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Comment by a2dam | Hacker News Reader

> At the end, she told me she would review my exam and have the results ready in a few days.

Yeah man I can go ahead and let you know early if you want.

I know this is a joke, but I'd be careful about assuming: I had a trained therapist diagnose me with ADHD ... incorrectly.

It turns out, there are other conditions out there that can appear to be be ADHD. If a trained therapist can confuse them, outside observers certainly can too, so it is possible that "very ADHD-acting" person you know might not have it.

(Or, especially for females, the reverse can be true, as not everyone with ADHD manifests with the same trademark hyperactivity.)

I understand this is your personal medical info, but could you drop any hints as to the nature of the misdiagnosis? I've learned late in life that I am neurospicy and learning from other's experiences in this domain has been quite helpful.

I listen to a lot of psychiatry podcasts, and they generally think that ADHD is being seriously overdiagnosed at this point.

Executive dysfunction, especially that which was not impairing as a child, has a lot of potential causes. Anxiety, depression (yes, ADHD can cause these, but these can also cause executive dysfunction in people without ADHD), OCD, Bipolar (manic people in particular often attribute worsening of hyperactivity and distractability to ADHD instead of mania), Schizophrenia pretty much universally is related to cognitive symptoms and lowered motivation even when not psychotic, and borderline personality disorder can cause changes in interests and identity.

For many of these conditions, stimulants can act as a band aid on something else. It can superficially make people feel better (of course, it's speed), but it can distract from other symptoms that are impairing functioning, and prevent people from seeking long term solutions.

I can roll with that. I do have executive dysfunction and other "fun" facets of a funky neurobiology. I also recognize that every body and mind is different and it's a personal journey to find the right tools.

I recognize that non-medical options should always be front line approaches but there can be a chicken and egg effect as to making that happen.

In my youth I adhered to a "better living through chemistry (wink wink)", I do now too (rip Mitch Hedburg) but the wink wink part is very rare and disciplined and now it's all about pharma and supplements to wring what I can out of what I've got left.

On the non-medical options front, I will note that my lifelong hyperactive and neurotic tendencies dramatically improve with a 3-4 day a week distance running training regimen. I enjoy running enough, even though it is very difficult, that I've kept up with it for several years. I'm not as consistent about this, but I also found yoga classes to be a way to make mindfulness fun and easier.

That's not to say I'm not on the medication train (despite moaning about medications a lot). I do personally avoid taking any controlled substances. This is easy because I hate how stimulants make me feel, but in general I worry about the effects of having a direct reward signal from taking a pill.

Exercise is one hell of a drug, to be honest. I suppose you shouldn't exercise for a few issues in particular, but in general, boy.

Jumping on this conversation a bit: I was recently diagnosed and am still very much in the "what helps?" and "what parts of my personality/habits are connected to this and which aren't?" stage. Do either of you by any chance know a healthy online space to discuss this with others?

I found Finally Focused by James Greenblatt to be quite helpful. He makes sure key minerals and vitamins are in a good range before prescribing stimulants.

This sometimes solves the problem by itself, or it reduces the levels of stimulants needed.

I would recommend avoiding any subreddit related to ADHD.

I honestly would try to stick to materials written by mental health professionals and possibly talking to a therapist (your company might have an EAP that can help with this) over interacting with any online community I'm aware of on this matter.

I find online mental health communities tend to be "if I have a hammer, everything is a nail," and aren't open to other explanations for any traits or struggles. They also tend to suck in the people who aren't doing better with treatment, while the people who found systems that work for them leave for greener pastures. On the opposite side there are communities that are anti-psychiatry and refuse to consider medical treatments. In general these spaces tend to be very black and white.

I do like the Astral Codex Ten open threads as a space that's relatively neutral on the topic, though they lean very biohacker in a way that gets ahead of the science.

I wish I could run. I recognize that exercise is a foundational facet of health all the way around. I'm "blessed" with enough comorbidities that make that a challenge but I am going to get a personal trainer to help me work through that.

Good idea. Feel free to try different options until you find something that you genuinely want to stick with. Running is just what I like, but my understanding of the current research is that it's more important to do something you actually want to do consistently for years than to do the ideal workout for 6 months and then quit exercising entirely.

People are way too happy when they find out that the treatment is taking speed every day for their whole life, as if this isn't going to take its toll on the body and that the brain is not going to adapt to this.

Differentials for ADHD include: panic disorder, metabolic issues, anxiety disorder, depression, adrenal disorders including deficiency and excess like pheochromocytoma, bipolar, autism, learning disorders, personality disorders like borderline and antisocial, OCD, trauma including PTSD and CPTSD, sleep disorders including narcolepsy, sleep apnea, restless leg syndrome, insomnia, ironically substance use disorder like cocaine and amphetamine addiction, thyroid issues again ironically including both hypo and hyperthyroid, seizures, hearing and vision issues, and life stressors.

So, uh, ... a whole textbook. And I probably forgot some.

It was originally called ADD. Then they forced the H in there for hyperactivity. And now they say there is non-hyperactive ADHD, but... they don't call it ADD.

So the first rule of getting attention for your paper is to re-define common terms...

The origin of ADD as a diagnosis is the DSM-III (1980), which calls it "attention-deficit disorder with or without hyperactivity". Do better.

The word you are looking for is Inattentive - when diagnosed they should state whether the diagnosis presents as Predominantly Inattentive, Predominantly Hyperactive/Impulsive, or Combination.

This comment is so funny to me, because I imagine you being distracted to make the comment before making it to the end where the psych did indeed review the new results.

Well I only know that because I skipped to the end. Then, while scrolling up I realised I missed the whole side-quest about promising to not cheat the test again, taking the test again, but then "accidentally" finding an exploit the system, and then cheating the test again, but this time cheating even more to see the results.

Then, scrolling up more I see that this whole thing started with seeing stars and then buying a telescope on amazon (probably at 3am).

And here I am commenting on HN instead of replying to an email...

Brother the test is quick, easy, and painless, and the results can be lifechanging.

The other thing is, ADHD in my mind is really a syndrome that starts with a symptom - inattention - that can be caused by so, so many things.

I have both, because of course I do, I had a medical problem that exacerbated my ADHD to a significant, significant degree (it's amazing I was able to be a software engineer for so long without treatment). So don't just tunnel vision in... as we tend to be prone to do. Get the whole workup with an experienced clinician, it's so lifechanging it's hard to describe.

I want to add that the comment is also funny to me because it and the blog post are very relatable to me. I don't mean to dismiss it at all. It's really important to get a good diagnosis for anything like this and not dismiss it or lock into the wrong diagnosis because of your own tunnel vision.

You wrote "the test is quick, easy, and painless" but I also want to note that it's not always. Depending on your country, parents, specific doctor, etc it can be very difficult to get a proper diagnosis and help. In some places a big criteria is diagnosis during childhood so if you're 30 or 40 you might have no chance. Or a chance but it depends on your parents retroactively answering a questionnaire, or finding an old report card with the right words.

As you said it's life changing to get the right help and I encourage everyone to pursue this.

The thing is, the test is super quick and easy. And then they throw 50 procedurally complex and tedious tasks at someone who can definitionally not do that, and they know that. Kafkaesque.

Btw no criticism implied on my end, I'm just now constitutionally incapable of not telling people they should get screened. Hmmm I wonder why I have difficulty resisting that urge...

I think I get your point. It's cruel to require Kafkaesque testing and that just makes it not worth it try. But too simple of a test can also misdiagnose.

The chance to be diagnosed with an appropriate gate varies greatly based on where you live and which doctor you can see and more. It can be anything from a 5 minute conversation, to 6 months of inconvenience, to no chance of even existing in your lifetime, to suck it up and don't ask because your career will end.

Right let me be very explicit: TOVA or equivalent are basically "play video games for 10 minutes as a part of your diagnosis" like the OP, the kafkaesque part is getting the appointment, and getting them administered, getting the diagnosis confirmed, going through the records and getting the prescriptions, everything around it :) they're actually pretty sophisticated tests, despite their palatability - I think if they had better ones they'd obviously use them.

"Sorry the psych is no longer available today. your appointment has been moved to the next available booking in 9 months time"

Or even better, "We have one available psychologist and they kinda don't believe in ADHD, so they'll see you but not actually grade the test correctly, so you'll have to try again, and as a bonus get labeled medication seeking". Not my experience, but...

" diagnosis during childhood so if you're 30 or 40 you might have no chance "

Huh? You don't have to be tested as-a-child, you don't have to call up your fourth grade teacher. You can self report your subjective experience.

"Did you have these problems as a child? Have you always had trouble doing your homework? Did stressing out about homework enable you to do the homework?"

They ask the question a few different ways typically.

I get it, perhaps it is different in your area, but I get the impression that an adult ADHD diagnosis is far from impossible.

In some countries it's almost impossible (I don't have any direct experience but I've heard tale that in e.g. aus/nz, east asia, south asia, etc people give up before getting diagnosed often), and my understanding is that in Europe it's virtually unheard of to have an adult diagnosis.

In the US, at least, it ranges from difficult to straightforward, but that's not true everywhere

In NZ it's easy, and some GPs can do it as of earlier this year.

IDK I'm just going by a friend moving there and not being able to get any of her existing medication prescribed, even though she's been diagnosed for literally 40 years.

Europe here. I have several friends that got diagnosed with ADHD as adults.

If you try to do it through the public system it's very difficult to even get an appointment because there's months long waiting lists. Basically if you have a job and function somewhat OK in normal life you won't be diagnosed in the public system. If you do get through it can be a long process where they want to interview your parents etc to determine if you had symptoms as a child. But you can also get a diagnosis through private practitioners and some of them function almost like diagnosis mills. A couple of video interviews and tests and you are done.

> ... my understanding is that in Europe it's virtually unheard of to have an adult diagnosis.

Can't speak for the whole of the continent but UK here and I got my ADHD diagnosis a few years shy of 50 years old. Wasn't tricky at all, just a long-ish (8 month) wait for a non-private diagnosis (not full NHS but via an outsourced provider via Right-To-Choose).

When going through the DSM-5 questions (during an ~80 minute interview) I was asked to give examples from both current life experience and from childhood, and that was enough.

Honestly it's really gratifying to hear that people around the world are getting the help they deserve, thanks for sharing.

Only recently in aus did an adult diagnosis get support from the government PBS scheme. And even then it's because they're letting retroactive childhood diagnoses be considered for the subsidised medication options.

As I said getting a diagnosis varies by region and doctor. A lot. It's practically impossible in some countries. And also depending on region or personal circumstances, it may not be easy to find another doctor or psychiatrist. Also note that in many countries, only a psychiatrist can diagnose it. Even if diagnosed, you might live in a region where most medicine for ADHD is illegal or have a doctor that won't prescribe them. If you just get disbelief after 6 months of waiting, and after another 6 months just get told stimulants are bad, you might give up.

If you search (eg reddit) for ADHD adult diagnosis, it is filled with horror stories. There's even lots of posts of people diagnosed and medicated for 20+ years that move to another country and can't get a prescription. Or you get a prescription, but the pharmacy won't dispense it or insurance won't pay for it. A typical post on these topics also has one or more people responding "I'm in the same place and it was easy" but also has one or more people responding "I'm in the same place and I tried for 3 years before giving up". By the way, it's also common for women to have more trouble getting a diagnosis compared to male siblings and friends with the same symptoms.

Why is it so life changing to get help? What kind of help is there besides meds?

If you pair meds with therapy and adjusting your life according to the things you learn about yourself through the lens of the diagnosis your quality of life can increase dramatically (at least it did for me).

Therapy, which (at least for me) has focused dually on adhd management strategies that can be very helpful (including, in particular, enhancing relevant social skills related to setting expectations and boundaries) and on identifying and modifying negative self-image issues and counterproductive learned behaviors (e.g. various forms of self-directed hostility that attempt to assert control over a neurophysiological issue).

It’s funny, I went to therapy a lot of times before I found someone I could stick with, and if I were to give my past self a list of what I’ve gotten from therapy, I think I would’ve been unimpressed. Nevertheless, I’ve noticed that I’m more confident and calmer, and it has definitely improved my relationships.

There’s a kind of virtuous cycle that happens where you replace a grumpy mindset where you’re always mad at yourself for not meeting other peoples’ expectations and always mad at other people for making your life hard, with a confident mindset where you understand yourself, are therefore comfortable relating to other people about your abilities and needs, and can focus on putting yourself in situations where you’ll be successful.

lol, we’re all writing the same thing. I’ll give you one example, because I particularly liked it. My therapist always talks about separating people from problems, and I never had any idea wtf he was talking about. And then he gave me this exercise where he was like, “let’s construct a narrative where this person’s eccentric personality makes them really good at something specific. Where would you expect a person like that to encounter friction and how would you manage it?”

It was sort of fun, we talked about how Arthur Schawlow (who co-invented the laser and won the Nobel prize) was banned from driving on Stanford campus and had to be chauffeured. And I finally understood what he was talking about; you can access this perspective for anybody by constructing such a narrative. What if everybody’s a misunderstood genius at something? Why not? How would you live in such a world? One insight among many.

I had to come back and comment because your "misunderstood genius" really resonated with me.

It's even beyond that, in my opinion. What if everyone had perfect health, physically and mentally, and had been educated to the absolutely top tier of their ability to accept? Perfect, individual tutoring? Excellent nutrition?

How much better off would the world be if we framed everything in terms of helping everyone be their best, every day, in every way? How much of the trouble in the world is the result of just... accidental awfulness, that we collectively could just choose to stop?

It makes me very sad that we live in a world where potential Nobel winners are dying of easily preventable causes, or working dead-end jobs.

Imagine you spent your whole life crawling, and someone taught you to walk, but for your brain. It's hard to describe.

The medication unlocks your ability to learn the skills you need to cope with the problems you have, and therapy gives you the outside feedback you need to escape your own brain trying its hardest to mess things up and hide the mess.

Imagine if every 10 seconds this guy was in your body taking over your hands for a second or two: https://www.youtube.com/watch?v=GguQu5Iderg

I will say how it was life-changing for me getting diagnosed as 39M.

The quick answer:

Understanding neurobiology and the meta-cognition about the why of certain behavioural patterns and experiences is extremely helpful to just calm down and "forgive" myself, and not judge myself so harshly. It's as if I can optimise my life by leaning on my strengths and importantly recognising and dealing with my weaknesses. Just the awareness lets me catch myself getting into patterns, and act on them sometimes, and just let myself be the other times without any guilt. This insight brings peace more than you think. I can now organise my inner dialog and enjoy the diverse thoughts while also being aware of my impact on people in my life.

I was skeptical of the meds myself. I spoke with about 20 people through AHD support groups and group sessions. The drugs are mostly a trial and error affair with side-effects and altered behaviour. My subtle lifestyle changes - keeping one true todo list, always logging down my thoughts and taking comfort in the fact that they are jotted down so that I dont have to keep going down that thought and actually get up and go catch the train etc already gave me the biggest benefits. Then I wanted to see for myself what the drugs could actually do. At the end of it I may choose to take them or not. After 8 months of slow analytical trial and error with a very helpful psychiatrist who understood where I am coming from, I now take a very small dose of Elvanse(Vyvanse) + Guanfacine on some days of the week where I feel like I could use the help. They are not life-changing. They nudge me into being more capable of being me. My wife can notice the regulation the drugs let me have - A win for me. My kid has a better relationship with me than before - A win for me. Could I do without? Sure. But, I choose to have that little support to manage myself to get to who I want to be around my family without losing who I am. To each their own.

Longer background:

Despite reading about and knowing the symptoms of ADHD, and being told by a professional 10 years ago that I should consider getting formally diagnosed, I thought to myself - "Hey, I am smart. I feel happy and satisfied. I dont have any problem. I'm good as I am. I dont need to do anything about it." and promptly kept sweeping any thoughts about it under the proverbial rug.

Until, I started seeing my son develop in front of me. Seeing all those symptoms - impulsivity, hyper-focus on few things and inattentive to most others, emotional regulation issues, extreme reasoning abilities in some areas while being "immature" in other areas. This was me growing up. Being smart and intelligent, but longing to fit in, struggling to deal with the mundane. So, I decided to get diagnosed properly. Basically, I could hide behind my smartness and the ability to manage my symptoms until it just myself in my life, and then my wife, and then my son, but when the second one came along, I couldn't manage anymore and the overwhelm started to show the real patterns.

It takes courage to be honest and vulnerable.

Definitely guilty as charged.

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