me like all of these features are zero-margin, so I see no reason to charge a recurring subscription. If you believe in your product, charge a small one-time fee or make it free. Otherwise, people who know how the sausage is made are going to always call you out for selling a glorified to-do list.

Hell, Brain Age for the Nintendo DS was cheaper than this stupid app. You'd think that we've come further as a society and developers, but nope: now you're paying monthly (or yearly, if you're one of the unlucky android users) for a toy with less features.

I'm frankly so done with YC at this point. I simply cannot believe that a benevolent person greenlit this.

To be honest, the feature list and roadmap give me a lot of anxiety. Shouldn't you create a product that that has simple direct tailored interventions, not a panoply of many choices?

Is this research based? Are you sure your "interventions" help?

> The average cost of an in-person ADHD CBT session in the US is $200-300 ($10k-$16k/year).

This is not true at all. If anyone is considering ADHD therapy, please do not let such misleading figures dissuade you.

For anyone with insurance, the average cost of a therapy session is often as little as a $15-25 copay. You could get 4-6 in-person, personalized therapy sessions with an experienced provider for the same price as the annual fee of this app, depending on your insurance.

Even self-pay therapists don't charge $200-300 unless you look at the most expensive cities like NYC [1]. The average self-pay cost is going to be closer to $125 in most regions, though providers often have what's called "sliding scale" charges for low-income patients that go much lower.

The $10K-$16K per year figure is also extremely misleading. In the United States, the annual out-of-pocket maximum for an insurance plan is capped at $8,700 for an individual in a given year [2]. Mental and behavioral healthcare is covered as an essential health benefit [3]. It's not possible to spend $16K per year on any services unless you attend providers that don't accept insurance, which is exceedingly rare. Don't let any apps scare you away from professional services by quoting unbelievably high numbers.

If anyone is considering therapy, please visit your health insurance website and check the cost. Don't be discouraged by anyone trying to sell you alternatives. For most people with insurance (including government health insurance in the United States), several sessions are going to be cheaper than this app and will also provide more personalized, in-person care.

[1] https://blog.zencare.co/therapy-fees-private-practice-by-cit...

[2] https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...

[3] https://www.healthcare.gov/coverage/mental-health-substance-...

YMMV; I have never successfully gotten ADHD CBT reimbursed by insurance. The $8700 is only for in network care and there are no reputable in-network providers that specialize in ADHD in my town.

I went to two in-network LMFTs that listed ADHD as a field they treated and they were complete shit. It was basic talk therapy with generic organizational suggestions like "have you considered keeping a todo list"

I went for 6 weeks with each just to make sure it wasn't just them establishing a baseline (and 6 weeks of copay was cheaper than a single visit to an out-of-network provider). In retrospect, the 6 hours of lost time was not worth it even if the visits had been free.

I have paid over $10k out-of-pocket in a single calendar year ($220 per session) to a therapist that actually helped and $0 was reimbursed by my insurance. I do live in an expensive area (SoCal) but not NYC expensive.

[edit]

None of this is saying I think the App from TFA will be useful; just refuting that everyone who is insured can get ADHD CBT treatment covered by insurance.

> YMMV; I have never successfully gotten ADHD CBT reimbursed by insurance.

The situation has changed significantly under the ACA now that behavioral health is covered as an essential health benefit.

But you do have to go through your insurance company's website to find the in-network providers. As you said, you can't simply pick a therapist and then try to seek reimbursement later.

Some of the cash-only therapists are great if you can afford them. Some therapists strike out on their own as cash-only after building a reputation and a loyal client base. However, it's not a guarantee of success as cash-only also attracts a lot of people who simply want to maximize profit and not deal with insurance, so YMMV.

I agree that there are terrible cash-only therapists. After my two poor experiences with in-network therapists, I asked around in the local area to other people with ADHD and there were two positive recommendations, both of which were cash only.

My meds are 100% covered (though I had to have my psychiatrist file some extra paperwork to get anything that wasn't Adderall or Ritalin) , so at least there's that...

The classic CBT (although not ADHD focused) book by David Burns is $8 on Amazon

That implies that it is easy to find a therapist who will accept insurance, which is not at all the case for many people.

Finding therapists who accept insurance is such a large problem in so many US cities that there are entire startups working to fix that (one example: https://headway.co/). $200-300/session is a low estimate for people in those markets.

I just perused through the website (as someone who is diagnosed with Asperger's, now part of the ASD, and may also be underdiagnosed and need to deal with the reality of having ADHD as well), I find it highly suspect that YC would fund this company.

None of what this website claims their website does aligns with any description of CBT for ADHD I've ever seen (either from practitioners, or from good friends of mine who undergo such therapy), and also is rife with "this app helps user do things in a self-directed manner" when having an executive disfunction is at the core of ADHD(!), as if the developers behind this app have never had ADHD and didn't even bother reading Wikipedia, let alone any actual research.

The billing system seems to be incredibly predatory as well, another typical anti-pattern used by companies that try to trap people with mental disorders.

Can someone from YC actually go on record and say this is part of YC S21? I don't see it listed officially from YC anywhere.

Not affiliated with YCombinator in any way but their website does list them as part of YCS21.

Link :- https://www.ycombinator.com/companies/inflow

Yeah, I looked at that list when I wrote my comment, it didn't look like Inflow was listed, but it does now (since you linked it).

nuero non typical wonder twins unite. f these people.

Hey, fellow invalid here. I will be checking out the app, but am unlikely to convert to a paid subscription due to my treatment already being covered.

One thing I find very off-putting, is the rose-coloured, almost "success guaranteed"-like image your website and app store page sketches.

This product is no wishing-well that your customerpatients can simply throw money at and magically feel better. For this to ever have any meaningful and lasting effect, they will have to put in some serious effort. This requirement should be very clearly communicated I feel.

Long-term dedication and commitment to a plan with uncertain results is not exactly what ADHD brains are known to excel at ;)

Edit: I also share the others' thoughts about your billing model not being very ADHD-friendly.

All-in-all, considering your listed expertise in this field, this is very concerning and not a good look at all.

Thank you very much for your feedback here - really appreciate the input here. We're making updates and changes to our onboarding + website and will definitely take your points into consideration.

The impact proper treatment can have on life quality is unfathomable without first-hand experience or having seen it in another. Getting more people access to it, if done properly, is something I can definitely get behind.

I sincerely wish you all the best and hope you can make this this concept work.!

One thing I've wanted in an app is some kind of organized quick way to do "where did i put that?" and "did I try this food option before and did I like it or not?"

My main concern with any app is remembering to use it. I have a dozen or so alarms, and todo lists, and I still forget to check them. Beyond some push notification, what ways can your app help me remember to use it to make it a habit?

you might want to try Notion or Evernote something like that; externalised memory is generally served by note-taking apps. Roam is also good, if you don't like organising your notes hierarchically. Remembering to use it is not an issue of memory, but of habituation; there are decent habit-tracking apps like habitica to help with that. Of course, the first habit you'll want to build is the habit of using a habit tracker! For me, the easiest way to do that was to plumb in the habits I already do (brush teeth, make breakfast etc) and focus on checking them off daily. Then I could build on that into making new habits.

I was diagnosed with ADHD last year after suspecting it for some time. I used Notion for this exact reason, but ended up switching to Obsidian with much more success. Notion is a great app and I even had a pro subscription for a while, but the number of widgets and options and different ways of doing things made it too distracting for me.

I'm glad you found something that works for you! I haven't tried Obsidian yet, but I'm tempted to when I get a little time to try it out, because open-source is just inherently better.

[edit] just looked it up, I thought Obsidian was open source but apparently not. Disappointing.

I agree, it’s disappointing. Personally, I justify my use case by considering that they have little incentive to “be evil” given their business model, and I have to make some sacrifices to get the outcome I want; not being able to inspect the source is a sacrifice I make for a very effective personal organization tool.

Obviously this is a decision I have made for myself and it’s just as likely to blow up in my face in the future as any other project, but I would encourage anyone struggling with memory or organization as a result of ADHD to investigate Obsidian.

My phone says I have 219 notes, many of which are pages long. I need a better way to organize them, especially when I need to add something. Large flat files of text get difficult to use. Maybe the apps you mentioned address that in some way, I'll have to look.

I actually do this and think its the best option. The app that is always there is best. Especially if its simple. I just use iOS notes, and they show up on my mac. Easy, always there, and fast to load.

I just dump everything into its own note, then write some keywords to search for. Lots of small notes. Searching text is easy and fast on modern tech, so forget organizations that are inflexible and will need to change, just use text search for everything and put every thought into its own note.

Have an upcoming flight? Throw the entire email into a note ( i attach the email file, not contents), then write "trip SFO NYC november 2021 delta thanksgiving" and i can just search "SFO november" or "delta thanksgiving" and find the flight details.

I even keep a note called "addresses" so any service i give my address to i know about. Very helpful when moving (i do a lot) and tracking what accounts need to be updated.

I found the important thing was not to bother cleaning up notes, or tracking old ones or doing anything complex. Just let them exist, and when i get bored (eg. on flight) i may go through and clean old ones.

Yeah they do - notion allows you to organise notes hierarchically, as trees or in databases (like a table where each row is its own page), and roam allows you to network your notes into a graph. Notion is probably better in your case, roam is more designed for building knowledge graphs when researching.

+1 for Notion. If you are interested, I would also look into a system like "Getting Things Done" or "Zen to Done" for a more bite-sized approach.

219 notes though, sounds like you already have a good habit of capturing your thoughts! Organizing tasks into current contexts has helped me a lot (At Computer, Housework, Wife,...). Best of luck!

give Obsidian a look

Re: "where did I put that" -- I got a set of Apple airtags recently and they've been a godsend. I also have an apple watch, so via the watch I can find my phone, and via the phone I can find my wallet/keys/etc... They're awesome.

Re: reminders, one thing I've noticed with any sort of reminder system based on alerts/notifications, is that while they work for a while, eventually my brain just starts ignoring the alerts. I honestly have no great solutions for that. This applies to any sort of organizational system I've tried, actually.

Yes exactly! The alarm goes off that says "empty the dishwasher" and my brain says "yup it's 7:15," then goes on to something else before I digest what the alarm is for.

I'll definitely check out airtags, thanks!

An ever-louder alarm that eventually electrocutes you will work. It'd need to be location-aware so it knows that you really did unload the dishwasher.

what i love is how apple takes advantage of my disability to steal all of my privacy with airtags and find my. i use it all the time but i f apple under my breath every time.

Trust me, it's not just your disability: Apple takes advantage of all their customers equally, regardless of race, gender identity, sex or financial status.

yeah but because you give up so much privacy with airtags and find my that it feels targeted at me as someone who forgets where stuff is, all the time.

try finding a positive association to attach to the alarm -- some form of dopamine hit or something so you can start to look forward to the alarm

(then you get the self control issue of not going for that dopamine hit every time it pops into your head!)

if they pay me to use it I'll make it a habit for sure :)

To others here, please avoid this app, there are too many red flags about it.

The testimonials on the site [1] are superficial. I only saw short term ones. Most people with ADHD have a track record of starting new things, being extremely enthusiastic only for it to fizzle out in a few weeks.

Case in point Adam says: "I'm recently diagnosed so it's really exiting..."

This is on the science page [2]: "Studies have shown that Cognitive Behavioral Therapy (CBT) is effective in helping to treat those with ADHD." It's the only actual science quote on there. It's a platitude if I've ever seen one. CBT does work. However how is this app comparable to CBT? It's not and it doesn't explain any of it.

The whole site is also extremely vague and light on detail. No mention on the kind of exercises, why they work and how they work. The screenshots on the playstore page [3] had more info than the site.

As other mentioned the opt-out is indeed predatory given the target audience.

Lastly, there are many great resources online for ADHD: A community for ADHD go to: https://forums.howtoadhd.com/ podcasts: https://drhallowell.com/listen/podcast/ https://www.fasterthannormal.com/

All in all, I'll avoid this app till I hear favorable things from the community.

[1] https://www.getinflow.io [2] https://www.getinflow.io/science [3] https://play.google.com/store/apps/details?id=inflow.adhd.pr...

I wish you luck!

I have the opposite issue. I'm ... what do you call it? neurodiverse (at one time, I was an "aspie"), and I can actually get locked into a fugue, so strong, that hours go by like minutes.

In the aggregate, it has worked out OK. I'm a damn good programmer (but a total nerd).

I do have family that have suffered from ADHD, and hope that your app may be helpful.

Hyperfocus is actually one of the odd trades of ADHD. If people with ADHD work on a topic that motivates them, they can easily loose hours just like you describe. However, if the task is too mundane or overwhelming, I can easily procrastinate months on them.

^ This. As a 45 year old recently diagnosed with ADHD, I realize how much of my life was described by things like this. The more I learn about ADD/ADHD, the more sense I make to myself.

Same. Some jobs I was hailed as a 10x programmer. Others I was worthless. Or even same company but different projects.

Pair programming was a massive benefit as it kept me on task all day.

Being bored was a physical pain for me. Meds took that pain away. Even after I stopped meds I was much improved as I no longer had that pain Association with boredom. Jus regular tendency to get distracted easily.

Isn't that crazy, that one could go 45+ years without knowing they had ADHD? It wasn't until I was... > 50yrs until someone I was talking to said "sounds like you have ADHD" and I was like "what???" But sure enough, after seeing a couple of specialists and reading up on it, turned out I had all the classic symptoms and was coping with it in a number of suboptimal ways. Knowing about it and treating it has improved my life immensely.

Almost exact same boat here, other than treatment; only diagnosed, still awaiting and finding treatment. But I think I can answer that question. Perhaps we assume that others are the same as us and have the same mental environment and are just better at navigating it? I assumed I was lazy. And considering the amount of substance abuse among adults who have ADHD, people often look at that as the problem rather than a reaction. Mental environments are invisible. The higher functioning people tend to work hard or be lucky. The folks on the margins or who are failures have no voice.

This sounds very much like me. Give me interesting work and I won’t stop, give me mundane work and I’ll find more interesting work till I have to do it. I’m 27, how did you end up getting diagnosed later into adult life?

I was your age when I was diagnosed, and it changed my life. I had suspected for years, and one day a friend gave me an adder all. I felt like everyone else seemed. I then found a psychiatrist that would let me book via email, and was near my work. I told him everything, including the illegal adderall, and we walked through questions and I believe his words were "you are the poster boy for adult ADHD". Within a year I had taught myself some new skills, within 5 years my salary had more than doubled.

The hardest part is making the appointments, if you have someone who will help you, ask them to. If you don't just force yourself.

Though as I put on another comment I might delete, ADHD isn't really about mundane vs interesting, at least not always. Sometimes I find myself focussed on the mundane, or ignoring the interesting and enjoyable. The pills aren't magic, and there is no cure, but if you suspect it I recommend finding help. Also, intense cardio exercise, high protein low carb diet, lots of water, and vitamins. I don't stick with any of them for long periods of time, but whenever I do it makes life easier.

A new coworker, who was recently diagnosed, said to me "you have a lot of the traits that I have that led me to getting diagnosed." So I talked to my doctor, filled out a short questionnaire, and it was official. Before seeing the doctor, I mentioned it to my adult daughter and her response was "Well DUH." Seems like everyone knew but me lol.

Not OP, but I suspected ADHD starting from my late teens. Looking back as a child I had impulsive behavior issues and caused harm to other children. Perhaps if I had been in a public or private school I would’ve been diagnosed earlier. But anyways as an adult I was really nervous to go to a shrink. Wound up going in my late 20s and received a diagnosis.

As others have mentioned, "Hyperfocus". is one of the symptoms of ADHD. ADHD is really a misnomer, it should be called Attention control disorder. The famous hyperactivity part that annoys parents and teachers is really just a way to self treat. Exercise in general helps, and one of the hypotheses I have heard is that the ADHD brain evolved to be constantly moving, and is only a problem with our modern stoic lifestyle.

Though back to hyper focus, it is a curse and a blessing. Without it, I would never get anything done personally or professionally. Though I will also ignore family, friends, and work for entire days on things that are meaningless and I don't enjoy.

Which really brings me to the core of ADHD. What you focus on has nothing to do with what you want, or what you enjoy. It is, to various degrees, out of your control.

That said, I'm going to give the app a try, I have had some ideas for an app myself, but haven't found the focus to work on it.

It's too late to edit, but after reading about the subscription model, I will not be trying this app.

What's the difference between hyperfocus and flow state?

Not much. I would say that a flow state happens on purpose for something you want to do, and you can easily stop your flow even though it may be difficult to get it started again. With Hyper focus it may happen to something you don't want it to, and you can't easily stop. In the moment it is hard to tell the difference, at least when it's something you want to do.

For example, I was late to an event for my child the other day because I was trying to improve the speed of a one time copy of data from an old computer to a new one. To the point that when I finally pulled myself away, after receiving multiple phone calls, it had been hours and the original method would have been finished if I had just let it run. I felt like I was being productive, but I was not. Once I realized I was wasting my time it took me two more hours to stop.

An example of a bad flow state is I’ll get locked in a Wikipedia hole. It might start on reading up on a topic I need for work (e.g. a class of algorithms), and then next thing I know I’m 6 degrees away from the topic I was supposed to be studying reading about a 16th century battle or whatever.

>> and I can actually get locked into a fugue, so strong, that hours go by like minutes.

This is the norm for ADHD as far as I can tell seeing how my kid behaves.

As I see it, ADHD is not an inability to focus, but an inability to control what you focus on.

To echo the other comments here, you are describing ADHD, not its opposite. ADHD doesn’t mean you can’t hyperfocus, far from it. It means you find it much harder than a normal person to directly control, through pure will, what to focus on and how widely/narrowly. So at times you’re highly distractible and struggle to focus on things (sometimes even when you know they’re vitally important, like listening to the questions in a job interview), and at other times you struggle to tear yourself away from a task you’re engrossed in (even when you know there’s something urgent you should be doing) - the fugue state you describe. It’s a lack of ‘executive function’, and you can actually see this on an MRI scan - ADHD brains apparently tend to show much less of this type of activity.

As a rough analogy, ADHD is to focus as bipolar disorder is to mood.

"As a rough analogy, ADHD is to focus as bipolar disorder is to mood."

Could you elaborate?

With bipolar disorder, you swing between extremes - depression and mania. Your mood seems to have a mind of its own, you can’t always control it.

With ADHD, you swing between extremes - unfocused and hyperfocus. Your focus seems to have a mind of its own, you can’t always control it.

This isn’t part of the colloquial zeitgeist, but the executive functioning issues of ADHD and ASD share a lot of common symptoms around a lot of social behavior patterns.

For example I am diagnosed as ADHD. But I feel I have some issues that put me on the autism spectrum. After doing a lot more in-depth reading I’m pretty convinced I am not autistic, even though many of my symptoms do intersect with autism.

Strongly encourage you read more books about ASD and autism and then seek professional advice if you believe it would make your life better.

For what it’s worth, that kind of time blindness induced by hyperfocus on some idiosyncratically captivating interest is also a classic manifestation of ADHD.

I strongly suggest that you engage with some professionals for this issue, not an app targeted at a single diagnosis.

Issues like you describe are difficult to self-diagnose and impossible for others to diagnose over the internet. You could have an ADHD-like etiology, maladaptive daydreaming, or you could have a seizure disorder. Undiagnosed seizure disorders can be particularly draining but are often easily treated.

Be wary of internet comments pushing you to a specific diagnosis, particularly ADHD. HN commenters frequently over-diagnose ADHD from comments about vague symptoms. Leave it to professionals who can evaluate you in person.

Ahh...it's all water under the bridge, for me. I've accepted my own proclivities, and learned to make them strengths.

I have no interest in the app, but I agree that folks who believe they may have any type of issues like this, should start by seeking professional help.

One of the things about HFA and ADHD, is that they can go undiagnosed for a lifetime; which is not always a bad thing. We can often be extremely productive members of society; despite challenges.

A lot of times, the behaviors and habits we develop, as mitigations of the symptoms, can cause more problems that the issue, itself.

> A lot of times, the behaviors and habits we develop, as mitigations of the symptoms, can cause more problems that the issue, itself.

Too true. If you can learn to leverage the mental differences it can become very valuable. Unfortunately behaviors/emotions/habits to counter symptoms that in the larger picture often aren't that significant can make life much more difficult than it needs to be.

> and I can actually get locked into a fugue, so strong, that hours go by like minutes.

Is this not a normal occurrence? I thought this is just how it is for everyone when they encounter a problem that captivates them.

Yes. Pretty much all the symptoms of ADHD are things that everyone experiences from time to time. People with ADHD just experience them far, far more often, in a way that often negatively impacts their career and relationships. And their lives tend to get better after being diagnosed, as they can start using meds and learning ADHD-specific organisation strategies.

Sure. It's just that the rest of the time people without ADHD can sit still for longer than ten minutes and don't uncontrollably interrupt people while talking.

Not diagnosing you or anything like that, but you should know that hyper focus is a symptom of adhd.

Maybe, but I know a family member with true ADHD, and it's quite different.

For one thing, he gets along with other folks, much better than I ever did.

There's no true ADHD. ADHD has many different manifestations. The one trait I have seen described that seemed most common was "difficulty with impulse control"

There are multiple types of ADHD, so you two may be discussing different ones. The commonly used categories are

1. primarily hyperactive (cannot stay physically still),

2. primarily inattentive (”daydreamer”),

3. combined type, with features from both 1. and 2.

According to a medical doctor I have true ADHD. Unfortunately I do not get along with other folks. I have no friends and family that refuses to see me. Work is a struggle to ensure I’m interacting with people in a neurotypical manner that puts folks at ease. That said, I also know people with ADHD who are the life of the party. It really depends on the person.

"Neurodiverse" is an umbrella term that covers a handful of things, including both ADHD and Autism Spectrum Disorder. What used to be Asperger's is now just one point along the autism spectrum. So you'd still be classified as neurodiverse if you had ADHD instead of being somewhere under the sub-umbrella ASD.

I won’t argue with you about this, as I’m tied up arguing about it already with my inner aspie.

I was excited to try it and gave up during sign-up because there's no free option. The 7-day limited trial of the paid version isn't the same as a free tier.

A lot of work goes into building and continually improving a product like Inflow and we need to charge a subscription fee for it to be viable. We believe that being more affordable than other options which means many more people are able to access the support that they otherwise would not have access to.

Nobody is saying your app should be entirely free. They're saying it should be opt-in after the free trial, and that you shouldn't be collecting payment information until people are choosing to pay for your product. That's good practice in any domain; it's especially important in the field of mental health care.

Many lawyers offer a short consult before they start charging. When we have work done on our house most contractors will provide an estimate and a brief discussion before charging anything. When we go to a store we can look at things before we decide to buy them.

A free trial for an app is along these lines; it's not saying your product is free, it's saying people can check it out enough to make an informed decision about whether they want to pay for it.

I also ended up dropping out at the same part of the signup. I don't have a problem paying for things, but I don't feel comfortable with a user experience that doesn't say up front how much it costs. It wasn't until I filled out all the details that it became apparent there are paid plans. That for me is a warning sign about what the company could do in the future.

This comes off as so incredibly tone-deaf to me that I now understand how you came up with this terrible execution and still think you were justified in the way you launched. This is your crowd. We are the target audience. We are your potential users. Listen. Apologise. Take notes. Get back to the drawing board.

yea but opt out auto annual renewal of 100$ is shady. Gtfo. You should let people actually trial the app or don't offer a trial. Also monthly subscriptions. If neither of those work then what value is our app actually offering?

Have you considered that this is maybe the universe's way of telling you that monetizing a zero-margin healthcare treatment is a bad idea?

I'd love to be proved wrong, but I can't help but feel like an app is last thing ADHD people need.

We definitely have some areas to improve with the onboarding. Many people with ADHD have found our app super helpful and we also have done a study with a university in the US assessing pre/post symptom/impairment change which has been super promising and submitted to a prominent journal.

nico your f’ing right

Your app claims to help with OCD, however, unless your app uses Exposure and Response Prevention (ERP), other forms of CBT are contraindicated for OCD treatment.

Can you explain succinctly how you help with OCD?

Why does your web page not explain what the app does and how it works, like with examples or something, anything, that describes what I would be signing up for?

Can I download this directly without signing into Google? I'm not a big Google or big tech supporter.

Also why does the front page of your app not explain precisely how it works and what it does? All it promises is an awesome black box that "helps". What does it even do exactly? Writing an increasingly complex "how it works section", like Fastmail had when I signed up or that great comic on cryptography, would be appropriate.

At risk of asking a stupid question, have you had people without ADHD try your app? Does this type of CBT have any potential benefits for non-neurodiverse people?

Not a stupid question at all! ADHD impacts executive functioning which a lot of people struggle with whether they qualify for a diagnosis of ADHD or not. While we have had users who don't have a diagnosis of ADHD use the app, naturally the benefits are felt a lot more by people who know they have ADHD.

This is insanely predatory, between this and that "skip the interview" app I've completely lost all faith in Y Combinator. I don't know how people are allowed to propose such villainous ideas, let alone conceive of one. My only mental recourse is assuming that you're either completely blind to the actual needs of people with ADHD, or you came at this from a money-first perspective.

hey sebisaacsinflow. i’m a nuero non typical, and i have a lot of hate for your company, and now, for you personally, sir. this app takes advantage of my mental state, and i would just like to state that one big time for the record. gfy.

Pick a few features and make them the free tier. Upsell some premium content, or have a “first three goals are free” model, unlimited goals in the subscription.

Anything but paying up front for a year.

If there was a free tier I’d download and try it.

Have you conducted a clinical trial demonstrating the app's efficacy?

Preemptive follow-up question: why not?

Does therapy actually work? I’ve always been under the impression that it was mostly placebo, and that only medication produces meaningful results. Happy to be proven wrong though

From my experience, I have found that therapy is only as useful as the work you are willing to put into it. If you have trouble opening up, interacting with people in general or committing to changing yourself, your ultimate goals with therapy will become vague, and without well-defined goals the entire system falls apart.

I don't know what to feel when people around me say I ought to talk to a therapist, leaving it as the only possible option for my mental salvation or outright refusing to listen to me about certain topics by saying the therapist needs to hear it, not them, only for the therapist to say they don't know how to help me. That is because I went just because someone told me to, because they did not want to listen to me, so I'm not motivated enough to get the most out of each session.

I started going with the intention of receiving CBT and I'm not sure if what we do can even be called that anymore after all this time. About the only reason I see my therapist each week is to have one person who is willing to listen to me in person instead of zero, and nothing particularly changes as a result. If seeing someone in person each week who is actually willing to listen is all that prevents me from becoming depressed, then it is a net positive result, but it is not life-changing in any real regard because of my lack of motivation or inability to properly utilize therapy.

During my diagnosis I discussed both pharmaceutical and therapy options with my psychiatrist. His take, which is definitely subject to his own biases, was "lots of my patients choose to do both therapy and pharmaceuticals, but after starting the drugs they kind of lose interest in the therapy part of things because the drugs work so well for most patients. Not all. Some have benefited tremendously from therapy."

It’s less because the medications are so effective relative to therapy. Ideal solution is a combination treatment. However, it’s hard to convince people to make scheduled appointments to interact with another person and discuss part of themself they’re not proud of, so many people reach for medications instead of therapy in all psychiatric conditions (not just ADHD).

Therapy is actually a wonderful adjunct to medication because it helps instill lasting behavioral changes. A lot of people mistake the early motivational boost of stimulants for ADHD remission, but once the energizing effect of stimulants disappears due to tolerance, they’re left with the same bad habits they started with. Therapy can help build a better foundation for when the energizing side effect of stimulants disappears and only the attention-enhancing effects remain.

The meds available for ADHD are remarkably effective relative to other psychiatric disorders though. For depression there are a number of (placebo-controlled) studies showing CBT + meds reduces symptoms more than either alone do, to the point there is a hypothesized complementary effect. It's also pretty common for moderate depression cases to continue with maintenance therapy but go off meds (with proper supervision ofc) once things are under control.

Therapy is a lot more work for the patient - more time consuming, more costly, can be emotionally taxing in the early stages, etc. So I understand the desire for a meds only solution, and in some cases that is possible. But talking about therapy more generally I would encourage anyone who can to give it a try, just as I would encourage people to put effort into their diet, exercise, etc.

Obviously make sure it is evidence-based therapy though, something like CBT that has been well-studied. There are flavors of talk therapy that are total pseudoscience.

Most people seem to think that medication for ADHD is great, but for my son, the side effects were unacceptable: nausea, vomiting, extreme irritability. If therapy is even an option, none of the medical professionals we’ve spoken to has offered it. Maybe it’s because he’s on the young side (7). Anyway, it’s frustrating that everyone sees medication as the answer when the side effects are so awful—but maybe our experience is outside the norm.

That sounds somewhat unusual, but side effects are a very individual thing. It might be you can't get a low enougb dose for your child. I'm a full, rather large adult, and I only need abouy 5-10mg of ritalin, and going above that is unpleasant. I'm sure I'd have been quite sick if I was taking that dose (5mg seems to be close to the minimum they'll do) at 7.

A lot of doctors start patients at crazy high doses (over 10mg) and a lot of patients do indeed benefit from 50+mg.

If medication isn't tolerated, starting therapy early seems like a great idea.

Side effects also vary with the active substance used, release mode, and other factors. Like with depression, ADHD treatment also starts with a process of matching the right meds to the person. So if the first prescription has bad side effects, tell your doctor and get them to prescribe an alternative. There's easily a dozen options to go through before giving up on meds entirely.

> I’ve always been under the impression that it was mostly placebo

I don't think placebo is relevant in the case of therapy because placebo itself is a psychological effect.

CBT seems to be somewhat effective but with these things people's experiences vary a lot.

They do placebo-controlled trials of therapy techniques like CBT, although for an educated patient it may not be a great placebo - similar to the problem with trying to placebo psychedelics. But basically you can assign the patients randomly to either an informational session on the disorder + unstructured talk "therapy", or the actual therapy method such as CBT.

CBT does perform quite well repeatedly in these sorts of experiments, particularly for depression (it is less studied in some other disorders although still promising). You're right there can be a lot of variance between people though. There can also be additional variance IRL due to therapist quality IMO.

Each ADHD individual is unique and will have unique responses to therapy, medication and other treatments or self-help measures. While we have worked hard to build Inflow for all members of our extremely diverse community, we acknowledge it may not be right for everyone.

It depends on your definition of "work" -- the impairments will not be impacted, but you can learn a lot of coping strategies to live a higher quality life.

> The average cost of an in-person ADHD CBT session in the US is $200-300

Is that real? Or the average cost in a city like NYC? My partner has been looking for this in the UK, and the cost is under half this (so long as you're not looking for a big-name London clinic)

The people I know in this field bill around $110-$120, though my friend readily discounts to $80 for cash pay patients who are struggling.

The $200-$300 might refer to the price they bill to insurance companies, which is not the real price anyone pays. Insurance pays the higher of the billed cost or the allowed cost, so anyone billing insurance makes sure to bill much higher than the allowed cost to avoid leaving money on the table.

In practice, people with decent insurance will be paying $15-25 copays on average, not $200-300. I suspect their marketing material is being deliberately misleading in order to dissuade people from actual therapy, which is not cool. Wish they’d just market it as an adjunctive tool instead of a therapy replacement while trying to discourage people from going to therapy.

Between this and the $110 automatic charge if people forget to cancel the trial, this app feels like they let the “growth hackers” loose on the app instead of trying to be genuinely helpful.

The cash prices in the US have gone up significantly since telehealth gained regulatory support and patient adoption after pandemic related lockdowns started. To the point of Inflow, they are offering both an alternative and supplement to this kind of care.

Context: I helped build and launch CareDash’s telehealth marketplace, which serves the large national players in mental health in the US.

I believe it's not outside the expected range for therapy services in the US. How much the patient pays depends on what their insurance will cover.

Almost everyone rightfully dug into the payment model, which is definitely super shady, but I'll be the outlier and argue that the premise—as detailed in this summary—sounds awful. Seeing someone for CBT is a real thing that I can put on my calendar and be completely engaged in. This is just one more bullshit thing I'm supposed to check on my black mirror every day and engage in some community with? Fuck. That.

I quit Reddit and Twitter for that reason (among others) and have zero other stupid detractors except HN. It's a good place.

If anyone is looking for a fairly sparse but totally free app with some minor tips and tricks, check out My ADHD for Android.

"This app isn't available in your country" (Brazil).

It's probably not in the countries where they can't automatically charge your card after 7 day trial period if you forget to cancel the trial.

I don't wanna know how high that bounce rate is because somebody failed to properly release the app

Not available in Germany either

Not available in India too.

This has to be one of the most negative reactions in the history of Hacker News.

Given it’s YC associated I wonder if YC themselves will launch an enquiry into how one of their products went down like a lead balloon on this very site.

I am supremely interested in this business idea. ADHD is an incredibly large population and frequently disadvantaged in ways they and others are incapable of seeing.

As a point of comparison I have a son with severe dyslexia and another with severe ADHD. My son with dyslexia was completely illiterate until almost the 4th grade and now he is almost making a 4.0 in high school with ease. ADHD is by far the greater challenge affecting everything from learning, functioning, and motor cognition.

I am a bit hesitant to comment here. The last ADHD related thread I saw on HN was the worst shit show I have seen on HN filled with big tears and many narcistic people injecting unrelated defenses against personal attacks that didn't exist.

> I am supremely interested in this business idea. ADHD is an incredibly large population and frequently disadvantaged in ways they and others are incapable of seeing.

This reads....shitty. "I'm interested in business ideas for large frequently disadvantaged populations"... I mean...are you interested in ways to make money off cancer patients, too?

Stuff like this app needs to be part of a diverse treatment plan, not some profit center for an exploitative corporation.

> The last ADHD related thread I saw on HN was the worst shit show I have seen on HN filled with big tears and many narcistic people injecting unrelated defenses against personal attacks that didn't exist.

There's something a bit ironic about this statement...

> I mean...are you interested in ways to make money off cancer patients, too?

If it actually helps treat cancer at a reasonable expense then absolutely. Medicine comes at a cost.

profit motive and reasonable expenses are diametrically opposed.

I sincerely hope you never find yourself bankrupted due to some condition outside your control.

Someone pointed out how individualistic the ideas of self help and self care are and that is all I think about when I see it now. I'd be interested in seeing what some community focused solutions would look like.

For people who are not into predatory apps: I’ve personally had great results with Ahead (https://helloahead.com). You get a professional diagnosis and CBT and they can prescribe medicine as well. It’s not cheap (the consultations are indeed $200-300 / hr) but it’s legit and most insurance plans should reimburse you for it (although as someone who is struggling with ADHD, I still need to file my claims, a year later).

Not affiliated, YMMV

As someone with ADHD, this sets off some (okay, many) red flags for me.

Some thoughts:

- Patient intake for ADHD is genuinely awful, you're right about that. The diagnostic/treatment process for ADHD often feels like it's designed to make people with ADHD struggle.

- CBT is generally helpful, therapy is an important part of treatment. I've seen good results from it.

- in-person sessions are expensive (although if you have good insurance you shouldn't be hitting $200-300 a session).

----

However:

- Non-personalized CBT may not be as helpful. One thing I've learned working with my therapist is that a lot of behaviors I thought were universal aren't, even among people with ADHD. We spend a lot of time breaking down what my motivators are, what things I struggle with, and we spend a lot of time brainstorming coping mechanisms and exercises that will work specifically for me. There is no single technique to deal with all of this, and you really need to have some way of narrowing in on what type of ADHD you have and what other conditions (anxiety, autism, etc) might complicate it.

- "5 minutes a day" is not really CBT to me. CBT is work, and I'm immediately skeptical of any app that tells me I'm just going to do some quick daily exercises and it'll change my life. Therapy doesn't work that way in my experience.

- I'll also note that the reason that the average cost of a CBT session is so high is because it's a personalized, one-on-one session that can last as long as an hour. So I feel even more that the comparisons being made here to traditional therapy aren't very apt.

- A self-directed routine that isn't being done with a real person kind of misses the point that people with ADHD often have trouble forming and sticking to routines. "You just need to do X every day and be mindful" isn't good advice for someone with ADHD, the whole point of CBT is to teach you how to do that stuff. But in this case, being able to stick to a consistent routine feels like a pre-condition to using the app.

- The app can't be used for diagnosis, and I really feel like diagnosis is important. Diagnosis, insurance coverage, and medication access are the reasons why the ADHD intake process is so complicated. Of course it could be better, but I don't feel like you can brag about circumventing the intake process if the way you're circumventing it is by skipping all of the hard parts that are of significant long-term value to people with ADHD.

- Medication is often used in combination with CBT, and I feel like it's irresponsible not to get into that or even mention it. The pitch makes it seem like CBT on its own is going to solve every problem, but for many people it won't. Therapy didn't work for me at all until I got on medication, and then suddenly I had the ability to start to utilize a lot of the techniques I was learning and to be more mindful throughout the day.

- Other people have brought up the pricing model, but I just want to reinforce that this feels predatory to me, it feels designed to capitalize on behaviors that people with ADHD struggle with.

----

Getting more critical. From the FAQ:

> We are not trying to replace medication or in-person therapy.

This is not how you're phrasing your post on HN. If you're building a quick helper app so that people can do daily CBT exercises, then say that. I wouldn't be so critical of an app like that, I can see a lot of use for a Duolingo-style CBT exercise/reinforcement app.

But when you compare the price of your app to traditional therapy and intake, you are creating an implication that your app is a substitute for therapy or medication. And it's not, you need to be more upfront about that and you need to stop comparing your product and your product's pricing to normal medical treatment.

----

With all of the above in mind, (to me) $100 a year feels too expensive for a 5 minute helper app that many people with ADHD won't have the ability to keep up with or stick to unless they're already getting therapy and/or medication.

If you do have ADHD, and you are feeling overwhelmed about the intake process, the best thing you can do is find someone without ADHD (a family member, a friend) who can help you through the process and diagnosis. It's difficult and time consuming, ask people you trust to help you fill in your gaps while you're figuring things out.

If you're interested in setting up your own CBT schedule and you think you have the ability to follow a consistent schedule, then buy a CBT book[0] and read through it and see if it's right for you. I am skeptical that self-help solutions will work long-term for the majority of people with ADHD, but at the very least you'll be able to get a little bit of an overview and figure out if CBT resonates. Heck, going off of the advice above, find a friend or a family member without ADHD who will go through the book with you and do the exercises alongside you. They won't be a licensed therapist, but they can help keep you on schedule and read off the page, and it's not like you're getting personalized one-on-one advice from this app.

[0]: I personally recommend https://www.amazon.com/Cognitive-Behavioral-Therapy-Adult-AD...

+1 on medication being a huge help. I deal with non-ADHD issues, but the same has been true for me: no amount of therapy was helping until I got meds figured out.

You make a really interesting point about diagnosis that I hadn't considered. Could an app like this _do harm_ by routing folks away from the traditional (albeit shitty) route of diagnosis and the subsequent treatment (insurance doesn't cover shit without a diagnosis)?

Hear hear. Thank you for your write up.

Just wishing YC was more discriminatory in who they allow into the program. This shouldn't have passed the smell test.

Please shut this down or pivot. This isn't a mindfulness or meditation app. It's a serious medical issue to which you're presenting an untested solution. If I created a new pill and said it helps ADHD, I would be shutdown. You're doing this with an app. You hope it will work but really you don't know. I started and sold a CBD business and the entire time, we made sure to never claim that it cures or helps any medical condition despite it having FDA approval for some specific medical conditions & 100,000s of customers saying it did. We refused to work with any company that did and cheered when the FDA sent them letters. You on the other hand, have a top nav page labeled: "Science" & you're laundering the reputation of a single doctor and some "advisors" to bypass the actual process.

As you read the other criticisms about your predatory business model, you should understand that this isn't just some pricing thing you can change, it's the fundamental misalignment between you and your customers. For example, you claim that the average cost of ADHD CBT is $200-$300. WebMD (1) & Consumer Reports (2), and every other result on the first page of google says it's more like $100 to $200. In your marketing, you're now spreading likely false information to make your app seem like a better solution, potentially turning people away from therapy by exaggerating the costs.

Look at your app marketing vs Charlotte's Web (3). Notice the difference? Charlotte's Web doesn't push BS science to sell their products. They don't feature doctors on their page or have a "Science" page in the top nav. They actually started to help a single little girl specifically and once it did, they fought to make their solution available to give people the chance to try it. You on the other hand, took a treatment clinic and thought, "Hey, if I turn this into an app, I could make a lot of money".

Because you position yourself as a medical treatment, your team won't care if it actually works, only if they can sell it. You will continue to spread false information that puts your app in the most favorable light. You will continue to creatively cheat your customers out of money with subscriptions and add-ons they don't need. This path you have set yourselves on inevitably pits you against your customers the same way Purdue pharma did with Oxy. You could pivot to a "Focus" app or something that doesn't position itself as a snake oil treatment to ADHD.

Honestly, I think you will probably continue on your path and just label me a hater. 3 years from now, maybe you've made a lot of money or not. I don't know. Lots of snake oil salesmen make it. But you certainly won't help people in any significant way. If you actually care about that, you should really reconsider.

(1) https://www.webmd.com/add-adhd/costs-of-adhd

(2) https://www.consumerreports.org/cro/2013/01/how-much-does-it...

(3) https://www.charlottesweb.com/

Doctor of Philosophy not Medicine I seem to remember from a previous reply.

If that's true, I think YC has a responsibility to shut this down. Potential customers will clearly make the same mistake I did.

I'd feel more comfortable if you had done some kind of double-blind testing with ADHD/non-ADHD and Inflow versus Garbled Inflow (just a bunch of features but no magic dust). Doesn't need to be publication quality.

We've actually done a study with a university in the US that has just been submitted to one of the main ADHD journals. It isn't double blind but it is a pre/post symptom and impairment study which is very encouraging. We hope to share a link once it is (hopefully) published.

A single study is worthless.

minor nit about your website: the top menu's css might need adjusting. On my laptop (dell xps) the last letter of each word shows up in the next line, like so:

    Abou  FAQ
    t     s

Triggered my (minor) OCD!

Edit: added minor due to comment below in an attempt to clarify. The wierd text placement does bother me, i'm not joking. but its not that bad that i cannot get past it and read the rest of the website. thought i'd let the OP know; dont mean to poke fun at people who have been diagnosed with OCD. i'm still learning these terms via a child who was diagnosed with ADHD.

Especially considering this is a post about mental health, can we please quit labeling being picky as OCD? OCD is a serious condition, not a "haha I'm picky" joke.

didnt mean it as a joke. I did not have another label for my pickiness as you call it. i'm still learning these terms via my child who has been diagnosed, but the thing that bothered me is that it was misaligned. i have similar issues with magazine stacks that are not aligned, for example. i thought that was what was called mild ocd, hence used the word. make what you will of that.

Fair enough, it's just a pet peeve of mine. Like people who had a few too many drinks and start cracking jokes about being an alcoholic.

Have you looked into OCPD? (Obsessive Compulsive Personality Disorder) From my relatively uninformed knowledge on the subject, that sounds closer to OCPD. (Of course, talk to a licensed health practictoner, not a procrasting software engineer)

OCD sufferers prefer to call that OCPD. Being bothered by stuff like that is nowhere near as serious as real OCD which can be traumatic and life ruining.

Thanks for pointing this out!

> Inflow makes accessing many of the benefits of in-person ADHD therapy significantly more accessible and affordable.

What evidence is there are your product is actually comparable to therapy? Or that it even works?

On Android it isn't available in my country. I'd like to try this out but can't.

as somebody with ADHD I appreciate the tool but your pitch should definitely be shorter haha

app is not available in my country.. so is my German ADHD different :-)

Works for me from Germany (on iPhone, language set to English [UK])

"We'll refund you if you forget to cancel"...

No I will not pay you. Subscription models suck.

As someone with ADHD, I can attest that none of us are reading this wall of text. Know your audience.

Good day!

as a nuero non typical myself, g….f…..y

yeah downvote the retard. gfy.

It would help if you could elaborate instead of posting gfy in various places.

i don’t think so

The ADD (1980) / ADHD (1989) world has always been fairly shady in my opinion. The argument that this disability was invented rather than discovered so that pharmaceutical outfits could push amphetamines on kids is fairly valid, and a lot of the 'adult ADHD' behaviors seem equally explainable as a side effect of amphetamine addiction:

> "ADHD drugs, such as Adderall and Ritalin, increase levels of the brain chemical dopamine and provide mental stimulation. This, in turn, allows users to become more focused and calm because they no longer need to engage in self-stimulating behavior."

> "The number of young people abusing ADHD medication has been steadily increasing over the last five years, with almost 9 percent of high school seniors abusing and approximately 35 percent of college students in the same category. And unfortunately, this misuse does have consequences: Over 19,000 people have suffered from complications related to ADHD drugs since 2013."

It gets less attention than opiate abuse as deadly overdoses are much less common, but amphetamine addiction has major psychological effects - whether we are talking about street meth, ritalin, adderall, desoxyn, etc., the general effect is the same.

In addition, there's no clear diagnostic test for ADD/ADHD (no way to even distinguish between the two), it's just an opinion based on the subjective judgements of psychiatrists - and yes, just as with the opiate business, there are kickbacks with the pharma outfits and reckless prescription practices.

1. https://drugabuse.com/blog/spotlight-on-adhd-meds-and-their-...

What if you experience side effects of amphetamine addition as an adult without having ever exposed to amphetamines ?

Yes, ADHD drugs are abused and it leads to complications. But, to quote Alexander Scott, "drug users use a lot of drugs": https://astralcodexten.substack.com/p/drug-users-use-a-lot-o...

As someone with pretty bad ADHD, to the point where I'm basically unemployable without medication (and I know that because I started working before I took any ADHD meds and almost got fired because of it), I don't agree with the characterization that ADHD was invented by drug companies.

One way to think of it is to see attention/motivation control as a spectrum. There are going to be people in the bottom X% of that spectrum, where it starts to negatively affect their lives. I'm thankful we live in a society that recongizes those people and has come up with ways to help them, since I've benefitted tremendously from ADHD treatments.

Recreational stimulant users use 10x to 50x higher dose then ADHD users. 20mg vs 1000mg of the same drug produces very different effects. If you are serious about treating your ADHD you take the minimum effective dose because if you become tolerant it stops working.

https://astralcodexten.substack.com/p/drug-users-use-a-lot-o...

oh fuck off.

> In addition, there's no clear diagnostic test for ADD/ADHD (no way to even distinguish between the two)

they're literally the same thing. ADD got renamed to ADHD in the publication of the DSM IV.

> it's just an opinion based on the subjective judgements of psychiatrists

No, there are standardized screenings with recognized scales, as well as evaluations to measure attention span.

This can also be said for several mental illnesses: depression, anxiety, ocd...

>> > "ADHD drugs, such as Adderall and Ritalin, increase levels of the brain chemical dopamine and provide mental stimulation. This, in turn, allows users to become more focused and calm because they no longer need to engage in self-stimulating behavior."

Yes. that's the point. Give 20mg of adderall to someone without adhd and see how calm they are. That dopamine boost brings someone with adhd up to neurotypical levels.

I'd also say: consider how many people are diagnosed with adult adhd without ever having been on a CNS.

They must be putting amphetamines in the water supply then, cause I have ADD symptoms and I never took them.

Reply on news.ycombinator.com