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ADHD is a horribly misnamed condition. It's caused by a delay in the development of the frontal cortex which puts people about 30% behind their peers in many higher order cognitive functions.

If depression is like the flu, ADHD is like missing a leg. You can't regrow or cure a missing leg, all you can do is use a prosthesis -- for ADHD stimulants are the prosthesis for the missing development of the higher order brain functions.

ADHD is a serious impairment to normal cognitive functioning. However everything a person with ADHD experience is a part of everyone's ordinary rational expectations: things forgotten, things missing, a lack of motivation, difficulty focusing, emotional dis-regulation, lack of social awareness. And that makes popular perception very difficult to correct -- because it isn't that these things happen, its that they happen to an extreme because of a significant neurological impairment.

I disagree with your missing leg metaphor (while agreeing with most else you wrote). I have raging ADHD, don't take medication, and do suffer from many of the cognitive impairments you describe, which are certainly disadvantageous. On the other hand I am way way better at some things than most other people - if left alone in the right conditions, I can hyperfocus and do great amounts of work or assimilate great quantities of information, I perform way better than other people in chaotic and emergent environments, and I am way better at coming up with novel solutions to problems or discovering connections between superficially disparate data points. In situations where normal people tire out easily, get overwhelmed by having too much going on, or get stuck in linear thinking patterns, I thrive because that's how my world is by default. That's one reason that a lot of people in film production have ADHD. Equally, it's why I hate post-production, because a lot of the time I'm understimulated and I get bored to distraction without constant realtime feedback from collaborators.

Incidentally I really con't like adderall much - it does work for me but I don't enjoy it and find the side effects annoying. As I said I don't take any medication, but I sure wish there was a safe legal way to dose small quantities of cocaine because that stuff works a treat and for me it's no more addictive than celery.

EDIT: I should clarify that I don't take medication at present, which goes back about 5 years. I did take a variety of prescription medications over the previous 10 years but was unhappy with the various side effects and never found a good long term fit.

> ... I perform way better than other people in chaotic and emergent environments ...

Yes! You can see more details in my other post: https://news.ycombinator.com/item?id=13188789

I dose myself based on what kinds of work I expect to be doing during the day.

I've always been an 'ops guy', though at the same time, I also write a lot of code. 'devops' before that name existed.

As a traditional 'ops guy', untreated ADHD is quite a nice characteristic to have, especially when shit's going down. It allows me to direct and redirect short bursts of hyper-focus, very rapidly.

In that state, it's hard to focus very long, but it's quite easy to context switch.

That's one of the advantages to my work schedule: I generally start working around 6am, way before most people are even awake, let alone working. So normally, during my first 4 hours at work, I write a lot of code. So I take my meds so their levels are highest then.

As people start coming in, I tend to switch modes, as I let the 'ADHD' take over.

In those rare cases where I had to manage a substantial incident while my meds were at a high level, I didn't perform as well.

During the 'heat of an incident', you don't want to go down any rabbit holes. You want to keep your eyes in a lot of places at once. But when I'm on my meds, I tend to be more 'depth first', instead of 'breath first', to use tree traversal as an analogy.

Honestly, I kind of consider my ADHD, plus meds that I can carefully control the dose of, as a kind of 'superpower'. (I mean, not really a SUPER power, but I mean as a nice advantage.)

I can relate very much to the depth vs breadth first as a metaphor to my working type when I'm on vs not on my meds.

The problem here, is in part I think, how poor people with ADHD are at assessing themselves. Autobiographical memory is very impaired, and often access to your internal emotional state and its relation to long term goals is quite weak.

So you do often find people with ADHD completely misjudging how good they are at tasks, compared to others, and so on.

I think you'll find many of the skills you rely on which give you this advantage, if you do in fact have an advantage, arent ADHD.

ADHD is a significant neurological impairment, and people with it are impaired in many higher order cognitive functions. These arent compensated for by divine intervention. ADHD isnt an alternative evolutionary pathway, nor is it part of the "healthy mixture" of society. And more than how good it is that we have some blind or otherwise disabled people around.

There really are disorders of the brain which constitute simple factual impairment, and to have this impairment improved upon enables the person to far more successfully achieve their own goals. ADHD is one such disorder: medication very often makes living the life you wish to live much easier.

It's perhaps a harsh reality, but it is reality. Significant cogantive impairment diminishes your ability to realise your own goals.

The popular mythology of the genius provided by mental ill health or disability is a pernicious one and is believed to the great detriment of many people. People with cognitive problems often cling to them in pathological ways, and this is especially common with ADHD people because they find it difficult to reflect over their life in the ways needed to realise the patterns of their difficulties.

I would strongly encourage every one with ADHD, or who think they might have it, to seek pharmacological help asap. Many of the symptoms can be greatly reduced with stimulants and they'll make realising your own goals much easier.

It looked to me like he described his hyper-focus and context switching as the advantage. ADHD causes both of those things. It looks to me like you imply that ADHD, as an impairment, can't cause an advantage in some situation. I disagree. People on the autistic spectrum, while undoubtedly also having abnormal brains, can process information in a way that others can't, sometimes giving them an advantage in 'cerebral' professions, while also possibly causing functional deficits in other contexts.

This feels to me like a one-size-fits-all reply, and dismissive of what looks like a valid and realistic self-assessment. "Significant cogantive impairment diminishes your ability to realise your own goals" doesn't hold true without context. A person may have a goal of not depending on medication, or choosing to view their state as a strength and building on their differences. Consider Stephen Hawking. I don't think he would have wished for his condition, but a friend of his once noted that when he got a book, he would remember what he saw, because he could not easily pull the book down again. If he didn't have physical impairments, he might have gone in other directions. He had to focus on a mental career. He took his position for one of strength and made the most of it.

I find your reply dismissive of this person's experience, reality, and values.

People with ADHD are incapable of making a "valid self assessment". It's a disorder of the specific faculties involved in being self-aware in the right sort of ways.

It's a very common phenomenon to encounter a person with ADHD who insists their life us going well but who are being fired every month.

We're talking about serious cognitive impairments not 'differneces' it's reckless to encourage people with this condition to avoid seeking help.

I'd argue that the ability to make a "valid self assessment" is missing from every person on the planet. We can only use the tools available to us, i.e. track our workflow against our peers, our performance in academia, etc.

I agree that we shouldn't encourage people to not seek help, that's no good. But people with the disease sharing how they can leverage it to their advantage can help.

Yes, but that's very unlikely to be the case. There are pop books out their peddling the idea that ADHD provides different advantages -- it's perverse and entirely non-clinical. No one is writing books about the wonders of blindness, or missing a limb -- because physical impairments are so obviously, on the whole, impairments even if we might imagine some circumstance they could be beneficial.

ADHD is a developmental delay in the frontal lobe which causes significant cognitive impairments, that far and away, on the whole cause havoc for people.

People with ADHD should not be encouraged to attribute their successes to their disorder, they are almost always due to unaffected cognitive skills -- NOT ones impaired by ADHD, or affected by stimulants. People with ADHD are often the worst at making this mistake which is why I wrote my initial reply -- because I am concerned for the writer of the comment that they are making this very mistake and that they should really be taking medication.

I can only speak to my own professional performance, as evidenced by people who have been paying me (quite well) to do various things for the past 25 years.

There are certain kinds of things I am better at when I'm not on my meds.

There are certain kinds of things I am better at when I am on my meds.

I'm not speaking for everyone, and I'm not encouraging people to not seek medical attention.

It's possible what I'm reporting is non-clinical, and I'll give you the benefit of the doubt and assume you're not speaking broadly when you use the word 'perverse'.

I am not down-voting your replies in this thread, but I understand why people are. You are using non-nuanced and absolutist language which won't be that effective in conveying your perspective.

I know very well (from personal experience and observing close acquaintances) that conditions like ADHD can, at times, make it very difficult to function in modern society.

But the fact that these traits are so widespread means they must have an evolutionary purpose.

And of course we can see that many highly talented and successful people are diagnosed with ADHD and related conditions, but are able to use their traits to great advantage.

Others cannot, but that's not because it's impossible, they just haven't been given the right support and opportunity to make best use of their natural cognitive preferences.

This is not at all to say that those diagnosed with ADHD shouldn't be given support, treatment or any other help they need to get by in life.

But the claim that ADHD isnt an alternative evolutionary pathway, nor is it part of the "healthy mixture" of society doesn't fit with accepted evolutionary theory, nor empirical evidence.

> But the fact that these traits are so widespread means it must have an evolutionary purpose.

No. The most you can say is that whatever causes it is not detrimental enough to reproduction (rate) to be actively selected out of the gene pool.

Objectively speaking, I agree with you.

I did read some material a few years ago outlining a way that ADHD could have been a real advantage, but I think that is still rather speculative.

True, it could be an advantage under $CIRCUMSTANCES, but there'd have to be some evidence other than "it hasn't been selected out of the gene pool" :).

It'd be worth your while to listen to the Sam Harris podcast with Eric Weinstein [1], who, on the theory that the propensity for religious belief is an evolutionary mistake that serves no useful purpose, makes the point (based in the research of his brother, Bret Weinstein, an evolutionary theorist who's spent two decades researching evolutionary tradeoffs [2]) that this trait is just so costly to human functioning that it would have been negatively selected out of the genome were it not to offer significant benefits in certain circumstances.

The same can be said for any other cognitive variances, including what we call ADHD, Autism Spectrum Disorders, Depression, Bipolar, etc.

And so we frequently see today, numerous people diagnosed with these conditions, experiencing severe challenges on the one hand but great benefits on the other - just consider the number of great artists and writers with ADHD or Bipolar, or inventors with ASDs.

So we don't need to theorise about whether or not these tendencies are sometimes beneficial, and whether they have been selected for in evolution; it's plain to see if you look around.

[1] https://www.samharris.org/podcast/item/faith-in-reason

[2] http://reinvent.net/innovator/bret-weinstein/

I'm not sure I can stand listening to another one of Harris' podcasts, but I'd be intrigued if you could explain what an economist+mathematician with some 'alternative' ToEs could teach us about ADHD. (I'm not dismissing it outright, but this definitely smells of woo, so please convince me to listen to that.)

Relax, I just thought you might find it interesting :)

But it's not necessary to prove the point, we can rely perfectly well on evidence and Occam's Razor for that:

- We can identify highly successful people who are confirmed or speculated to have (or have had) ADHD: Richard Branson, Ingvar Kamprad (Ikea founder), Nikolai Tesla, George Bernard Shaw, Jim Carrey, Walt Disney, Kurt Cobain, Robin Williams. Even if we aren't convinced that each of them exactly fit the ADHD diagnosis (which is inherently fuzzy anyway), we should be able to agree that they are/were all cognitively atypical in ways that are somewhat consistent with the conventional diagnosis of ADHD.

- In each of these people, we can see how their atypical qualities are/were integral to their talent and success, I.e. a rich imagination and enhanced creative capacity; being able to absorb and process many different ideas at once and mash them together to produce new concepts; being comfortable challenging conventional thinking and living outside mainstream norms; having the charisma to communicate new ideas to others and inspire action and change. We can also see significant downsides, most notably in Cobain and Williams who ultimately took their own lives, but anyone with these kinds of conditions will report significant difficulties, which is not surprising; in nature, every benefit comes at a cost.

- We can easily imagine how these qualities would have been beneficial throughout evolutionary history, and how it would always have been beneficial to any society or tribe for a minority of the population to have carried these traits, in order to find new solutions to problems, to invent new systems and technologies, and to break down outmoded traditions and practices to make way for the new.

By your reasoning, ADHD only confers a cost on its carriers, but not one that is severe enough to be selected out of the gene pool. I.e., ADHD is a genetic accident that has continued to be maintained in the gene pool despite having a great cost to the fitness of those who have carried it.

But the "genetic accident" theory doesn't survive Occam's Razor. In addition to it being unlikely to have survived and remained so widespread if it only imposed a cost against fitness, we just don't need to add it into the explanation when the explanation works perfectly well without it: that ADHD-like behaviour is beneficial in the right circumstances, and is necessary to exist in a minority of members of any tribe or society in order for it to survive and progress.

> In situations where normal people tire out easily, get overwhelmed by having too much going on, or get stuck in linear thinking patterns, I thrive because that's how my world is by default.

Huh, yeah that's exactly how I see it, as well. Too bad it's impossible to always be in those situations...

> I can hyperfocus and do great amounts of work or assimilate great quantities of information

As someone who has been medicated on and off, I can tell you that hyperfocus is not something that medication will switch off entirely.

It is merely that if you want to stop, you can, and you can train yourself not to hyperfocus on irrelevant things like video games, clicking through Reddit, writing blog articles that don't get posted, etc.

ADHD is all about being unable to properly tune your attention without taking what to other people would be considered heroic levels of effort.

I agree with pretty much all of this. It can be a benefit in certain situations. I kick ass at hackathons. I can dive into the middle of an unfamiliar code base and quickly get oriented and solve bugs that the other developers haven't been able to. I can solve interesting and complicated problems across many domains like few others can. The problem is, life isn't just a series of interesting and complicated problems. In fact, the vast majority of it is trivial and boring and dealing with trivial and boring things is exhausting.

I started taking medication in my mid-20s, despite having been diagnosed with ADHD around the age of 12. I also have been diagnosed with dysgraphia.

I think the effects of dysgraphia are much more akin to losing a limb than ADHD, but taking medication is honestly one of the most life-changing experiences of my life. I tried medication way back when, and the side effects were horrible. I didn't try them again until I was having trouble at work, and I visited a psych for a doctors note requesting some mild accommodations related to my dysgraphia. I had avoided medication because until that point I was sure I could do anything else anyone else could, and I was afraid it would fundamentally change who I was.

That fear was largely unfounded. Some medications give me side effects, and some make me feel like I'm not myself. Eventually I found the right medication and dosage. After about a month on that medication, I looked at what I had accomplished and I was so overwhelmed with emotion I honestly cried. I had been making life so unnecessarily hard for myself, and I had been so hard on myself. Like, I cannot believe how much easier everything is. I feel like I used to get everywhere by running in molasses, and then someone told me about highways and cars.

The thing about medications is that they don't turn your life around for you. They basically give you the power to control your life.

Maybe there isn't a medication out there for you. Honestly, a huge part for me was finding the right doctor. He is one the few docs I've ever met who specializes in adult ADHD, and he's really fucking sharp. I don't actually like our meetings very much, cause he's not much of a conversationalist and is pretty gruff, but he knows his shit. He's willing to write prescriptions that most doctors won't write because the dosages are too abuseable or whatever. (And his other specialty is addiction, so he definitely has a view on that).

For instance, I tried Ritalin, and I hated it. I just felt angry the entire day I was on it. I was suddenly aware that I should be concentrate, but I couldn't concentrate at all. Instead of spending several months titrating me up on Adderall, he just gave me a pretty high dose, since my reaction basically indicated my ADHD wasn't going to respond to lower levels. Adderall helped, but the side effects were miserable. I felt like I wasn't myself using it, almost like a zombie. I felt like I couldn't change gears at all.

Anyways, long story short, I found Evekeo actually worked best for me. Adderall is 25% levoamphetamines, and 75% dextroamphetamines. Evekeo is 50/50 levo/dextro. My basic understanding is that Levoamphetamines affect the rest of the body, whereas dextroamphetamines mostly affect the head. For this reason, the DEA has typically felt that l-amp has less clinical value and is more abusable, but the difference between Evekeo and Adderall is night and day for me. I actually feel like myself. Now, I have never taken cocaine, so I can't tell you how it compares, but if you feel like adderall takes away your ability to do all of those things you listed as benefits, I'd say that Evekeo is worth a shot.

I can relate to wanting to truck it out though. After my second consultation, my doctor said he was amazed by all the achievements I have in my life, given the degree to which I am ADHD. His assessment was that I must be one of the most overwhelmingly stubborn people on the face of the planet. I never have thought as myself as a stubborn person, but my family and closest friends would definitely agree with that statement. I think that stubbornness is what prevented me from seeking help earlier, but also what motivated me to keep going.

From what I've gathered over the years, dextro-amp is primarily responsible for focus, attention, and (potentially) euphoria while levo-amp is primarily responsible for peripheral effects like anxiety, jitters, and other "body-centric" things.

As a result, I've always understood d-amp to be considered more abusable and part of the reason for the mix in Adderall and generic equivalents (although it's also allegedly a better mix for treating most ADD/ADHD).

It's why you can get Adderall if you're diagnosed with these disorders but it's rare to see anyone prescribe Dexedrine (which is just d-amp). Abuse potential is higher and also l-amp lasts longer so the mix may be seen as more effective overall as a pill you take once or maybe twice a day.

Never heard of Evekeo though.

As a side note, it seems a lot of ADD/ADHD sufferers should be diagnosed with (instead of or also including) ODD or an executive functioning disorder.

Our brains, largely, are badly designed. And it sucks, especially with the HN crowd, we'd all be ten times more productive if we didn't all suffer from the same shit.

For readers, ODD == Oppositional Defiant Disorder.

Basically ADHD is just a symptom checklist, what causes it also causes a whole variety of other stuff not included in the same checklist for somewhat @political" reasons.

In particular ODD means being reflexively and exaggeratedly defiant and hostile to authority. Possibly because its associated with external demands that are inherently difficult to meet (because of the ADHD part) and so quite tortuous and frustrating.

What's remarkable is that the oppositional characteriststs associated wiith ADHD are significantly helped by stimulants. Which doesnt make any sense, if the oppositionality were some personality characteristic. It arises due to the very same cognative impairments.

> causes a whole variety of other stuff not included in the same checklist for somewhat @political" reasons

Like what?

I have ADHD. I tend to notice that other people I know, who also have ADHD, tend to have a lot of other "not normally associated with ADHD" things in common with me. But I don't know which are true correlations, and which are just pareidolia on my part.

Stimulants work because ADHD brains have whacked out dopamine regulation. Stimulants help smooth out the peaks and valleys associated with ADHD. Hyperfocus = overstimulated by dopamine, inattentiveness = understimulated. Taking a stimulate provides a consistent baseline level to help reduce the extremes.

Stimulants work because they activate the underperforming portions of the prefrontal cortex related to attention management.

Chalking it up to dopamine is a gross simplification.

Adderal, for example, stimulates the release / reduces the re-uptake of dopamine, norepinephrine, epinephrine, serotonin, histamine, and CART peptides.

This is the first time I've heard of ODD. To be honest it seems almost comical that defiance of authority has its own medical diagnosis as a disorder.

According to ODD, every pioneer in human rights (I.e. Susan Anthony, Thomas Jefferson, MLK, Jesus) should be regarded as mentally ill and drugged into submission.

The symptoms of the disease don't necessarily translate to having the disease. Not everyone that is sad has clinical depression, not everyone that is obese suffers from glandular disorders. Etc.

Not every problem a guy has with his girlfriend is necessarily caused by the capitalist mode of production.

It's not a generic "defiance to authority", as I understand it's more like anyone trying to exert any kind of authority over you is bound to generate a kneejerk negative reaction, big issue or small, reasonable or not. Could be a parent, supervisor, partner, teacher, cop, etc. ODD is not related to an actual battle against your oppressors.

ADHD /is/ classified as an executive dysfunction (specifically, in regulating attention).

Autism spectrum, schizophrenia, depression, and parkinson's disease are other well known disorders classified as an executive dysfunction.

ODD ("a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months") is not at all the same thing.

Badly designed for what? Coding CRUD apps?

This is a real question, not rhetorical: Does ADHD exist in similar numbers in societies that are less sedentary?

Is this "30% deficit" (citation needed) conquerable by training and meditation?

It wasn't for me. It may be for some.

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