ADHD and monotropism (2023)
monotropism.org
monotropism.org
I would say I have "hyper focus", to the point where if I'm working on something interesting, I will lose track of time and am unable to redirect my attention to anything else.
This makes me incredibly "spacey" as often my mind is still fixated on the task even long after I've stopped working on it. It also makes it very hard for me to accomplish any task I don't think are interesting...
And often a new idea will strike me like an epiphany that immediately takes the top spot of my attention.
The result is I have hundreds of half finished projects in flight across countless areas of interest.
The diagnosis, for me, became obvious when I reframed it from "lack of focus" to "poor control over what I focus on".
That's exactly it, and why I prefer it be called an executive function disorder rather than any kind of focus disorder.
I can focus just fine. Too well, actually, to the detriment of all else, including physical needs like eating and sleeping. But I can't control it. I don't get to choose when I'm productive or when I'm not, let alone what I actually focus or work on. I could go weeks at a time where absolutely nothing is interesting enough, everything is painfully boring, and I'm so task paralyzed I just can't do anything. Likewise, I might give into a project for 48 hours straight non stop.
It's amazing I have a job at all, to be honest. I am also autistic, and it is a special kind of hell at times.
I find monotropism an apt way of understanding it. A normal person's attention is like a flashlight they control that illuminates much of a room at once. Autistic brains are a tight beam flashlight, almost a laser for some, with its aim difficult to change. ADHD brains are more like a tight beam flashlight on a motorized mount that swivels in all directions, but you're not always in control of where it swivels to...it's like an AI constantly overrides your direction inputs and points the light at what it deems most exciting or urgent at the moment.
If we're going with that metaphor, I'd phrase it more in terms of that mount being prone to jamming. My attention doesn't go to completely random places, it only goes to places I want it to, but then gets stuck on things that wouldn't hold the attention of a neurotypical person.
> but then gets stuck on things that wouldn't hold the attention of a neurotypical person.
Indeed, attention is frequently held for many hours or even days on the current subject of hyperfocus. I too have great difficulty deliberately directing my attention toward a subject I don't find exciting, but find it easy to get locked in on my natural interests. Hyperfocusing on one of my passions is delightful, even if it detracts from other important things.
> it only goes to places I want it to
That's true for me in a sense, but I've had so much trouble from hyperfocus states that I don't think about it quite that positively. I hyperfocus on a new hobby every week and buy tons of stuff for it that I abandon for the next week's hyperfocus. I get locked into politics and flame wars that make me stressed and sad the whole time, but waste hours on them. I would like to get locked into one of my passions that I always enjoy and that also enrich me in some way, but I end up spending hours hyperfocused on researching some esoteric topic of the day instead. Or worst case I hyperfocus on potential sources of doom and how to prevent them, but maybe that's not due to ADHD alone. All of those are things I "want" to focus on in some sense, but in many senses I very much don't want to.
That's why lack of control of the focus' subject seems one of the most important aspects to me. In my metaphor I guess I'd say something like the focus of the AI that's overriding my direction inputs is what's getting stuck on a subject.
I don't think about that in a positive light, it's just factual information that helps me understand the shape of the problem. It's about recognizing that the places my focus goes to aren't random and arbitrary — I've never gotten stuck on, say, the intricacies of tap dancing, because I have little to no interest in tap dancing, and no reason to care. I did get stuck on knitting for a short while because I bought some pattern books as a gift for my mother, and had a peek inside — I _wanted_ to have a peek inside, what I didn't want was to lose a few hours to it.
In many parts of the world during tribal times, feeling like you didn’t have control and feeling like the world is unpredictable is probably going to lead to death. Hyperfocus on getting things under control (in specific areas) would be useful, for example hyperfocus on shelter before winter if you feel like that is not under control, or hyperfocus on the food supply if that is not under control.
In the modern world it’s plausible to me that the conditions are just so out of control of the individual that the mode never turns off, and you get random seeming intense focus and irritability around lack of control and lack of focus on social fluidity (which in the tribal environment was basically N/A since everyone was basically the same as each other and you didn’t need these flexible protocols for socialization) etc etc.
I’m not diagnosed with autism but I feel like I have a lot of the classic traits and when I pay attention to my environment a lot of things bother me and I feel better when I fix them. But so many things bother me that it’s basically impossible to fix them all and then I disassociate from them. The things that bother me are like “this design is bad, fix it” but I can’t change all the objects around me like one could in a tribal setting where everything was made in house. Same with routine that is impossibly complex compared to tribal life.
It is also worth noting that I have encountered an effective therapy for ADHD, which also works miracles for many with autism. It is available at https://thecraigschool.org/. Unfortunately their therapy only works in prepubescent children. That's because it requires the child to make a strong 2 year emotional commitment, but nobody is ready emotionally to predict how they will change after puberty hits.
Still the fundamental principle of the therapy is generally applicable and interesting. It is to condition to child to the idea that, "Every should must come reinforced by a want." This emotional reinforcement results in getting the most possible out of their executive control. With the result that the child becomes able to task switch away from, then back to, hyperfocus.
It is worth anecdotally noting that I've known a couple of people without ADHD who conditioned themselves to the same idea. They reported that they have both the ability to engage with hyperfocus, and to task switch in and out of that state. If we as a society focused on instilling "shoulds" with mostly positive reinforcement, this would be more common. So what brings people with ADHD and autism up to normal executive control, could bring normal people up to superior executive control.
If I was starting over as a parent (not that I want to, I'm done with that part of life!), I would definitely use this idea to inform my parenting.
> "Every should must come reinforced by a want."
> Unfortunately their therapy only works in prepubescent children. (...) but nobody is ready emotionally to predict how they will change after puberty hits.
Here is my understanding of the issue with the therapy based on my experience with it.
They have created a therapeutic environment with so many rules and demands that the child encounters a constant stream of shoulds. They also implement a carefully thought out set of rewards that gives constant positive feedback for those who are succeeding.
But that positive feedback loop only gets started after the child is succeeding. And therefore it is essential that children enter the program with an overwhelming desire to succeed, and in a state where every one of those shoulds will connect to that overwhelming desire. They have a carefully optimized intake process that creates this initial state. That results in a child who is absolutely emotionally committed to a two year very difficult program.
The problem that I see with people who are older is that once we enter puberty, we become more resistant to receiving constant demands from adults. This undermines that initial commitment. It also undermines the positive feedback loop that is essential to maintaining the commitment into the second year.
Even if I am wrong about why it happens, the program told me that they have an age cutoff because the therapy program doesn't work after kids hit puberty. It isn't just an abstract theory. They tried it, and concluded that it doesn't work.
> The problem that I see with people who are older is that once we enter puberty, we become more resistant to receiving constant demands from adults.
The key to it is this. These kids absolutely HATE the experience of lacking executive control, in a classroom. Teachers have no idea how often they launch verbal attacks, but it is sheer misery for the kids.
Then they encounter this program. The program sits them down. Explains how it works. Lets them poke around. Talk to the kids in the program. Verify that it really works. And lets them know every rule, and every reward.
Then the program tells them, "You can't come unless you have completely internalized it. Every time you fail, you must remember how badly you wanted to succeed. We can't give you a second chance. If you have any doubt, prepare yourself longer."
Separately we parents are told, "This has to be your child's choice. You cannot try to convince them in any way. If you try, we will know and your child will fail. If your child asks questions, answer them honestly. If your child says that they are ready, ask them if they are SURE. If they say yes, then they can come. Not until."
And now the kids are caught. They absolutely know the tiger that they want to escape. It is their daily life. They absolutely know that there is an escape. They know how it works. They know that it works. And they know that it won't work if they have any doubt. Every last rule. Every time they hear it. They must WANT it. For 2 years.
It took my son about a month and half to declare himself ready. The first few months were misery for him. But I'd never seen anyone so determined to succeed. And succeed he did.
Pretty impressive that they can get these kids to this level of awareness, making it feel like it is their own choice. When I look back at my childhood, I can't remember I had any agency like that, nor awareness that you could have one.
For ADD/ADHD it is easy to go off the rails. But if the stereotype of asian discipline and expectations of overachievement holds, than that surrounding might offset the possible distracting experience of an uncommon environment I guess.
I haven't heard that before...I need time to ponder and process that, but on the surface it sounds like gold!
The parents and town I grew up with were extremely religious and authoritarian. I grew up hearing how our personal desires should be ignored and suppressed, and only the will of God and authority figures matters. I think neurotypical people may be more able to function with such a mindset, but it's a losing battle for ADHD brains to try to force themselves too far from their natural wants/interests. Especially since lack of emotional regulation is a significant(but less discussed) difference for ADHD, focusing first on emotions and reorienting wants before focusing on getting the task at hand done might make a lot of sense for us.
I feel like knowing this tendency has made me extremely protective and avoidant of taking on tasks. I appear “lazy” to the outside observer. It’s something I’m still trying to solve.
Its not exactly a recipe for reliable technology but neither is what the managers are suggesting (or rather, suggesting differently today than they did yesterday) so I manage to make it work out OK most of the time.
Normal people can think "I need X, let's work on X" but ADHD people are at the mercy of what's "chosen for them" by their brain.
This was probably fine 4000 years ago, when the world was looser, and people could find their place in life regardless of their particular quirks, but not so much nowadays.
This difficulty or inability to direct focus can be "trained away" with enough effort, but it isn't easy at all.
Nowadays we get by by occasionally solving a problem that nobody asked to have solved but golly the solution is kinda neat.
And even later on, community life, with fewer distractions, less sedentary boredom (like in a modern office job) and fewer demands for precise timing and continuous focus, also made it easier. Even school either didn't exist or was a much loser affair than the institution we know for the past 2 centuries.
I'd prepare for winter 10x more easily than focus on some boring ass corporate task in a world filled with bullshit distractions and endless structured and strict time demands. And I'd have an extended family plus community to help with things.
Consider how people think it's rude if you're somewhat late on a rendezvous or meeting etc. Then consider how clocks and precise timekeeping weren't a thing for most of history, nor was reliable transit, cars, roads, and stuff. You got there, when you got there - even today in more rural countries.
I forget where (and I really ought find it again) but I recall some linking of ADHD as simply the kind of traits that are necessary for survival -esque scenarios.
I know that I don't feel as awkward and weird when I'm in nature or building huts or what have you. Seeing the abundance of what nature has to offer and the possibilities actually feels far better than being in a concrete building and being forced to walk ONLY in designated walking areas.
My ADHD always feels the worse when I realize that I have to abide by _insert_arbitrary_deadline_here.
Similar here. For me, if I'm given some arbitrary deadline in the future, it almost guarantees I'm not going to do the thing until the day before, or depending on the task, hours before it's due.
"Hey webguy, we need this report by the end of next week" means I'm not doing it until Friday afternoon, and I have no control over it. Doesn't matter if I try to work on it earlier, just won't happen.
It's having an interest based nervous system. We crave novelty, urgency, interest, and challenge to do anything.
My essence knows, without a shadow of a doubt, that time is cyclical. And just because some person or org says, randomly today, that something NEEDS TO BE COMPLETED by next Thursday or the world ends, doesn't actually change the nature of time.
There have been countless things in life where, as a civilization, we simply allow for trivial shit like this to have actual, life altering consequences. I think we're dumb.
Is this likely? My overgeneralizing gut feel would be that more people who would have traits which might be perceived as unusual and impede survivability 4000 years ago would be more likely to receive a chance to live a regular lifespan in most today‘s societies.
And today we're much less about having extended families and communities that take care of their members and lend a hand.
At best we have some half-arsed provisions by an indifferent state, and we're left on our own. A slip and you're broke, or homeless, or depressed on your own.
It's only in the past few hundred years where focus actually matters: knowledge workers, and some factory work where lack of attention resulted in injury.
They don't mean "this person can't focus on anything", but "they can't focus on their school projects, their work" etc. They don't care if "but hey, I can hyperfocus for months on the history of late Roman battles or throat singing techniques".
The shear breadth of experience is sometimes staggering.
The difficulty for me is translating that into sustainable income. Job and experience hopping is great when your young, but then you get older and your resume portrays you as a total flake. (And admittedly, of the project is slow and boring, I might just dip. Life is short, I have things to do. And sitting still in an office for 8+hrs a day isn't one of them)
We really do need an update to the diagnostic criteria and descriptions for ADHD, Autism and their combinations (DSM6?). I think monotropism is a good overarching description that aligns better with what we with these diagnosis experience.
The closest to reality anyone tried to describe are Dr. Amen’s ADHD “types” and regions of the brain related to attention-deficit symptoms. But it’s much more complex. E.g. when you don’t process Folic Acid due to MTHFR mutations, chemicals can be generated that cause other genetic mutations in the brain over time, causing psychosis. And some stimulants with likely undiagnosed predisposition of paranoia can cause schizophrenic-like symptoms for years. If you just take what a psychiatrist or even the supplements that Dr. Amen would suggest, it may be a miracle for some people, but for others that miracle may turn into a nightmare. I didn’t recognize that I was having hallucinations and paranoia until years later.
I’ve found a set of things that I eat and natural supplements that work for me, and it took years of struggle. I miss the meds, but they didn’t make me better, they almost ruined my life.
When I had my brain scanned, it was explained to me that ADHD isn’t a matter of lack of willpower or distraction - when you intentionally try to concentrate or focus (rather than when focus just “appears” naturally like it does for some tasks you’re interested in), blood actually flows away from your prefrontal cortex so you really do become worse at regulating decision making and have worse performance at whatever task you’re trying to accomplish. Whereas for people who don’t have this problem, intentionally concentrating forces blood into the prefrontal cortex, improving your performance.
It was also explained that even though we usually think of ADHD as a “hardware” issue with our brains, that’s rare. It’s normally a conditioned response related to how we learned to process stress and anxiety. The idea is that if you can improve your ability to handle your underlying stress and anxiety (through trauma therapy, healthier lifestyle and habits), your mind becomes much better at handling choice and focus. Although I haven’t been able to therapy my way out of it yet.
Not being able to focus on the things you need to focus on (or doing the boring routine stuff).
I’m audhd which adds a bit of extra fun - diagnosed adhd in August. Meds have been amazing
OCD seems to be characterized as having anxiety of fear about the obsession, which isn't something I experienced at all. I don't know much about the disorder though so would be worth doing some more research and introspection
So, lack of focus, then? Lack of focus after all is not the same as inability to focus in general.
It's more the inability to focus on what matters, without getting distracted and focusing on another thing.
On the article I would somewhat agree but it’s too limited a view. It ignores too much of the at current assumed underlying causes that we know are relevant. For instance, it’s more correct to say that autism is associated with an increased attentions to “details”, not small things, and challenges with associations and broad concepts, maybe grounded all the way down to increased dendritic connectivity due to less aggressive pruning. of Also, the effect of motivation to focus over a period of time on unrewarding activities is not well incorporated into this theory of (monotropism). I thing there are some valid obersvation but it’s way to simplistic a model when working with real life ADHD. For instance, on interesting commonality seems to be inability to filter out information. But ADHD are unable to filter out Salient content (like a conversation) and autism are usually unable to filter out details or granular sensory stimuli.
Anyways. Ask and I can attest give my perspective
The Job Fit (The more interesting intervention). Sometimes we need to figure out if the problem is the job, not the person. Some people with ADHD simply cannot tolerate meaningless or monotonous tasks. An active person, for example, probably shouldn't work as a data entry clerk. for instance a 50-year-old builder who becomes a manager because his body is too beat up for hard labor. He is suited for leadership but can't stand the administrative work. Even if he wants the job, the boredom of the paperwork makes him miserable. These are the people who often present as depressed and benefit most from medication, as it gives them the stability to tolerate boring but necessary tasks. So basically spanning everything from small techniques, to existential and professional evaluation of best fit, to medication. Everyone is different.
In office, I listened to music almost my entire career, it’s the only way I got anything done for whatever reason, to the point I almost got fired once when a manager tried to stop me heading out briefly to pick up a replacement set of headphones when mine broke. I threw a literal tantrum almost, all I knew is I had no music, and that it was essential I did so I could continue doing what I was doing.
For some reason however, when I made a transition in the last few years to WFH, I’ve been living this bizzarely very different approach where I sit in almost complete silence all day long, and it’s the most I’ve ever struggled with my…focus for lack of a better word.
I now truly wonder how much this may have to do with this huge struggle I’ve felt to remain engaged or on task. I’m getting my job done, but 90% of my effort is me having to force myself to get it done rather than…just getting it done like I used too.
I suddenly feel very stupid.
I've worked in education and helping kiddos get accomodations and fixtures for their learning has made grow a huge amount of compassion and empathy for myself in this respect.
I think the reality is that this new way of working is still relatively new for human beings. For eons we had more natural, environment based rhythms and then suddenly we're thrust into artificial air and lighting environments staring at papers and now screens.
Our eyes and minds wander to literal infinite spaces on a screen, while our body is sitting in the exact same space (often in the same posture) and we all pretend that "this is normal". But our body keeps score and you can't BS it. It takes its toll.
I too WFH and while my days are somewhat longer, it's only because I do life things while I do work things (as if reality actually has a distinction) and it's better for my mental health.
I sit on a yoga ball, I have an office chair, I do standing desk. There is a beautiful garden behind my screen that constantly beckons me to stop staring into the phony black mirror.
Sorry for the rant, but just know that you're not the weird one. Our systems and processes are the weird ones. And it's our prerogative to find, or construct, better ones for our flourishment.
When I was in college, I was prescribed them again just by my primary care physician. I didn't say I was having trouble focusing, I said I was having trouble with wakefulness. I still do sometimes. It was hard to stay awake in a lecture setting for some reason, borderline impossible on days when I had several in a row. Medication definitely helped me get through college but it was a rough time.
As an adult I don't take them, but it is hard to really work the full work day. I have always performed well enough that nobody questions it (and in some cases have brought so much value to a company that nobody cares), but it is a constant source of stress. I resonate with the top commenter in that I also have hundreds of unfinished personal projects across all domains. At this time in my life (33 y/o) I am more concerned about mitigating the constant stress I feel than I am about the actual ADHD symptoms. I am ok with my many personal projects clashing with each other.
At one point a few years ago I was stressed enough about my job to seek medication. For some reason I was not able to get the information about my diagnosis from my old primary care (from 8 years ago) and the one before that was pediatric and didn't seem to count. I talked to a therapist for a bit (which was not useful), got a diagnosis, and then talked to a psych briefly via zoom, and went on medication for a month before deciding (again) that it wasn't worth it. The whole thing was kind of disheartening.
Things are very weird when it comes to ADHD treatment and diagnosis. There seems to be a tendency towards the same 'easy button' when it comes to ADHD. I also don't think it's exaggerating to say that just about every single person I know well enough to have spoken to about these things says that they have been diagnosed with ADHD, often medicated. I don't think very many of them actually do have it. Sometimes I'm not even sure if I do, or there is something else going on.
I'm not sure what to conclude after all this except that maybe there are no answers for me in this space. It's frustrating, but I've never opened up to exploring this problem without the same exact solution being thrown at me, a solution I know is not sustainable for me. I've never spoken to a doctor who's ever suggested it could be anything else. Should I just find my own way, since I seem to be able to function well enough?
> For these people, it’s almost more physiological than psychological.
This stands out to me. I have lifted weights in the past, have not been well physically conditioned in cardio activity since I was diagnosed with type 1 diabetes at 22. Cardio tends to cause my blood sugar to become unpredictable (or at least you have to actually be really rigid in maintaining your exercise patterns to keep things predictable). Maybe a bit of biking or running would do me some good. What would you do?
That is a bit hyperbolic (we clearly have real knowledge of the underlying neurological mechanisms), but closer to the truth than most people like to acknowledge.
The DSM was never meant to carry the burden we've placed upon it. https://asteriskmag.com/issues/12-books/you-arent-in-the-dsm
Misguided: there's now a focus on causality and precise identification based on symptoms and negative impact caused that wasn't present in the days of exorcisms and shamanism. Those eras were primarily characterized by people in positions of (often corrupt or unqualified) authority declaring diagnoses for others, largely without the consent of the diagnosed. Now, the default mode of mental health treatment is now focused on identifying symptoms according to specific rubrics, and diagnosing (or not) based on the presence of those rather than the agenda, religious feelings, or whims of people in positions of authority.
Partly right: what I described above is the default or desired diagnostic approach. We have a long way to go before it's actually performed for everyone. Coercive diagnoses are not uncommon even under modern medical/diagnostic practices: parents seek out spectrum or ADHD diagnoses for kids who aren't suffering, just not meeting parental expectations; psychotic people are handled by modern mental health systems with extremely low autonomy, etc.
Conversations here are also often confused: diagnoses for many mental health conditions are qualitative and measured not only by symptoms but by harms. The DSM and friends aren't like the diagnostic instruments for cancer or heart disease: physiological indicators are much rarer in mental health, so mental health diagnoses combine enumerations of behavioral symptoms and negative impacts caused to one's life. That implies a subtlety that's hard to come by among non-medical-professionals: you don't "have" ADHD (or OCD, Autism, etc.) in the same way you "have" an ulcer; you have those conditions if you present with a certain subset of the symptoms for the diagnosis, many of which are behavioral. Whether a particular treatment is merited has to do with both symptoms and the harms posed by those symptoms to your quality of life. So saying "I have ADHD" is a less meaningful statement than "I have some symptoms of ADHD and they seriously damage my quality of life, therefore I seek treatment".
Add to that our limited (but growing, and better than it was in past decades) understanding of pharmaceutical treatments for mental health disorders--many of the drugs we use to treat, say, depression or ADHD behave with all the subtlety of driving a bulldozer through a convenience store because you wanted to get a gallon of milk--and you have a complex area discussed using outdated binary pathological terminology. That's a recipe for suspicion and confusion.
In short, it is, as you say, hyperbolic to characterize modern mental health treatment as shamanism. But lingering corrupt medical practice and the complexity of the field for laypeople make it hard to see how, specifically, things are improving in this area.
However, it is an interesting article if you ignore that bit of bluster. The amount of overlap and traits commonly associated with ADHD and autism.
That folks with Autism and ADHD may have large portions of their symptoms occur because they focus too much on some specific things, to the detriment of others - like emotional well being/regulation - can still be falsifiable (better than most psychiatric theories for sure!) and useful clinically.
Personally, it lines up with what I’ve seen and experienced.
That there is another (perhaps chemical, or brain structure) theory too doesn’t necessarily change that!
Just because it doesn’t describe 100% of situations or work 100% of the time doesn’t mean it couldn’t be shown to produce useful predictions and work or not.
And yes, that isn’t particle physics type falsifiable, but it is medical treatment falsifiable. Kinda. Newtons theory never predicted Mercury’s behavior, but was still super useful eh?
Oof. I'm glad I turned down the volume in response to this warning. Why not just remove this awful sound?
Not diagnosed autistic, but ADHD.
With the older concept and diagnosic criteria for autism there was less overlap. ADHD and autism used to be considered mutually exclusive diagnoses. Autism used to imply delays in speech and most people diagnosed also had significant intellectual disability. Autism is now a dramatically larger umbrella than it used to be with the last couple of DSM editions merging Aspergers and other conditions with it and making it not be mutually exclusive with ADHD. The shift in definitions makes autism extremely difficult to discuss in public because people have wildly different concepts of it depending on when they learned.
Side comment, merging Asperger's into autism was motivated in part by awareness of Hans Asperger's evil deeds and not wanting that association. It was also championed based on enabling help/protections given to autistics to folks with Aspergers as well, and maybe because being part of a larger and harder to ignore pool would help autistics with intellectual disabilities get more attention as well. So far I haven't seen a clear explanation of why it made sense in terms of better understanding the condition/difference, everyone that discusses it focuses on perceived potential social good.
The final paragraph touched on it:
> It is, I think, too early to say with any confidence that autism and ADHD (or KCS) share a common root in monotropism, but the overlapping traits of the people receiving each label clearly demand some kind of explanation, and preliminary results do suggest that each is strongly correlated with monotropism – especially in combination.
Also, a definition of monotropism from their homepage (not my writing):
> I believe that the best way to understand autistic minds is in terms of a thinking style which tends to concentrate resources in a few interests and concerns at any time, rather than distributing them widely. This style of processing, monotropism, explains many features of autistic experience that may initially seem puzzling, and shows how they are connected.
I’ll say I’ve found “treatments” from both schools helpful. Even though I resisted stuff on the autism side for a long time because I felt “insulted” by it and was convinced it was a diagnosis made in error.