
Ask HN: If you have ADHD, what are your strategies to deal with it? - anon_ADD
I am a developer at a small company.  I suffer from ADHD and it has started to take its toll.  The trouble is unless the problem is interesting, I am unable to maintain focus for more than 20 mins.  Subsequently, I spend a lot of time in HN,Slashdot, reddit etc.  I have managed to meet deadlines(by pulling all nighters before the deadline) but I know I could have done a better job had I started earlier.  The other side effect of procrastination and inattention is my family life suffers.  I am constantly anxious about work not done at home and my wife hates it. Drugs(Ritalin etc) do not work for me as I do not tolerate the side effects well(cannot sleep at all). While I am going to give drugs another try,  I was wondering if there were others developers who had ADD and what their strategies were to deal with the situation.
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cgshaw
Controlling my ADHD became much easier once I figured out the science behind
what was causing it. I was "diagnosed" as a young child, but my parents didn't
"believe it" and it shaped my youth. I was a bright kid, but a terrible
student, impulsive and had trouble with organization, finishing things, etc.

It's worth noting that ADHD has a huge co-morbidity with other diagnoses, bi-
polar, depression, manic depressive, anxiety, etc. Often times if you treat
the other condition it can help the ADHD and vice-versa. More than anything
it's trial and error. It took me probably 18 months to really figure out what
works best and I'm still not great at totally controlling it.

I started with therapy and drugs. I've taken ritalin and adderall. Between
those two drugs, I tried many different variations in dosing. The best for me
was a 10mg XR in the morning and 2.5 mg IR in the afternoon. Without the IR
I'd get a bitch of a headache in the afternoon / evening.

On the regimen I got the best grades of my life. I was in the Top 10% of my
law school class that semester. But I felt like shit. My eye twitched, I was
constantly thirsty, my skin was really dry it was weird. So I took another
course. I started meditation and working out. I have worked out a lot before,
but I went to more of an aerobic based workout after I read the books below.

It's kind of hard to get legitimate insight on this. Folks don't like telling
their story. Feel free to email me if you want. I'll try to update this as the
thread goes.

1\. Spark the science of exercise by John Ratey (great read by someone who has
ADHD) 2\. Driven To Distraction : Recognizing and Coping with Attention
Deficit Disorder from Childhood Through Adulthood by Ed Hallowell and John
Ratey.

~~~
anon_ADD
Thanks a lot. I will get the books and see what they say. The biggest hurdle I
have is there is no easy way of diagnosing other symptoms you mention. I find
that I know more than my doctor about this condition and the internet is a far
better resource of information than him.

On a side note, I think one of my sons inherited my genes and has the same
problem. He is young enough that bad organization, not finishing things etc is
not causing him problems yet. But I expect that to change once he goes to the
elementary school. What are your thoughts on giving ADD drugs to children?
Would it have helped you if were on a drug regimen when you were young? I am
scared of giving him drugs because of the side effects you mention(I get most
of what you get plus the extreme insomnia). But if it is going to help his
quality of life and learning, it might be a worthwhile thing.

~~~
cgshaw
ADHD is highly hereditary. My mom's hyperactive and my dad's passive, it
manifests in entirely different ways. I had some major insomnia as well, but
that's been an ongoing battle. I knew WAY more about ADHD than the two
different docs I saw. Primarily because I had a breakdown and read dozens of
books on it before I realized I really needed help. I was working for a big
law firm over the summer and just lost it. I had trouble working a lot in a
mundane job I didn't like and I struggled big time. The most important thing
is to find ways to do what you like. I can remember times where I'd slept 10
hours and woke up to read for class and fell right back asleep. You
subconscious is a pain in the ass and when you have ADHD it can be nearly
impossible to force yourself to do things you don't want to do. The only
reason I was able to titrate my meds and play around with the dosage a lot was
because I was very articulate with my doctors. I would explain what I read,
how I felt, why I wanted to try different things and they were supportive.

Far and away the best treatment for insomnia was to workout--hard. That's what
Ratey's book is about. Not the vanity like I'm going to try to get jacked
workout, but stressing out your body to the point where it focuses on
rebuilding your body so your brain is forced to relax.

I've often thought about how I'd raise my own kids (married, but no kids yet).
I think I would let me kids fucking explore and play with them a ton. It's
hard being a square peg and fitting in the round hole of compulsory education,
but there has to be a better way than just letting him/her flounder like my
parents were forced to with me. (Not by choice, they just didn't know better
the information available on the brain and psychology is about 1,000 times
better than 10 years ago).

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sachitgupta
I don't know if I have ADD / ADHD; but I find it hard to concentrate for a
long time. I think the biggest thing I did was accepting that I suck at
dealing with distractions and don't have much willpower when dealing with
them.

So - I put in artificial barriers in my environment. I keep my room and desk
clean so there's nothing to distract me. I installed LeechBlock on Firefox to
block twitter, facebook, and all the other sites that distract me for the
whole day except 8-10 pm (I should do this on my office computer too!). Every
night - I make a list of what I need to get done and the next day I write down
if I was productive or not.

All in all, cultivating the awareness that I suck at time management and
inserting artificial barriers in my environment has helped me a lot! Good
Luck!

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JabavuAdams
Get enough sleep. Sleep deprivation has a profound effect on one's ability to
focus and to rationalize excuses for not focusing.

Interesting data point: the most disciplined worker I've ever seen -- someone
who can hit 15 min deadlines for knowledge work -- ends up surfing if she
doesn't get enough sleep.

Consequently, she's fanatical about going to bed at the correct time.

It's something I'm trying to work on, but I think I'm basically addicted to
sleep deprivation after about 20 years.

~~~
anon_ADD
When I am in a deprived of sleep, I can barely focus on anything straight.
That is why I stopped the drugs because it was killing my sleep. The issue is
I am unable to focus when I have had a good 8 hours of sleep. I end up
focusing on fringe but interesting problems while losing sight of the
important ones.

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theflubba
Try blocking all distractions. Auto-hide the dock in OSX, get rids of tabs,
block reddit, HN, facebook in /etc/hosts, sign out of instant messengers. If
you notice any other distractions, write them down as they occur. Drugs do
help, so ask yourself if the insomnia is worth it.

~~~
anon_ADD
Thanks. I have been blocking all the sites at work in the hosts file. I like
the idea of writing down the distractions. Last time I tried the drugs, the
consistent insomnia just made me a zombie. It was great for the first two
days, but after that I just crashed. Also, I am not sure what the long term
effects are. Still, I am going to give it another shot.

~~~
theflubba
You should. After a week or so you won't have trouble sleeping (maybe you're
dosing too late in the day?), but I'm always on the lookout for improving
without drugs, although I've pretty much come to the conclusion that getting
things done is a matter of just sitting down and just doing it, no methods or
apps needed. After 5-10 minutes of doing something, you're closer to "flow",
which you've probably read about on HN.

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pb-add
A few tips. Not solutions, but touchpoints:

Assess your health. An injury left me with a lot of nasal congestion and
discomfort. This severely limited my focus compared to prior. Allergies, etc.
can be similar. Regarding this, I've become increasingly convinced that many
psychological and psychiatric diagnoses are diagnoses of symptoms stemming
from underlying physical problems. And our (U.S., at least) fractured medical
system means that the underlying causes can easily go undiagnosed especially
with regard to these cognitive impacts. (The poster child for this might be
sleep apnea; at least it now finally has mainstream recognition.)

Environmental sensitivity. I have an extremely difficult time tuning out
surrounding activity -- particularly human activity. Conversations, people
fluttering about in my peripheral vision, etc., destroy my concentration.
Assess your workspace(s), the variations in their activity levels, and any
corresponding variations in your productivity.

With peace and quiet, after an hour or two I could (sometimes still can)
achieve what at least in the AD(H)D domain is sometimes termed "hyperfocus".
Once "in the zone", I could _really_ concentrate, and I could then achieve not
just more volume of work in a given amount of time, but also a depth of
insight and analysis that others often just couldn't achieve.

If it's noisy and disruptive, though: Fergetaboutit. Sometimes, once in the
zone my focus would become so intense that surrounding disruptions would
simply fade out of my awareness. Not always, though, and it is something I
could not / cannot control.

I should add that I do _not_ have difficulty interacting with people.
Actually, most people seem to rather like working with me. Being around them
is just fine, when we actually are working together. But when I need to do
something they are not an active part of, their presence can be very
distracting.

Medications. Turns out, I'm rather sensitive to these (I'm just a sensitive
guy, I guess; I suppose that explains my meager dating life ;-). Many
psychiatrists have no concept of this. St John's Wort helped me some (though
not necessarily for ADD symptoms; in fact, I sometimes wonder whether it makes
them a tad worse for me). Zoloft and its many siblings and cousins made me
much, much worse. More recently, I've run across some descriptions of what is
called "serotonin poisoning" -- too much serotonin. My symptoms on
typical/standard doses of e.g. SSRI's fit this to a T; yet, despite describing
these symptoms to the prescribing psychiatrist (to be clear, not just a
physician), this condition was never even raised by them as a possibility.

Eventually, I learned of a psychologist with a psychiatrist wife, whose
profile seemed rather similar to mine. And he had found that one rather low
dose of Adderall in the morning was all he needed. I tried that -- after
finally finding a psychiatrist who was willing to consider its use concurrent
with St. John's Wort -- and, after finding even 5 mg too much, settled on 2.5
mg. My difference being that I'll typically take 2 doses 6 hours apart (the
effective life of many drug doses, for me).

I'm not saying you fit this profile. But there are elements that may be of use
in considering. And be aware that, at least in my experience, there are a lot
of "professionals" out there who won't have the first idea about really
helping you.

That doesn't mean you shouldn't try. But keep your sense of self, self-
respect, and the old bullshit meter set to "High".

One final thing regarding medications. About... 7 or 8 years ago,
psychiatrists started pushing low doses of anti-psychotics for (initially, at
least) off-label treatment for a broad range of other conditions, including
AD(H)D. Well, it turns out that at least one factor in that was a push by drug
companies to develop new markets for these drugs. IIRC, in particular Johnson
& Johnson ended up settling with one or another government agency for an
amount in the many millions of dollars, for what was determined to be mis-
represention and violation of regulations in this regard.

If someone starts trying to sell you on the idea of Risperdal or one of its
many siblings and cousins, I'd consider very carefully and insist on a very
detailed argument for this, before proceeding. The lower doses are supposedly
safer, but these classes of drugs are -- in my limited layman's understanding
-- not something to take lightly, as it were.

Actually, one more thing, I guess, about medications: For Adderall, at least,
there apparently are differences between the brand drug and generics, and
there are -- in my anecdotal experience -- definitely differences between the
different generics. I experienced the latter unexpectedly when my pharmacy
changed suppliers in their stocking of a generic equivalent. It was not a
pleasant experience.

As I say, it was for me completely unexpected. Only after having the initial
experience did I google around and learn that I was not alone in it.

A final postscript: Heavy, daily exercise also helped me. Unfortunately, a bad
leg injury subsequently quite severely limited this for me. But I'd recommend
it, if and as you can.

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Loginid
First off, don't beat yourself up - 20 min is good. Just make sure that 20 min
work periods are punctuated with 5 min break periods.

I have ADD (not ADHD), but here is what works for me.

1\. Drugs - After much resistance to the idea as well as near exhaustive
experimentation with alternative therapies, I tried Concerta and was amazed at
the results. On the night of my first dose I had what felt like the best sleep
of my life.

2\. Awareness and understanding of the symptoms - If you are like me, you are
not procrastinating because you lack focus -- you are procrastinating to
achieve focus. You are effectively self-medicating with adrenaline. The
resultant constant anxiety about both not working and upsetting your wife
keeps you sharp as well. You still are going to need the 'fix', but strive to
get them from either drugs, or different behaviors.

The solution for me was to strategically fill all of my 'free-time'. It sounds
like you have a wife and kids, so this should be easy. Lean into being a good
husband and father. Block out dedicated family time where you are focusing on
them and not stray thoughts about work. It is the 'limbo' state where you are
present at home but thinking about something else that is the killer.

Make sure that this time is centered around an activity - not TV/Computer.
Cooking. Washing dishes. Doing Laundry. Playing with the kids (for real).
Painting the guest room.

This does 2 things: it keeps your family happy, and leaves you just enough
time to cram in work when it is time to work. Too much time on any one task
will put you in 'limbo'. I'm sure that your problem isn't just at work, I'm
willing to bet that you are not making a habit of being present in the moment.
Off hours practice being present at home will only help things.

Also, it sounds like you know that boring problems make you procrastinate. It
may be worth looking into ways to make boring problems interesting...

3\. Administrative Pre-Planning - I know that trying to work around anything
that could derail my attention is not going to work. The solution is really as
simple as removing the possibility for those distractions to occur.

Seriously - Restrict your internet access with site-blocking , headphones to
keep co-workers away (even without music - I can't listen to music / TV when I
am trying to work). Whatever your triggers for 'limbo' are, acknowledge them
and make sure that you have no chance of being exposed. Not ever.

4\. Unwavering Planned Routine - This doesn't work without #2 and #3. I could
never stick to routines because I needed the rush that I got from a chaotic
lifestyle. When you turn it around, you can get almost the same rush by being
optimally effective at any one time. You can race the clock for your fix. If
you have to decide at any given time what to be optimally effective at, you
will deliberate and go into 'limbo'. Pre-planned routine is a good way of
overcoming the impulsivity and reduced long-term executive-cognition that is
characteristic of the condition.

~~~
anon_ADD
Thanks for response. I realize the too much time problem. I will try the
strategy of filling in all my free time. I have blocked of all the sites in
the hosts file. I do find myself instinctively clicking the browser, but I
seeing blank pages snaps me out of the procrastination mode. I idea of
preplanned routine makes sense too.

How long have you used the drugs? Do you suffer any serious effects?

How long you been on drugs? Do you s

~~~
Loginid
I am 'middle aged' (oh, God...) and have a wife and two young kids. I first
had someone mention to me that I might be ADD this past April/May. After a
bunch of research, I convinced myself that it might be true. Iwas officially
diagnosed in August and have been on drugs since then. So it is early days for
me...

The plan for me is to use the drugs long enough to cement behaviors that help
me manage the condition within my current situation. For most of my life, I
haven't had a 'straight-job', a marriage and two kids to raise. I structured
everything so that I could basically do anything that I wanted, whenever I
wanted. Now that I have to manage having family and a job (at least job in the
short term), I need to have some way of maintaining consistent behavior. Right
now the drugs are working for my situation.

I know the thinking-difference that this condition brings is a comparative
advantage to others. I am way more creative, and much better at solving
problems than others are. I just kind of suck at being reliable right now.

Personally, I have no side effects that I notice (none at all) with correct
dosing and control of my behavior.

Within the first few days of being on Concerta, I had a stressful rush-job on
one of my files at work and slipped into my 'work-zone' behavior (my main
symptom is overfocus). The combination of the new drugs, and the adrenaline /
anxiety was a strange sensation, probably what most experience when being on
amphetamines. I just don't put myself in that situation anymore.

Other than that, I've nothing to report.

You might consider that it was not the drugs alone that were keeping you
awake. You may have a great deal of latent anxiety that only becomes a problem
once you 'wake your frontal lobe up'. That anxiety is what I used to stay
sharp before drugs. Maybe massage or meditation would help you get to sleep
when you start on the drugs.

I do not claim to be an authority on the research, but I believe that the
statistics are that more people die from using Asprin every year than medical
stimulants (not that death should be the only measure).

There is evidence supporting good outcomes for the medical use of stimulants
dating as far back as the 1930's - longer than any other class of drugs. The
medical consensus is that they are safe.

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hasenj
eh, I don't know if ADD/ADHD are real "disorders" or just personality
temperaments.

I know I can't get in the zone right when I wake up, I have to first satisfy
some other basic needs like food and human interaction. I'm not a robot.

That, and sleeping well.

Basically my advice for tacking this problem, and what I've been doing for a
while (and seems to be working for me) is to not start any coding or working
until after several hours from waking up. Maybe even half way through my day.

