"this was like discovering DNA"
July 26, 2021 3:57 AM   Subscribe

David Cain of Raptitude (previously, previously, previously) has blogged for over a decade about his efforts at improving his life, including several structured experiments around "A place for everything, and everything in its place", meditation, exercise, and more. This year, Cain received an ADHD diagnosis and wrote: "One of the bigger bombshells was realizing that this mystery issue is the whole reason this blog exists. Raptitude has been my response to living with ADHD and not knowing it."

Cain has also written an explanation of what ADHD is like for him, "for two reasons: To help other people understand what ADHD actually does.... [and] To help myself understand and manage ADHD’s effects in my life."

Further quotes from Cain's "What Raptitude Has Always Been About":
I guess I didn’t suspect ADHD because I was too busy doing everything possible not to look like a kid who has ADHD.

When I did finally try medication, it felt like being released from prison. I could just do things, in the direct and uncomplicated way other people seem to.

What’s most exciting to me is that, after a decade of blindfolded molasses-walking, I can finally begin to realize my original vision for Raptitude. Because I have simply not been able to.
The comments on that post also include several people's stories of realizing they have ADHD.
posted by brainwane (72 comments total) 108 users marked this as a favorite
[It would be nice if most of the comments in this thread were from people who struggle with executive function, as people with ADHD do.

If you have contempt for any/all self-help blogging, or scorn Cain for being a white Canadian male who blogs about self-help, please skip this thread.]
posted by brainwane at 3:58 AM on July 26, 2021 [44 favorites]

IIRC this also basically happened to mefi’s own merlinmann. It also basically happened to me, although with OCD instead of ADHD.
posted by overeducated_alligator at 4:02 AM on July 26, 2021 [10 favorites]

In case I forget later (ha), thank you for posting this. I'm a woman and just a different person than this guy (who I hadn't heard of before!) but a lot of my experience echoed his. I'm still waiting to try medication but yeah, I had been struggling for years and years, trying to figure out what was wrong with me and why everything was so hard, coping purely through anxiety and fear/shame on overdrive to compensate, and things finally really dramatically fell apart during COVID, and after seeing a therapist for awhile in response to that meltdown, she hit on ADHD and the more I dug, the more things fell into place.

To be totally candid, things are still very hard and I suspect medication would help more than the ever-increasing amount of coffee I drink, but having some more insight about what is likeliest to work for me, rather than just expecting my brain to work like a neurotypical person's and being devastated when, yet again, it didn't, has been the only reason I even made it through this past year and a half alive. I recently wrapped up a two-month ADHD skills class that was hard to get through, but I think worth it.

If you read the OP and it resonated I really really encourage you to look up some resources and talk to a healthcare professional if you can, because constantly doubting and hating yourself and not understanding why nothing ever works right and why everything about you seems wrong is a miserable way to be.
posted by bowtiesarecool at 4:57 AM on July 26, 2021 [25 favorites]

If I try to add any detail I'll never post this, so I'm just going to compare the waiting list for adult AD[H]D diagnosis in my region with the waiting list for trans healthcare.
posted by polytope subirb enby-of-piano-dice at 4:58 AM on July 26, 2021 [16 favorites]

It's a bit of a meme at the moment. (Especially with Tiktok (tw: Guardian)) And yet I do see myself in all of their experiences as well. I even mean to get an appointment to have myself checked but somehow I just didn't get around to it, yet.
posted by dominik at 5:02 AM on July 26, 2021 [1 favorite]

I carry a provisional diagnosis of ADHD.

Starting methylphenidate was one of the two most immediately effective pharmaceutical interventions I've ever felt. Especially in my work life. I could get through slow clinics that were previously quite mentally painful to endure. I could work through patient calls efficiently. I could stick to my to-do lists. Things requiring multiple steps didn't immediately seem daunting beyond measure.

When Cain describes how he made it through school until he didn't, it was familiar. I made it through high school and college doing really well--although I started to notice that while I thought I was a great writer I could never bring myself to actually writing for the classes in which it was required. I hit medical school and my performance plummeted. I got through okay except for the immense blow to my ego. Then residency training smashed into me.

An eight-hour day was one thing. I could marshal my mental resources to see patients and write notes. Rounds could be intensely painful. But on thirty-hour call I was a basket-case. I shrunk in horror at the idea of being there the whole time. Answering calls the whole time. Seeing patients. Having the list of things to do grow and grow. For every new task I imagined the five subtasks within it, and then the four sub-subtasks within those. It was like Zeno's paradox of motion but in real life for me.

At the time I interpreted my intense negative feelings as anxiety and impostor syndrome as well as (ironically given the impostor syndrome) a lack of competence. I got treated with anxiolytics and I felt okay enough to get through it but I absolutely loathed every second of residency.

Cain describes his experience as one of only ever being able to see one small section of a larger goal-directed enterprise. Never being able to see the whole. My experience is analogous. I have thought of it as an automatic, unavoidable, and involuntary atomizing of all tasks. Without fail I imagine the subtasks and sub-subtasks and feel so dismayed and discouraged it's impossible to start. What I used to decry as a procrastinative impulse I now understand as an inability to integrate subtasks into fluid wholes. It's basically losing the forest for the trees at an executive level. And of course this is very different when tasks are engaging or salient in some way. Which is why it never occurred to me that this was anything other than a failure of will. Even as I studied neuroscience and became a practicing neurologist.

I have this other behavioral tic wherein I find it very hard to commit to a future thing. Making written goals in my professional life is especially hard. But even things like agreeing to clean the house on the weekend cause me to phumpher and dissemble. I know it will be extremely hard for me to accomplish those things so I don't want to give false assurances. I am also extremely dependent on my calendar because otherwise I will plain forget about things as important as giving a lecture or meeting my chair.

Meds are fantastic but I can't keep on taking stimulants every single day because I become tolerant to them and a little anxious and irritable. So I'm still trying to figure out how best to medicate myself without burning out on it.

Settling on ADHD is just an immense revelation. For higher-functioning folks who have been able to skate through a lot of life's challenges but later hit a wall, it's also an immense relief to be able to describe the thing that you always knew was "wrong" with you and which you couldn't quite explain right to anyone looking quizzically at both your potential and your failures.
posted by adoarns at 5:03 AM on July 26, 2021 [49 favorites]

I tend to feel about my ADHD the way my late uncle talked about his alcoholism: it's never going away. In fact, despite having gone years since taking meds and only occasionally seeking counseling, I have an appointment today to see about going back on meds again.

The strategies and skills I have depended on successfully for years just haven't been enough during the pandemic.
posted by DirtyOldTown at 5:37 AM on July 26, 2021 [12 favorites]

I haven't dug deep into his writings yet, but on first glance, there was a lot that resonated with me. Concentration especially.
I think my problems lie more on the autism spectrum, but have never gone for diagnosis. ¿Por qué no los dos? It seems like serotonin is involved in both.
I never thought of myself as ADHD, because hyperactivity isn't a word I would ever associate with my behavior, but it's worth reading more.
posted by MtDewd at 5:43 AM on July 26, 2021 [3 favorites]

You can be fully aware of the importance of listening carefully (such as when being given instructions by a police officer, or your new boss during your first day at work) but the attention may still phase in and out, possibly to your anxious thoughts about how badly you need make sure you absorb all of this information.

hoo boy I feel that

I very recently got a diagnosis for executive function disorder and am in the middle of waiting to finally be able to pick up my prescription. reading stuff like this, plus the nagging sense in the back of my head that my childhood ADHD diagnosis hadn't magically gone away, is what got me to seek a proper neurological screening and get that diagnosis.

it's been really helpful across the board to have a more detailed and nuanced understanding of what EFD can do to your ability to listen, to concentrate, to communicate - in my marriage it's helped tremendously in giving me a way to articulate to my wife why and how I'm also frustrated when I'm looking right at her, hear her instruction/question/comment, and don't actually register it to respond in any reasonable fashion

I also find their theory re: hyperfixation really compelling, that the brain is seeking dopamine response. it matches how I listen to music (divebombing into a single album/song over and over until I've drained it of all emotional effect), how I consume TV/books (either obsessively or not at all, with particular difficulty starting a new thing), and how I participate in hobbies (the thrill of improving gets me obsessed with a hobby right until I hit the skill plateau and the input of effort to output of dopamine balance shifts), and also everything else...

anyway. thanks for posting this!
posted by Kybard at 6:06 AM on July 26, 2021 [24 favorites]

and in what feels like a fitting detail, I see most of what I said (and other things that resonate for me besides) came up in the piece after the part at which I arbitrarily disengaged and started writing my MF reply!
posted by Kybard at 6:17 AM on July 26, 2021 [14 favorites]

Echoing others here, I feel seen. I had not heard of this guy before, but am interested to read more of his writing.
posted by snwod at 6:30 AM on July 26, 2021

No, that's not "an explanation of what ADHD is like for him" - it's an explanation what ADHD is for ME. Oh boy does he get it right...
posted by DreamerFi at 6:42 AM on July 26, 2021 [3 favorites]

I think my problems lie more on the autism spectrum, but have never gone for diagnosis. ¿Por qué no los dos?

MtDewd go get that diagnosis - I've got both indeed and all this resonates sooooo much...
posted by DreamerFi at 6:45 AM on July 26, 2021 [3 favorites]

This was very, very relevant. I feel described.
posted by glaucon at 6:50 AM on July 26, 2021 [1 favorite]

I've struggled with ADHD my entire life, eventually starting medication in my early 30s. Doing so has been incredibly helpful, but I still struggle with a lot of executive function. Getting started is always a problem. I can, and do, hyperfocus on the wrong things. I still rush through work, and miss details.

Yet, my emotional control has improved. I feel calmer, my head feels clearer. I notice this most after I skip my meds for a day to take a tolerance break. I know it's working, now I just need to figure out the best ways to ensure my brain functions at its best, not just for work, but for the rest of my life.
posted by SansPoint at 6:58 AM on July 26, 2021 [4 favorites]

Okay, does anyone on here with ADHD compulsively talk to themselves? I talk to myself all the time and it is precisely as this guy describes. I've occasionally wondered about ADHD or autism because people in my family tend to have mild forms of the characteristics which go along with either or both.
posted by Frowner at 7:02 AM on July 26, 2021 [19 favorites]

i (old-ish white cis male) suffered with generalized anxiety disorder and panic disorder - into my early 40s. it was a relief to understand it and get some meds and therapy.

i also still grieve for what my life might have been if i had not-shit parenting and medical care. selfish, but there it is.
posted by j_curiouser at 7:05 AM on July 26, 2021 [15 favorites]

Why didn’t he tell us if he burned the thing on the stove at the end? Because I have been in that exact situation so many times that I’ve had to make a rule that if a burner is on someone else in the house must know.

His description of a midlife anxiety bloom is perfectly described. Everything “works” (eg shambles along breaking bits of your life in the process) until it doesn’t (eg you lose the faith that things can improve and stop believing you’re a good human). Thank you for posting. I have known for a long time that I am neurodivergent with some level of attention disorder / executive function issues for close to a decade but this has probably pushed me into seeking formal diagnosis.

ADHD is particularly malicious due to our cultural stereotypes of it as something that only young boys have. Realizing you have it as an adult makes you feel like someone who has failed to grow up in more ways than one.
posted by q*ben at 7:15 AM on July 26, 2021 [13 favorites]

I'm getting a little tired of the universe throwing up huge neon signs that say "GO GET ASSESSED FOR ADHD" when I don't seem to have the mental faculties or executive function to navigate the healthcare system to do so.

It's starting to feel a little pointed, honestly.
posted by wakannai at 7:43 AM on July 26, 2021 [39 favorites]

Once upon a time, trying to figure out why things were so damn hard, I tried to write down all the mental rules I had for having a conversation. After an hour and six typed pages, I gave up. Perhaps there should have been the realization that most people don't have lists of rules for talking to someone else.

The ceiling is missing in my living room after some water damage from the tub above. I didn't really notice after the first week, only when prompted by a sense of embarrassment when someone new came over, but never enough to fix it. It's been like that for 15 years.

My pandemic-induced diagnosis, by now two professionals, was two months ago at age 51. It was a struggle to find practitioners who didn't say "But you're successful!". Yes, by warping my brain and behavior into unnatural shapes, and taking on heaps of anxiety. And even that couldn't get me through grad school.

Medication has been okay, but not the revelation from the article. I'm still struggling with decades of adaptive behaviors asserting themselves. And with resentment for not finding out sooner. And the years and years of social damage.

I'm fixing the ceiling now, though.
posted by SunSnork at 7:45 AM on July 26, 2021 [25 favorites]

frowner: Yup, I have a running internal narrative, and regularly talk to myself to try and get myself to do things.
posted by SansPoint at 8:05 AM on July 26, 2021 [4 favorites]

Another person who was diagnosed with ADHD in my late 40's.

Without fail I imagine the subtasks and sub-subtasks and feel so dismayed and discouraged it's impossible to start. What I used to decry as a procrastinative impulse I now understand as an inability to integrate subtasks into fluid wholes.

This right here sums up most of my experience with ADHD. I used to think it was a massive failure on my part which wasn't helped by other people telling me it was a failure on my part.

I was talking with my doctor about having mental issues and felt like I had run out of excuses and the old workarounds I had utilized were becoming less effective and my life was becoming more and more unmanageable. She recommended that I go and get evaluated as possibly having ADHD.

So I went and while I was filling out the pre-exam questionnaire I was astonished at how many of the questions were so on point that I felt more than a little paranoid as to just how did they know so much about me, it felt so personalized, so much more intimate than I could even imagine. When I took the actual tests and the person evaluating me told me a few weeks later that I had severe ADHD and had probably had it for my whole life, it was like a veil had been lifted, that it wasn't all my fault, the relief was so profound that I actually broke down reading the email.

I have been on stimulant medication since shortly after that diagnosis, and it has changed my life to a degree that I thought impossible. It wasn't a cure, but it makes me feel like I can actually do things without falling victim to that "atomizing" that adoarns mentions. It felt like my executive functionality wasn't totally gone, that it was just being suppressed, that there was still hope.

I had been beating myself up for years and years feeling that it was my fault, that I was lazy and unmotivated, that I kept getting fired from jobs because I was a poor employee, that if I just "buckled down" and worked harder that I could be better. I was so far gone that I constantly self-talked myself into a huge emotional hole of depression and self-loathing.

When I look back at the person I was just five or six years ago, when I read old correspondence, when I review old projects, etc. I can still feel that tug, but I definitely am aware of it and can avoid the mental path that led me to that horrible place.

To say that the diagnosis, consequent therapy and medication changed my entire life seems like an understatement.
posted by Sphinx at 8:09 AM on July 26, 2021 [16 favorites]

Do people usually not have a running internal narrative?
posted by dominik at 8:10 AM on July 26, 2021 [2 favorites]

Do people usually not have a running internal narrative?

Not in the same way that people with ADHD do. My spouse and son both have internal narratives, wherein it's like their brains are actually talking to them, nearly all the time. My internal narrative, on the other hand, is more like ideas that pop up occasionally and bits of songs that fade in and out.
posted by cooker girl at 8:21 AM on July 26, 2021 [18 favorites]

For a smart, motivated person with ADHD, there is an endless array of strategies that you can enthusiastically pour your time and energy into to try to stay on track—and as a younger person, I was served by a whole industry of people like Merlin Mann, and David Cain, and David Seah, and David Allen (a lot of Davids, lol, hmmm) and it surprises me not at all that one after another of these folks are finding out late in life that they have ADHD, just like me, their fickle disciple.

Seems like you just reach a point where you're too old and haven't got the energy any more. You're still smart, you still know all the strategies, you're still creative enough to create more strategies, but you just don't have the energy to execute and sustain them, and you're forced to confront the fact that, wow, other people don't live like this—why not?

Thank heavens for Ritalin.

I wonder what my life would look like if I'd had a diagnosis and medication a decade or two ago, and I could have put all that energy and creativity and intellectual effort into my science and my teaching instead of spending it all manufacturing and maintaining a series of elaborate organizational systems to take the place of the faulty mechanisms of my built-in executive function.
posted by BrashTech at 8:43 AM on July 26, 2021 [27 favorites]

I've been thinking for years that I likely have ADD or another executive function disorder, but I haven't been able to get myself to a doctor to do anything about it. Reading this article is giving me a panic attack. I came here to post this comment instead of finishing the article. Maybe today is the day I [put an item on my 37-item to-do list to] contact a doctor.
posted by agentofselection at 8:51 AM on July 26, 2021 [7 favorites]

I just read "Delivered from Distraction" by Dr. Edward Hallowell and highly recommend it for anyone suspecting or navigating a diagnoses for themselves or a family member. The real eye opener for me was recognizing how I've been self-medicating with caffeine and alchohol, how badly those have failed me, and being able to shift to self-medicating with exercise and better nutrition. I have tried several stimulant mediations under the guidance of a physician, and the side-effects for me are such that I prefer not to use any except under specific circumstances.

The great thing about Hallowell's book (and his practice) is that he really puts an emphasis on the special talents associated with these types of brains, and encourages patients to positively lean into those talents as much as possible rather than solely focusing on all the things that they're bad at.
posted by stinkfoot at 8:56 AM on July 26, 2021 [5 favorites]

Finding someone to do testing was difficult for me, both in my own inattention and in the relative scarcity of adult ADHD providers.

My existing therapist kept reminding me, and on reminder, I would put a burst of activity into it that day.

I eventually had success finding an assessment by contacting my local university hospital and asking for a recommendation. If anyone is in Colorado, memail me and I can forward the name. There was quite a wait; apparently the pandemic has caused a huge surge in assessments.
posted by SunSnork at 9:03 AM on July 26, 2021 [4 favorites]

Okay, does anyone on here with ADHD compulsively talk to themselves?: I frequently notice that I am talking to myself, explaining what I am about to do as if narrating an instructional video, but from my point of view it's more as if I'm frantically trying to convince some judgemental observer that I actually know what the hell I'm doing. I try to keep it subvocal so people don't ask me what I'm muttering about.

I have managed to channel this professionally, in my first office job my boss noticed I liked to explain processes so had me write things up. In my second job they had no written procedures for the new workflow system so I started writing them for my teammates who got confused, they made that my job, and twenty years later I am a 'procedures and training specialist' writing up procedures and narrating instructional videos. Basically over the course of two decades in this company I turned my own need to continually pick apart processes (rather than actually doing the damn work) into a job where I pick apart someone else's process and write it up.

On the other hand I am barely able to stay on top of my workload because ADHD. I know I have something like ADHD as it runs (stampedes) in my family and my executive function is fubared but I also have a deep distrust of all medical professionals so I shall never be diagnosed.
posted by buildmyworld at 9:06 AM on July 26, 2021 [20 favorites]

Having ADHD and anxiety, my internal narration whilst taking stimulants was essentially "BE CAREFUL! DON'T FUCK UP! YOU ARE SO CLOSE TO FUCKING UP! YOU CAN'T MISS ANYTHING! CATCH EVERYTHING! BE PERFECT OR DIE!" My time on them helped me learn about the gaps between how I function and how other people function (especially social cues) but they also made me an anxious mess.

After giving them up, I got by for years by having complicated organizing habits at jobs with constantly shifting activity types. But the pandemic has made everything monotonous and repetitive and now I'm thinking I should at least look into the newer nonstimulant meds.
posted by DirtyOldTown at 9:11 AM on July 26, 2021 [2 favorites]

Take five minutes and fill out the ADHD self-assessment checklist from the WHO and Workgroup on Adult ADHD. Follow the directions and if recommended, seek consultation with a health-care professional, showing them the results.
posted by seanmpuckett at 9:15 AM on July 26, 2021 [20 favorites]

I got diagnosed ten years ago or thereabouts. Gamechanger to get on meds and start understanding what was going on; finally started getting some coaching this past year and that has helped a bit as well, though I'm having a hard time articulating my goals for the coaching - and as soon as I settle on one, I want to change it. Par for the course, I guess.

It's different for everyone, but some of what he talks about sure fits for me.
posted by nubs at 9:19 AM on July 26, 2021

I was fortunate enough to be diagnosed as a girl, in third grade, in 1984 - but I am *still* wrestling with understanding the effects. It turns out I have to do everything with the same brain, so *everything* is affected.
posted by jocelmeow at 9:27 AM on July 26, 2021 [3 favorites]

I just want to say I am on this train too boy howdy. I liked how he talked about how mindfulness & meditation actually did help him because it's the only thing that's ever helped me and it seems like people only ever bring it up to shit on it so that was nice.
posted by bleep at 9:34 AM on July 26, 2021 [4 favorites]

Oh, dear.

I have an appointment to discuss ADHD with a psychiatrist in a couple of weeks. I had one earlier this year but I missed it do to being overwhelmed with work and anxiety and *waves hands at the last year and a half*.
posted by loquacious at 9:35 AM on July 26, 2021 [8 favorites]

I've been under massive pressure from my family to *not* have ADHD. Everyone in my immediate family has been diagnosed, and I got stuck with the role of family life organizer/planner/reminder. Someone who remembers things and organizes things for other people can't have ADHD, right? So I've been telling myself for years that of course I don't have ADHD, I just need 3 devices and countless post-it notes to remind me to take my medicine, take food out of the freezer to defrost, to plug in my laptop, to brush the cat, to remind so and so to go to the doctor... I compulsively clean and fidget because I'm anxious! My subtle stimming is just self-soothing! I can't concentrate on what people are saying becasue I'm self-centered! I can't focus on training materials because I'm stupid and flighty!

Anyway. Guess I'll be printing off that checklist once Alexa reminds me.
posted by Stoof at 9:40 AM on July 26, 2021 [11 favorites]

I didn't blog about it, but I similarly have spent my entire adult life desperately scouring self-help books and books on productivity, how-to books, etc. to try to develop workarounds to address what in retrospect was hideously obviously ADHD. I had even been diagnosed as having an anxiety disorder, anxiety that magically vanished when I started addressing myself as someone with ADHD rather than someone with anxiety.

It was a hard thing to realize, because, unlike this author, I didn't have a caring father who helped with school, but instead an emotionally abusive father with an explosive temper who's entire approach to issues that now so obviously were ADHD was to respond with emotional violence. It was a very hard mental turn to make this past year from seeing myself as a gifted child with an inexplicable laziness and a father who was excessive but reasonably upset by this to realizing the truth of it, that I was a child with an undiagnosed disability and a father who abused him for it -- a pretty common experience in ADHD, from what I gather.

I have successfully developed a lot of tools to address the fundamental executive disfunction at the core of ADHD, a lot of it through trial and error, and now that I understand the issue it's gotten a lot easier to address it. It's hard not to be frustrated at 52 years of my life passing without me understanding something so basic about myself, and it's hard to realize how much of it I have had to go alone, because when you're not neurotypical, people are not typically your allies or advocates, but instead see your disfunction as puzzling and irritating, and so you hide a lot of it from them.

At least I now know what's going on, and better now than never.
posted by maxsparber at 10:14 AM on July 26, 2021 [22 favorites]

ADHD has been a hot topic in my social circles for the last couple years, as many in my demographic (late 30s-mid 40s) get later in life diagnoses -- so I've seen that screening checklist come up quite a few times, and have gone through it a few of those times to find, as expected, that I'm not marked as likely having ADHD.

Which makes sense! A lot of the detail/organization/executive function stuff covered by that checklist, and mentioned in this blog post, isn't a struggle for me at all. But then there are other parts that resonate so, so hard, and I really wonder what to do with that info? Is there another "brain thing" that would explain half of these symptoms without the other half? E.g. telling myself I'll pay attention to what's obviously about to be an important plot point in a move/TV show, and then zoning out less than 30 seconds later, constantly abandoning hobbies because I can't get through the initial skill plateau, planning things on paper but not being able to follow through because (omg yes) I can no longer capture the feeling of wanting to do the thing, and (seriously, triple yes) constantly revisiting and wearing out the dopamine hit of favored songs or emotionally resonant moments from books or TV shows.

Like the author, I was treated in early adulthood for social anxiety, and while that was absolutely necessary and did help me in some significant ways, there are some traits I attributed to that that are clearly ... not that.
posted by pinwheel spark at 10:44 AM on July 26, 2021 [6 favorites]

First thing I’ll say is what I’m about to share is contextually specific to me, and I think it’s quite likely ADHD manifests in different folks for different reasons. I think most any self-help space loses a good deal of its netting value if we don’t know enough about the human, so here goes this human.

With that said, these symptoms are spot on for me, but I tie them to my complex post traumatic stress disorder caused by abusive and authoritarian caregivers within an abusive and authoritarian society(1). That’s not to detract from the diagnosis, for sure, but strikes me as one of the many comorbid diagnoses most folks get in lieu of a comprehensive CPTSD diagnosis (as that diagnosis I believe is decidedly not sanctioned for U.S. clinical work).

For me, my attention was dictated by angry adults through emotional and physical violence as young as the age of 3 (I suspect sooner, but memories are what they are). Anything that didn’t bring threat of violence is just not as important/interesting to my nervous system. This informs why I imagine terrifying outcomes in otherwise innocuous situations, b/c that will hold my attention where non-terrifying outcomes may not.

Anecdotes that particularly align with my experiences and that I’ve vouched to traumatic circumstances in my own life:

When an activity is stimulating, it magically allows you to concentrate on it. You feel synched up, compelled, engaged. Attention isn’t perforated like it usually is. Note that “stimulating” doesn’t always mean fun. You might hyperfixate on reliving an argument you had earlier, reading horrible news headlines, or imagining hypothetical scenarios about someone trying to hurt you, or anything else that triggers emotion and immediacy.

Hyperfixating on arguments, reading horrible news, and imaging being hurt are all things my nervous system does because these were necessary and trained survival mechanisms of having ones attention dictated from a very early age to respond to threat of fear from caregivers. Reading a book? I couldn’t freckin do that and pay attention to the changed facial expression of my sibling across the room, footsteps in the next room, nor the raised voice in the conversation two rooms over. Not just for one day, for hundreds/thousands of days (in varying iterations). There’s no threat in anything but the argument from earlier, the impending doom the news portends, nor someone definitely planning to hurt me. My nervous system has more power than my thinking/cognitive brain and it’s about threat analysis first and foremost. It’s not. Even. Close. Though my stories try to belie.

While I’m engaged with an immediate step (e.g. writing this sentence) I have little sense of what the entire paragraph or article is about, what it might mean to be finished it, and whether the current step is contributing to that.

Saaaaaame. Though my current rationale for this process within myself was I have no recollection of caregiver apprenticeship of entire tasks while talking me through gently (as a child needs), but I do have recollection of thousands of public school assignments that I machine learned how to complete to teacher/authority figure satisfaction. This has led me to be an outline-machiner in my uni days where I start with high points and bullet down based on connections my mind makes to the top bullets. I don’t think I ever have a holistic vision, just an ongoing branching of ideas I can take one step at a time.

You have more stress because you can’t get things done and you’re worried about getting fired. You aren’t in the best career for you because you couldn’t finish the schooling. You have low self esteem. You constantly fear bad reactions and disapproval from others. You keep everyone at a distance so they don’t see how dysfunctional you are. You have lower status in society. You’re also in competition your whole life with people who don’t have nearly as many issues.

The getting fired thing for me is fear of abandonment. Abandonment by where I thought I was valued and literal abandonment of my needs as I lose access to the currency that entitles me to necessary resources of human survival (much less just enjoyment).

Fearing disapproval and bad reactions from others, yep. Fearing lower status in society, yep. Def my CPTSD caused by neglectful and abusive caregivers in a neglectful and abusive society for me.

At a certain point, something serious happened to the characters (a crew member was killed in a mysterious accident) and I became riveted by a book for the first time. I was suddenly absorbing each sentence, seeing the story unfold like a movie, and I could not stop. I read it all afternoon and all night, and finished it the next day, riddled with goosebumps, while my teacher was taking morning attendance.

Very true for me. I read very little fiction through elementary school. The first book I recall becoming engrossed in was It, by Stephen King, in 6th grade. I then read through several more of his novels. My guess now is, if I was reading something that was not scary, about 10-15 minutes in I’m waiting for a shoe to drop. If I get settled and forgetful of the danger around me, then it startles me and catches me off guard. Waaaay too dangerous for my nervous system. But if I’m reading something scary and intense, well the room temperature of my insides is now lining up with my outsides. No dissonance, and I’m wired for the impending doom if need be (i.e. I’m not “taking a break” from fear, I’m in the fear, shoes are dropping, and they’re not dropping on me, bonus!).

Social interaction always felt dangerous.

I won’t paste the entire paragraph here but yeeeeep. I said things at inappropriate times like, a lot, and I earnestly believe it was tied to lack of safe social conditioning in safe spaces with caregivers. Without that, you’re out there with folks who did have safe spaces while still working out growing up human in society. That’s some scary shit that must be learned!

It seemed like other people, regardless of their apparent intelligence or talent, figured out virtually everything more easily. This was confusing because I knew I was smart. I could figure out things I was interested in — sometimes impressing myself and others with how clever I could be — but I just did not have this capacity to figure out necessary-but-uninteresting stuff that almost everyone I knew seemed to have.

This is me, and I believe the cause was, once again, not learning with safe caregivers from a very very early age (I’m talking learning to talk, learning to walk, learning to potty train, learning to converse, learning to mirror, learning to play). I looked to siblings and society on “how to be” because a loving relationship with a caregiver did not allow me to reflect that love into myself in spaces they themselves couldn’t see (i.e. if angry or “not good enough” parent faces come into my nervous system, angry or “not good enough” relationships are developed with my inner world). As a result, other people always “had it figured out” because I was relying on emulating what others are doing as opposed to experiencing the process of learning/engaging with stimulus and feeling internally safe because of reasons stated.

ADHD is characterized by poor working memory, so I couldn’t simply relax and listen, and trust that I would to be able to (a) comprehend fully what was being said, and (b) be ready to respond appropriately when called upon

Yes, so much yes. But the consequences, for me at least, of not comprehending what was said, and not being ready to respond were violence. I think this is generally true for lots of folks in school systems as well, but the fuel and lack of airbags from caregiver conditioning made it existential and enduringly true.

A specific and intense fear of being put on the spot and asked to explain myself

Yes so much yes. Related to the societal aspects, I have a feeling this aspect of ADHD is exceedingly prevalent the further you get from cishet, white, Christian man in America. As I’m writing this I’m reremembering times I believed much/all of my abuse was my parents own intimacy ineptitudes coupled with their insistence upon forcing supremacist ways of being into a tiny body from a young age (so my queerness/transness was in perpetual stuff by my inner workings for decades).

Almost never achieving long term goals.

This was true for me for a long long time and probably still is (you don’t know what you don’t know, or I don’t, at least). I was fortunate to find friends and support that helped me at pivotal times and have been in trauma informed therapy and support groups for the better part of a decade now. Also my societal privilege growing up as a presenting cishet white man with parents who could navigate systems of power helped me dodge certain setbacks that might’ve made this permanently true.

I compulsively talk to myself in full monologues or dialogues – out loud when alone, or internally with others.

Very true for me. I must win in here so I can be safe out there. It’s taken the aforementioned better part of a decade, but developing a loving/supportive out-loud voice for my inside voices, coupled with aforementioned trauma support system, helps so much with this.

Meditation has been the only thing that has consistently helped me to function, although it is extremely difficult at times.

Same, related: I went to a 10 day meditation retreat, practiced the method for 4-5 months, then had a psychic break resulting in active suicidality that led to aforementioned resourcing noted above.

This is most apparent when it’s live – at a concert, or a movie in the theater, I feel like I don’t quite know how to enjoy it, like I don’t know how to settle into the activity of enjoying the show.

Very true for me. Enough humans around me and my nervous system must survey. Must. Also must look normal. Emulate.

Another part of this phenomenon is a social spinoff to that – with concerts anyway, I’ve often felt like I need to look like I am effortlessly enjoying the show. I’m very conscious of whether or not I’m bobbing my head to the music, and to what degree, and whether I look like a tool. This feeling of alienation is one example of a greater theme of just not feeling like I belong in the world in the same way others do.

Also true for me vis a vie emulating how others do rather than having been taught to experience in safe ways in a safe environment.

I always ate portions that were too large, fell too easily for snack foods even when I didn’t like them, ate between means and at times even had a second dinner if I wasn’t too full.

100%. Dinner table was a trial and rarely ended without a scapegoat. East fast. Get away. Gorge later somehow.

Extreme rejection sensitivity

So true. I was rejected by the two people that made me. When that’s affirmed by others, oh god I’m dead.

There’s another aspect though, and it applies to all strong emotions. When you have ADHD, your brain is hunting for stimulation, and anything salient will do, which includes all strong emotions. I would find myself attracted to reading bad political opinions, and then get angry about them, and rant in my head or out loud about them.

All. The. Time. Helps my experience line up with my chemicals/nervous system. Cognitive dissonance, bye bye!

It takes longer to figure out ways to do new things and engage with people in new ways, because it’s all on hard mode for you.

True for me. Once the treadmill of forced new experiences ended (e.g. k-12 education/college and all the related social interactions and potential activities), learning new things can suck if I’m not really resourcing myself to take care of myself.

A habit of trying to sound smart

Another yes. Sounding dumb meant you were worthless growing up in my household. Intellectual parents coupled with above mentioned deficiencies of theirs. Approval was the closest thing to love. Disapproval was abandonment at best.

All of this is contextual/my experience. I make no assertion of ubiquity for sure and also believe I have diagnosable ADHD. I was talking to my partner last night about how amazing it would be if self-help authors wrote deep and honest inventories of their life experiences to line up how they got to where they are and what informs their perspective. I figured I’d give it a go myself with this as childhood trauma is rarely discussed personally in public, and the current exploration of the overlap of these conditions (ADHD and CPTSD) in schooling has been very intiguiging to me .

(1) To not digress in-line. For the U.S., prevailing hegemony is the ancestral memory of genociding slavers that incepted legislative, regulatory, and corporate culture in materially all locales within present day U.S. borders. Said shegemony says if you’re not propertied, make value for the propertied using your body or die. This is fairly self-evident on its face, but certainly demonstrated by U.S. institutional responses to COVID. I believe this to be inherently dehumanizing and traumatizing for human organisms.
posted by CPAnarchist at 10:54 AM on July 26, 2021 [15 favorites]

Like so many others here, it me.

I underwent a formal neuropsych evaluation recently as part of a process for fiddling around with my meds, since the ones I'd been on before weren't working as well anymore and seeing how profoundly worse my working memory is than my other cognitive abilities explains so much.

Like...I've been to Japan twice, for three weeks each time, and took a few short classes, listened to some language tapes, and attempted to self-study with workbooks. After all of that, I can recognize the kanji for "yama" because I usually book hotels on the Yamanote Line in Tokyo, and I can recognize the kanji for "no" because it's in a lot of anime character names. I can say "please", "thank you", "hello", "yes", "no", and "excuse me." That's it. My husband went with me on the second trip to Japan, and between listening to about four hours' worth of language tapes and looking at station signs for a week, he managed to teach himself enough to be able to puzzle out katakana and to understand when he overheard two Japanese people say "What time does the festival start?" "6:30 PM." I HAVE NO IDEA HOW HE DID THAT
posted by telophase at 11:40 AM on July 26, 2021 [2 favorites]

That "What ADHD Is Like" post has so much in common with my experience, except for the part about reading books being difficult. The part about attention fracturing is exactly on point.

Last year, I finally made an appointment to get an ADHD evaluation. It was over Zoom because pandemic. First I had to fill out a couple of online/paper questionnaires. Then the psychiatrist had a phone call with my parents to hear about my childhood history.

(What I remember is that my parents reviewed my daily planner every night to make sure I didn't forget homework, and they would check on the progress of my assignments. During lectures, no matter how hard I tried to pay attention, I'd inevitably lose the thread between one word and the next and then I had no idea how much I'd missed. I was good at problem sets and grammar exercises, but couldn't start a writing assignment. When I did start, it could take ten minutes to get a sentence out. These things are all still here today except that nobody is managing my time for me.)

The psychiatrist determined that I don't qualify for a diagnosis because there isn't strong evidence of ADHD in my childhood history. I got good grades and did great on tests.

I'm so tired of not remembering what I wanted to do twenty seconds ago. I don't know where to go from here.
posted by henuani at 12:03 PM on July 26, 2021 [4 favorites]

Okay, does anyone on here with ADHD compulsively talk to themselves? I talk to myself all the time and it is precisely as this guy describes.

Literally all the time, from waking through to falling asleep (in fact I only really know I'm falling asleep because the things I'm saying to myself start to become disconnected from the moment I'm in, although they still make sense on their own terms). To some extent, I wouldn't even describe it as compulsive, in that it feels less like something I do, and more like what I am. It's unclear to me how I would experience the world at all if I weren't constantly discussing it with myself. When I first learned to talk, apparently I just spoke out loud all the time I was alone. For a few years my parents knew I had fallen asleep when they heard me stop talking.

The advantage of it is that I can express myself very clearly and rapidly when I speak; I just sort of tune in to the right bit of the chatter and open my mouth (although it actually slows my writing down because I can't keep up with my own internal editorial commentary and have to keep going back to change things). The downside will be appreciated by anyone who has ever lived with a person who just. won't. shut. up.
posted by howfar at 12:30 PM on July 26, 2021 [5 favorites]

Oh the comments on that first previously are... unexpectedly pro-/neutral-capitalism.

Anyways just adding another "his description of how his ADHD makes him feel/affects him" is 80% bang on for me too.
posted by vespertinism at 1:13 PM on July 26, 2021

Eight years into my middle-aged-but-definitely-lifelong ADHD diagnosis, I'll admit I skimmed this, except for the "Always feeling like people “get” something I don’t" section...in the hopes there would be something about emotional labor. And there was!

If people with good executive function are reading this thread, please know for other threads that women with ADHD can have trouble with "maintaining a household, and fulfilling normal obligations like shopping for Christmas gifts, filing taxes, or returning items to the store." This one definitely does.
posted by gnomeloaf at 1:38 PM on July 26, 2021 [10 favorites]

Okay, does anyone on here with ADHD compulsively talk to themselves? I talk to myself all the time and it is precisely as this guy describes.

I literally take long walks specifically for this purpose.
posted by maxsparber at 2:00 PM on July 26, 2021 [3 favorites]

I'm helping some of the people I love get their ADHD diagnosises. I hope it helps them- reading about adult symptoms of ADHD is very useful for me to be sure I'm correct in my layperson diagnosis of them, and it will assist me in advocating for them when they can't do it for themselves.

Thanks for sharing!
posted by Braeburn at 2:15 PM on July 26, 2021

To manage life, human beings need to be able to focus on what is relevant at a given moment, even when that thing isn’t stimulating or salient

I'm not going to self diagnose here, but I have struggled with exactly this my whole life, as a raft of "jonathan is so bright and capable of excellent work but doesn't have his shit together" school/work reports attest. The desire to do something stimulating or at least soothing in some way rather than the most important thing that needs doing is a real challenge, and one I've always attributed to a lack of self discipline or a weirdly specific sort of lazy anxiousness. Hmmm. Maybe time to see a therapist again and get a pro take.
posted by Jon Mitchell at 2:28 PM on July 26, 2021 [5 favorites]

I need to make a second opinion appointment. My psych said I had adhd tendencies but that I was too functional to require the meds. I sort of understand given the interactions of medications I’m on, but it was frustrating to get all the way to doing the tests and be told you’re coping too well for help.
posted by dorothyisunderwood at 4:09 PM on July 26, 2021 [3 favorites]

Like many others here, I'm finding this so poignantly descriptive of myself it almost brings me to tears.

I've suspected I had undiagnosed ADHD since early 2020 when a high school friend posted to Facebook about her diagnosis and the relief brought by medication. Everything she said resonated. Then last year, pandemic plus perimenopause slammed me into the brick wall.

The most relief this has brought me is understanding the things about myself and my past which I thought were really really weird and which I never saw anyone else have struggles with. Like being a super smart kid whose maths marks went from As to Ds in one term because I got a new teacher who mumbled and I literally could not understand him and was too embarrassed to ask anyone for help. (Asking for help is for losers, not super smart kids). Or being a child who was teased for compulsively engaging in behaviours I now recognise as stimming (lifting my upper lip to touch and sort of stroke my nose, sucking my cheeks in, wringing my hands...) Or getting weird obsessions with things and totally fixating on them for a while then dropping them. (The Titanic! Wives of Henry VIII! The Manson murders! Vintage perfumes! The history of colour! Mediaeval herbal medicine!) Or hating phone calls so much that to this day I lie and say I've done them.

I want so badly to get a diagnosis, but. But.

Every time I have mentioned to someone in my life (friends, family, co-workers) that I think I might have ADHD, I get almost the identical reaction. "Are you kidding me? You're the most together person I know! You're so smart! You're so successful!" Apart from the one who laughed and said, "Sorry to tell you, but I think it's a little late to do anything about that". Yes, I am very good at masking and compensating and putting things into place to compensate, and I don't seem to have a problem to outsiders. I worry that my doctor who I've known for over a decade will think the same thing.
posted by andraste at 5:28 PM on July 26, 2021 [9 favorites]

That is my exact assumption, that I will not be considered bad enough for medication. I just keep reading things that resonate with me and are apparently signs of ADD like picking your cuticles, using piles as organization, craving novelty, procrastination, and social anxiety. Next you'll tell me that my abysmal handwriting is a symptom!

I am also concerned that I will start diagnosing everyone around me.
posted by soelo at 5:55 PM on July 26, 2021 [2 favorites]

I've talked here about the late in life realisation that my (now ex) husband has ADHD. At which point I started recognising similar traits in my kid. My current partner has ADHD and gently floated the idea that maybe I have it too. All three are inattentive, and for my partner and ex, meant as little boys there is an expectation that it can't be that bad since they aren't in too much trouble. And even though my kid does well at school I know what it costs. Within three minutes my GP had made a referral for a child psych and firm promises to come back if we couldn't get in quickly, just based on my two sentence report and my kid's behaviour. Not disruptive but three topics in once sentence, jiggling, all of that just at that appointment.

The moment my kid is not actively learning, they are flighty, dopamine seeking, and scattered. My partner is similar. I, however, have PTSD and auditory processing issues, so while sometimes similar (please distract me/oh god I can't focus) I do think it is different. The executive function aspect is really clear to me when we work together on things. But put the three of us in a lecture hall and there is just no chance we are engaged the whole time.

I love my kid and I want better for them than what their dad had 30 years ago, or an aunty 20 years ago, or even my current partner. It really helps to have this kind of thing out there, or even ADHD tiktok, because it helps them understand why their brain is a certain way and it isn't because they are a bad person, or broken, or wrong. And also ways to cope when trying to fit into the capitalist hellscape.

I did talk to my therapist about ADHD or autism. I tick more boxes for the latter and the treatment is pretty much the same as what I do and take now. ADHD has a very well established medication path, which is the only reason I am pushing hard to get my kid diagnosed, so it is an option. My partner is currently wrangling an attempt to go back on meds and even with the established diagnosis (mild, because he is smart and did well at school, obviously...) it is a lot to manage. Even with supportive people around.
posted by geek anachronism at 6:11 PM on July 26, 2021 [3 favorites]

I got a referral to a psychiatrist. Filled out forms. Talked for an hour and a half. Verdict: I would have qualified for a diagnosis as a child, but now I seem to be coping ok, and since ADHD is a developmental disorder, and I'm an adult, nothing to do here.

I found this validating on the one hand, and frustrating on the other. I mean yes, I do have a number of successful coping strategies I have evolved over the years, but I would like help because it's exhausting and the constant sense I could be doing better than I am makes me sad. At 51, I don't have that many years left to flourish in.

But, psychiatrist time is rare and expensive in my country and medication is impossible without a formal diagnosis, so I muddle along. And yes, David Cain's description is about 80% my experience too.
posted by i_am_joe's_spleen at 6:38 PM on July 26, 2021 [3 favorites]

(One good thing is a hilarious conversation with my recently departed father who said something like "Teachers and so on always make out like ADHD is a terrible problem, but it's mostly a problem for people who want you to pay attention to them". )
posted by i_am_joe's_spleen at 6:40 PM on July 26, 2021 [18 favorites]

Next you'll tell me that my abysmal handwriting is a symptom!

Your abysmal handwriting is a symptom.

Well, more precisely, marked difficulty with some graphomotor skills, most often handwriting, is dramatically more common in people with ADHD than the neurotypical population, but is not a diagnostic criterion. So, technically, your abysmal handwriting is suggestive of ADHD, and given the other suggestive characteristics you describe, certainly warrants further investigation. It should also be noted that graphomotor difficulty is common among neurodivergent individuals generally, and the significant overlaps between the various clusters of neurodivergent traits can make it hard to tell what labelling is most appropriate. I am diagnosed with both dyspraxia (DCD) and ADHD, but there's evidently no boundary between the two: it's just that whatever difference exists between my brain and a neurotypical one manifests in ways that fulfill both sets of diagnostic criteria.
posted by howfar at 2:22 AM on July 27, 2021 [9 favorites]

Reminder for folks who want more help: there's an ADHD tag on Ask MetaFilter, and some other threads about it that aren't tagged "adhd" but that you can find through search.

People who need some help getting around to backlogged tasks (such as doing an assessment checklist and booking an initial mental health appointment) may be interested in some pair-accountability and group-accountability websites and tools. Someone could even set up a synchronous online event where a few MeFites do the task together at the same time.

And if you don't have a medical diagnosis but suspect you may have ADHD and want specialized help, you can get an ADHD coach without a medical diagnosis.
posted by brainwane at 3:26 AM on July 27, 2021 [10 favorites]

Several folks posted that they either were assessed negative or are afraid to get an assessment because they are too "together" or got good grades or are too old for a "developmental disorder". These are very common misconceptions.

Like the author I didn't get my diagnosis until my early 40s. I was diagnosed twice -- once in the US, and again in the Netherlands when I moved here. The second diagnosis involved an attention test (you play a very_boring video game while wearing a head tracker for 20 minutes) that showed my ADHD is off-the-charts for inattention and hyperactivity. I was a straight-A honor student in school, and in college, and I got a masters before I knew I had ADHD. I'm usually a half hour to an hour early for classes and meetings. I was never a bouncing-off-the-walls kids -- I was a staring out the window kid. ADHD is not a developmental disorder. It is a life-long brain disorder. Some people can learn to compensate enough to be successful as they grow up, but they will also be working waaaaay harder than everyone around them, I certainly was (and wasting a ton of time being too early all the time just to be on time), or they were able to get a job with staff or assistants that took over the parts they couldn't do.

And here's the thing a lot of doctors and psychiatrists who have insufficient training in ADHD don't realize: the biggest problems for us are the ones no one else can see or measure. The distractions? Even if I can eventually find enough moments of clarity to get some work done, the distractions are hellish to live with. It feels very much like having five toddlers that you are responsible for running around you at all times. While you are trying to work, cook, carry on a conversation. Without meds my bored brain invents distractions, constanly. Some are of the horrible, mortality-contemplating type, but others are quite pleasant like vacation planning when I'm not actually planning a vacation, and others are entirely mundane. All feel as relevant as the thing I'm supposed to be doing and it usually takes a very long time for me to realize I'm off on an irrelevant tangent. Imagine the depression that builds from a lifetime of finding yourself unreliable. Even the thing you want to accomplish for yourself, that you know you're smart enough and capable of doing, you .. just .. can't. And the social avoidance and fear you development after so many failed interactions, that might not affect your job, but it certainly will affect your wellbeing.

No matter how together you seem on the outside, living with constant mental overwhelm, and the fallout from constant mental overwhelm, is torture. And it's uneccessary torture, since we have effective treatment for it. If anyone tells you you are too old or too successful, get a second opinion. Because that practioner is woefully out-of-date with their ADHD knowledge.
posted by antinomia at 4:15 AM on July 27, 2021 [22 favorites]

A huge factor in managing efforts towards a goal is working memory, which is poor in people with ADHD. You don’t have as big of a cognitive “desktop” to keep several important pieces of information in the mind’s view at once, which is something almost all goals require.

This means that when you get older and your memory gets worse, your ADHD gets worse too.
posted by Obscure Reference at 6:32 AM on July 27, 2021 [8 favorites]

If anyone tells you you are too old or too successful, get a second opinion. Because that practioner is woefully out-of-date with their ADHD knowledge.

Yes, this. I have been successful before my diagnosis, but as we age and change, the coping skills and strategies we have may not work anymore. Or you just get tired and exhausted by the state of overwhelm and it wears you down. Lots of doctors don't understand it - I've been lucky in that my family physician has a son with ADHD so he immediately took the discussion seriously and was open to learning more about it in adults; but that isn't every situation.
posted by nubs at 7:47 AM on July 27, 2021 [2 favorites]

If anyone tells you you are too old or too successful, get a second opinion. Because that practioner is woefully out-of-date with their ADHD knowledge.

And exhibiting such extensive ableism that I wouldn't trust them to practice juggling near disabled people, let alone diagnosis.
posted by howfar at 11:10 AM on July 27, 2021 [3 favorites]

After one of my children was diagnosed there was a thought worming around in the back of my mind about what might have led to it, what might have predisposed them. As I familiarized myself with some of the ways the condition manifests, more and more of it seemed familiar to my own experiences. I was able to relate to their struggles and tried to provide support for many years.

It was not until late last year, however, that I started to consider the possibility that I fell somewhere on this spectrum myself. It took a few months to nerve myself up to ask my psychiatrist to refer me for evaluation. It had become really hard to think and do. I was given a self reporting questionnaire where I reported a high affinity for many of the listed symptoms, then scheduled for an evaluation.

The evaluation consisted of being administered the Conners CPT: a test that is basically the world's most reductive video game. I grew up in the 70s and 80s when video games were simple affairs, even made some of my own that were about as simple as this test's task, so I understood what was being asked of me to do during the test. I wound up hyperfocusing on it. I've played shittier games.

Well, apparently because hyperfocus is not really currently considered a significant factor by many diagnosing doctors, the fact that I did not struggle to hit the space bar when an X came on the screen meant I sailed right through. The company that collates the results said there was no indication of an attention problem and the whole affair was dropped.

I just drink a lot of coffee and criticize myself all the time, these days.
posted by majick at 11:49 AM on July 27, 2021 [8 favorites]

A friend said recently she couldn’t really believe I have ADHD. Because I am in some ways very successful (advanced degrees, athletic achievements, creative output, long term marriage) and because I’m a little intimidating. Also because she’s an educator and knows that disorganized people have taken to saying they’re ADHD. It’s not just disorganization, as the links in the opening post set out. I’m intensely organized. INTENSELY. I have systems, generally multiple overlapping redundant conflicting systems, and I have learned how to trigger hyperfocus when I need it. Also the quadruple espresso first thing helps.

It really pissed me off that she said it when she had just watched me lose my wallet five different ways right in front of her in the restaurant while I was sitting there focused on how I was going to pay the bill, while having a very intense conversation with another friend who is also ADHD.

Do people really not SEE these things? I guess not. I feel as if it must be obvious. But my mother didn’t believe it either until she and my sister took an online test on my behalf, which also pissed me off. And unlike my friend, my mother was there in my first two decades when the rolling disaster was at its awful worst.
posted by Peach at 6:19 PM on July 27, 2021 [9 favorites]

The evaluation consisted of being administered the Conners CPT: a test that is basically the world's most reductive video game.

To the best of my knowledge, the use of CPT as a diagnostic tool for ADHD in adults lacks empirical foundation. This appears to be medical gatekeeping rather than a serious attempt at diagnosis.
posted by howfar at 6:53 PM on July 27, 2021 [6 favorites]

This appears to be medical gatekeeping rather than a serious attempt at diagnosis.

That's what HMOs do for a living.

The experience was more the frustrating because I had said pretty clearly at the outset that I was very reluctant to consider medication -- there's a strong chance of it exacerbating another condition that is already only moderately controlled -- and was looking to use a prospective diagnosis as a way to access services and support. They needn't have worried about keeping their precious meds out of my hands.
posted by majick at 8:30 PM on July 27, 2021 [1 favorite]

Yeah, those video game-like tests, and also brains scans, are not considered diagnostic for ADHD, according to several experts in the field (I would look up the references but I know it would send me down a research rabbit hole that I need to stay out of today because I need to clean the house because people are coming over for the first time in, like, 18 months, yay!). Diagnosis should consist of a screening survey and an in-depth interview and that's it. They will talk to your family to ask about your childhood if that's possible, but it's not required if your family isn't available. Part of the interview involves ruling out (or ruling in) other confounding (or comorbid) diagnoses like OCD, autism, etc.

The place I went that used the game test relied on several interviews for the actual diagnosis (with a psychologist, psychiatrist, medical doctor, and a nurse practitioner/case worker, this place was amazing) and used the video game test to help them evaluate how the meds were helping. Which was nice for me since in this country they require that you try methylphenidate first, which does nothing for me but make me feel meh, and the game test ended up showing that very clearly after a single dose. The reason those tests are not considered diagnostic is for exactly the reason you mentioned, majick, that some people find them novel and end up hyperfocusing on them. Kind of like BMI -- useful for research, not useful for studying an individual.

But also, stimulants aren't the only meds that are affective in ADHD, and these days they're pretty good at finding something to work around most medical issues. One of my meds, for instance, is clonidine, which is a blood pressure lowering medication that happens to also help with ADHD. For me it helps cool down some of the overwhelm and anxiety that the stimulant I take doesn't cover. And there are others that aren't stimulants but are effective for a lot of people. The stimulants just happen to be the most effective for the largest number of people, and unlike a lot of other psychiatric meds you can just stop taking the stimulants cold-turkey if you have a problem and they're completely out of your system in few hours.

And yeah, I get being frustrated by parents, family members, and friends who don't think you have ADHD. My approach is to say something like, "I know right?! I would have never guessed it, either. Turns out ADHD is not at all like what I thought it was, I had a lot of misconceptions." And so far that approach has not failed me yet. My mom, when I first broached the subject to her, was like, "oh no, you do not have ADHD. Your problem is that time somehow.. time just works differently for you." (Cue annecdotes of me being late for things, not being prepared or being surprised by things that had been on the calendar for months, taking forever to do things I said would just take a sec, etc.) I was able to send her Barkley youtube videos where he talks about how time blindness works in kids and she was like, "oh...". And later, "omg your dad had ADHD". Yep. ADHD is, indeed, extremely genetic.
posted by antinomia at 1:47 AM on July 28, 2021 [7 favorites]

Someone I know pointed out an interesting point in a research paper* saying that different practitioners trying to assess the same person would usually disagree about how to diagnose that person!
[...] ratings of the DSM-IV ADHD by a single observer have adequate test-retest reliability, but the concordance between 2 different raters is low-to-moderate for the overall diagnosis of the DSM-IV ADHD (mean agreement=45%) and all 3 subtypes (11-31%). These modest levels of inter-rater agreement indicate that different raters identify partly nonoverlapping samples of children, and that even when 2 raters agree than an individual meets criteria for ADHD, their ratings frequently place the individual in different subtype groups.
My acquaintance noted: "If you ever needed strong evidence that you should seek a second/third opinion if you're not happy with your diagnosis, this is it..."

But this paper is from 2012; I don't know whether practitioners (in the US or worldwide) have gotten more consistent since then.

* A 2012 paper: "The Prevalence of DSM-IV Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review" by Erik G. Willcutt (PDF, 10 pages). Quote starts on the second page, in "Diagnostic Algorithms Used by Studies Included in the Meta-Analysis".
posted by brainwane at 2:50 AM on July 28, 2021 [3 favorites]

Some more discussion and a research link in a new thread.
posted by brainwane at 9:51 AM on July 28, 2021

"Many tasks felt so hard to navigate that I seldom finished them. I tried to organize my life around not having to do them."

He says this like it's a bad thing. In a way, I think having executive function difficulties has given me a healthier outlook on the value of doing some things less or not at all.

Obviously this depends on the task but I think the world would be improved if we gave more thought to whether something ought to be done rather than doing it just because it can be done. How many environmentally destructive behaviors (e.g., maintaining lawns with chemicals and burning gas) and harmful to people behaviors (e.g., accumulating more wealth than any person needs) do we do simply because society tells us we ought to do them and we consider them possible for us?

This isn't to denigrate getting tested and getting treatment — I've done both and found them valuable. But others have mentioned that there can be advantages to having a mind with ADD or executive function difficulties, and in my case I think it's given me a healthier perspective on "should we even be doing this?" questins.
posted by Tehhund at 1:43 PM on July 28, 2021 [6 favorites]

Today I'm taking my kid for testing and I am weirdly nervous. I'm scattered as hell because we just moved, they share time with me and my ex so who knows where paperwork is, and I know it isn't reflected very well in their report cards. They behave well, mostly do homework, but as time goes on at school it's harder and harder for that to be maintained. And there is so much of it relying on us as parents, particularly whoever is primary caregiver. I am exhausted myself right now, and we were just talking about masking and behaviour yesterday. But I don't want to sit somewhere and be told that all the things I recognise and see in my kid are normal because report cards, because those obscure the routines and schedules and other workarounds we employ all the time. They don't show their time blindness and distraction, the hyperfocus, the whole of it. Because it feels like every bit of willpower and focus is spent on school and at home it's nine reminders of the same routine we have had for six years, the constant piles of belongings, the blank stares because they are wiped out from everything else. It's having rubbish bins in every room and reminders on all the phones, and multiples of everything. It's all the techniques I learned dealing with their dad, or my own versions of those things, and sometimes it doesn't work and I'm sitting here scouring Facebook and my emails to try and fill out a form, the night and morning before the appointment. It's watching my kid in tears because they try so hard and forget the things that are important to them, or break things, or just don't understand why it happens. And the latter happens less because we talk about executive function and probable ADHD, and all those things so they don't internalise it into "I'm lazy" or things like that.
posted by geek anachronism at 2:22 PM on July 28, 2021 [3 favorites]

He says this like it's a bad thing. In a way, I think having executive function difficulties has given me a healthier outlook on the value of doing some things less or not at all.

This is a valuable insight. As a kid in school I used to marvel at how organized and "together" some of the kids were. How their wardrobe was always on point, how their hair always looked nice, how they knew what was "in" and what was "out", what was relevant and what was not.

It turns out the way they do it is by spending gobs of time on being organized, making sure their wardrobe is always on point, et cetera. And it turns out that if I put in comparable amounts of time I get pretty similar results. Medication (stimulants) and/or meditation do help. But then I don't get to do a lot of other things, and indeed it's all too easy to be snared by the lure of Being An Organized Person and get nothing done, except the getting done of things, which feels like forever fending off arrows.

Just having that knowledge is itself a useful skill. Life is a lot of work for the best of us, it's not always easy. But it doesn't have to be always hard. If it feels like all you're doing is fending off arrows all day every day, consider taking cover.
posted by dmh at 3:09 AM on July 29, 2021 [2 favorites]

I need to get organised and checked for this with my doctor. Had a psychiatrist suggest I might have ADHD, so it's not as if I've not had the hints before.

General question around coping strategies. Does anyone else deliberately do something deliberately mildly distracting while working? If I put an audiobook or movie on in the background, then I know that's going to draw my distracted attention and I can keep working, rather than ending up on Metafilter or something.
posted by MattWPBS at 4:48 AM on July 30, 2021 [3 favorites]

Man, back to wondering if I should try meds.

I spent two years waffling about trying antidepressants and was terrified of the side effects, but actually there haven't been any noticeable ones and meanwhile the uncontrollable sobbing and suicidal thoughts are both gone.

The psychiatrist agreed I probably have ADHD and once the noise from the depression went down we could discuss whether I should also try medicating the ADHD as well.

With depression, sometimes I had better days, and I'd be like "haha actually I'm fine proof I don't need meds" and then I'd have a bad day and be like "hmm actually maybe this isn't normal". The same pattern is showing up with the ADHD. Some days I am a MACHINE of PRODUCTIVITY who can do EVERYTHING. and then a week will go by in which I can barely focus on anything at work and every simple activity is just an insane, overwhelming effort. And it's like, maybe it doesn't have to be this way?
posted by Cozybee at 5:28 AM on July 30, 2021 [1 favorite]

>General question around coping strategies. Does anyone else deliberately do something deliberately mildly distracting while working? If I put an audiobook or movie on in the background, then I know that's going to draw my distracted attention and I can keep working, rather than ending up on Metafilter or something.

Oh yeah for sure.
posted by Cozybee at 5:28 AM on July 30, 2021 [2 favorites]

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