It reminds me that ADHD is really not that useful of a name, executive function disorder would be a more accurate name from when I was looking into ADHD in the past. It's not about attention deficit per se, as that's downstream of struggling with executive functioning. At least it's the definition that lines up with my experience best (I have ADHD). I'll make lists in order to keep track of important tasks (which in theory would help with attention deficit) but then I'll sit down to do the things on the list and... can't. It's such a hard thing to explain, but no amount of attention hacks can get me over the hump of doing the tasks I'm dreading. That seems much more related to executive functioning.
For me it’s that as soon as I intend to begin a task, I start thinking about every step, and everything that might go wrong at every step, and planning contingencies for every hypothetical problem, and on and on.
So suddenly the task seems totally overwhelming, when I could just… not do it. So I find a time later I can attempt it and after a few times it is no longer novel and I forget about it.
If anything is hyper-active, it’s the executive function part of my brain that is driven to plan out every tiny, hypothetical detail before I can start.
What’s missing is the reward and internal incentives for doing things when there are other things that do feel good to do (that aren’t what I need to do).
I'm the same way and I've found there's no real way around it. I've found it's actually a really useful way of thinking for complex projects and planning and prioritization, but bad for getting things done. The only things that work for me to manage this:
1. Relentlessly make distractions high friction. Block websites, go to the office if you get distracted at home, etc.
2. Use time-based daily planning instead of goal-based (stuff like pomodoro helps). If I put "create work plan for project Z" on my to-do list, it is ambiguous and I will put it off forever. If I just say "Spend 25 minutes on work plan for project Z, no pressure on outcome/output", I make tons of progress (and often can continue the task for a while)
I, too, experience that. I am anxious and I overthink and I am avoidant. Vyvanse helped a ton, but it was producing health complications, so I am taking something else that's not as good.
It's not a substitue for counseling, but consider talking to your favorite LLM chatbot. It will provide generic advice, but it will probably work 80% of the time. Sometimes being told what to do is good enough of a kickstart.
Or I can give you the crappy advice that works. "Just start."
Look up "mental rehearsals" I think it's called. You do like 2 dry runs in your head. First, you let your mind kind of do what you're already doing, imagine obstacles and challenges along the path to completion. Second, try your hardest to picture yourself calmly overcoming each of those obstacles through to completion. It makes it seem more attainable.
This is a great insight, I wonder if that's a sign of Innatentive type ADHD. But I would say that the process of thinking of other things that also need to be done, is not done by the executive function part of the brain. The executive disfunction is the decision not to begin the task.
I experience the same thing very frequently. I likened it to activation energy in a reaction, that no matter what I did I couldn't create the required electrochemical bias in my brain needed to put ideas into action. It's like being stranded in your own mind, you know what you need to do, but the 'go' just never arrives.
I eventually discovered that the adrenaline response from extreme stress ('if I don't get this fucking thing done by 7:30am I'm fired' kind of thing) allows me to lock in and do the thing.
>I eventually discovered that the adrenaline response from extreme stress ('if I don't get this fucking thing done by 7:30am I'm fired' kind of thing) allows me to lock in and do the thing.
I went the other way. I knew from the start that this "trick" helped me work. It took until my 30s to learn that that's ADHD and that I can skip the stress with medication. God knows how many years of life I've robbed myself of with the stress spikes.
For me, the side effects of the medication are intolerable. I wish there was a way to get that starting impulse without stimulants or SNRIs which kill my libido
If it helps, another trick I used to use was external help. As in, calling a colleague and starting in pair programming or simply discussing or whatever. Having eyes on me had the same effect as the looming deadline without the stress.
You have to learn to be super trigger happy with it, otherwise you fall in the trap of 'I've been inactive for too long, I can't call and reveal that I haven't started'.
A phrase I've heard is to "put it into existence."
By sharing the idea with somebody else, even just communicating your intention, it becomes partially reified, better-anchored to things outside yourself.
Yes, I agree, I'm lucky that legality was never a concern.
I'm covered by public healthcare so access to medication is stable and costs literal cents. My only complain is that ADHD is not at all known here so it took time and luck to get a diagnosis, because the possibility wasn't in my radar.
It was a surprise to visit London recently and see the amount of ADHD-related ads everywhere (books,clinics, etc).
>interesting. the meds help me in many ways, but often I still need that activation energy to kick things off
Similar problem here. ADHD meds have different thresholds for allievation of ADHD symptoms and for negative effects.
Usually the bigger the dose, the more symptoms allievated, but the higher the chance of side effects.
In my specific case, methylphenidate had too much side effects, but was the one that helped the most with focus/task prioritization/task recall.
Lisdextroamphetamine on the other hand has much less side effects (sweating, emotional detachment), but doesn't help that much with task recall and prioritization. But still helps with anxiety, emotional deregulation (being too emotional, too fast, over non issues and taking long to calm down) and general focus/working memory.
Funny that people talk here about looking at ADHD more like executive function disorder. Because I first came upon that idea in Thomas E. Browns video seminars. And he wrote a book on that in 2005 - Attention Deficit Disorder: The Unfocused Mind in Children and Adults.
I actually used material from his book, Outside the Box: Rethinking ADD/ADHD in Children and Adults, to help get diagnosed. I already had one negative diagnosis behind me. And in that book Brown has a lot on clinical requirements for diagnosis) and how research data shows that it's wrong.
He also has books on high functioning ADHD+ASD, like Smart but Stuck and ADHD and Asperger Syndrome in Smart Kids and Adults: Twelve Stories of Struggle, Support, and Treatment. Tho the last two are more about using specific cases as examples of how you don't have to be "stupid" to have ADHD.
Because to quote the first diagnostician, "you sure do have a lot of ADHD symptoms, but I've never seen anybody with ADHD who has such high scores on the iq tests". Too bad that being good at guessing a pattern in a picture doesn't correspond to life success.
That wouldn't work (for me, at least). As soon as I figured out the pattern, I'd know I had a week after the 'deadline' and then the pressure is off until that week is passed/nearly up
That's been my experience with tricks. I'll think of some clever trick to work around my ADHD, and it'll work great for about two weeks. Then after that I'll start anticipating it and working around it. The self-defeating nature of ADHD might be one of the most frustrating things.
Everything is due NOW, seems to work best for me. Just a list to make empty, so I can sleep. Give me deadlines, or ask for estimates, and the task is doomed.
I use the same analogy explaining to people what my meds do. They’re a catalyst in that they lower the activation energy of doing anything other than doomscrolling
I've always considered it Too Much Attention Disorder.
The way I like to think about it is that neurotypical people have a beam of light shining out in front of them, wherever they turn their head the light shines and that's where their attention is. Nothing else distracts them from where the light is shining.
With ADHD (for me at least) it's like 50 beams of light scanning the entire room constantly for 'something'. This is too much attention to things that I'm not really interested in, but can distract me from anything I'm trying to do or wan't to do.
For things that I am really interested in (like writing code) the 50 beams of light all manage to synchronise and focus in the same place and that's hyperfocus.
Attention means an ability to ignore unimportant things. This is why the disorder is attention deficit - your ability to ignore distractions is diminished.
It's a confounding definition for me because of the inherent ambiguity, along the lines of a double negative. A disorder of ignoring, what does that tell us about what we attend to?
I often like to point out that we are completely blind to the most common thing around us, nitrogen gas. This blindness is good, because it allows us to attend to everything else, instead of stumbling around through a fog and over cliffs and into the maws of ambush predators.
While it's usually part of a rant about false color pictures in astronomy, it applies cognitively too. It's about the signal to noise ratio, and what constitutes signal versus noise can change in an instant.
Yea, ADHD attention is a like targeting system that has only one setting - it's constantly seeking the most stimulating activity nearby and never stops - sometimes the most engaging feeling activity even changes from minute to minute.
But the hyper-focus can be magical when it targets the task you need to do!
Indeed, I wouldn’t give up hyperfocus for anything. When it kicks in, it genuinely feels like a super power. It’s pretty much given me a career; but also just pure enjoyment from creating and making.
I find similar behaviour in myself, particularly that dreading a task makes it significantly more difficult to start. I find that if I can manage to do just a little bit, even just open the application and maybe look around a bit at what I need to do, it really gets the momentum going for me.
Do you think there's anything that differentiates what we might call "general task dread" that perhaps anyone experiences to a certain degree from a more broad executive function disorder? Or is it that dreading leading to task paralysis is one of many symptoms of an executive function disorder?
How are you for task completion? For me, transferring a load of laundry from the washer to dryer is not an atomic operation. There is ample room to get derailed and wander off during the twenty seconds it should take. It can be interrupted by almost anything. Oh, I forgot to send that message. Oh, I forgot to check for the parcel. Oh, I need to go to the store today still. And I will walk away and forget to come back and finish.
Pretty good. I don't find I get derailed by other tasks but I do find others related to what I'm doing like "Oh, dishwasher's done, let's empty it, but oh wait let's clean the counter first" and then end up cleaning the sink and emptying the garbage as well
I think the frequency and level of impairment is what differentiates normal executive dysfunction from an executive functioning disorder.
Perhaps a bit rhetorical, but how often does this task dread occur? Does it also ever occur for things you want to do, not just obligated to do?
For me, I experience this issue for many tasks everyday. Then again, I have never had a normal executive functioning, so I cannot claim to know what it is like for normies.
I’ll also add that ADHD is more than just executive dysfunction too.
I'm really bad at it for things that aren't novel or really interesting, especially repetitive tasks, like doing illustrations for a customer for example, I know what to do, I've done it hundreds of times, but I'd just rather be doing something else. It does also happen for things I want to do but only usually if it's something I'm not confident about. Like I want to do a really comprehensive gardening setup this year, I've done all the research and planning, I just have no experience sewing seeds or growing vines, or how to setup indoor seed hatching, and I'm just dreading the whole starting process and have put it off too long- I should've started mid-April.
In my mental model of ADHD, executive functioning is at the center of an hourglass-shaped graph. The bottom half consists of multiple "internal" layers/systems (neurological, psychological), in which some deficiency or deficiencies cause a lack of executive functioning (arrows point up from layers down below upwards to the central element of "executive functioning" to visualize the direction of causation). The upper half shows the outward facing layers/system behavior, social relationships, skills; the arrows point only upwards. I don't have any scientific source for this graph, but I never experienced any "ADHD"-related problem that I couldn't understand through this lens. Happy to share my sketch if anyone is interested.
Someone else who describes it like I do. You sit down to do a task, and there's an "invisible wall" between you and the objective. You physically CAN'T type on the keyboard if it pertains to the task at hand. You get up to go on a walk, and all of a sudden CANNOT WAIT to get back home to start the task. It sounds like the most enjoyable thing ever! Until... you get home and are greeted by the "invisible wall" again...
When I was a teenager, this would sometimes get so extremely bad that I could only describe the feeling of forcing yourself to push through this wall as almost painful.
My body would tense up to the point of shaking and I could feel my brain absolutely SCREAMING "NO. NO. NO."
Yeah, it’s a common topic of discussion in the various adhd discussion groups across the internet. Unfortunately changing the name would have some unintended effects because a bunch of regulations and other things are using the current denomination
Executive function problems are symptoms of ADHD, therefore renaming it as executive function disorder would omit the root cause. Dr. Edward Hallowell proposes Variable Attention Stimulus Trait (VAST) as a better name.
Ah man I feel you. What helped a bit for me is relentlessly trying to get your career focused on only fun things. It's a long term strategy, but I am now a not-so-successful-yet entrepreneur but I do love about 95% of what I do and that makes me do things fast and without it feeling like effort.
The world is what it is, change is the only constant. Improvise, Adapt, Overcome. It is a mantra that brings positive outcomes. Try to love something in the improvise/adapt/overcome process that like or may learn to like, with time. Don't drop your own agency in a world filled with agents.
I always picture it like trying to force and hold a strong magnet flush against the like pole of another. It seems like it will be easy at first, but the closer they get, the harder it becomes and just as you are about to manage it, they fly apart and the magnet gets stuck to an even stronger one nearby.
You manage to pry them apart, but it goes flying through the air and only to get stuck on an even stronger magnet still. And on it goes, over and over, until the magnet is stuck on the biggest, strongest magnet.
Your attention is constantly being repelled from less engaging activities to more highly engaging activities, and eventually you land on whatever the most engaging activity is nearby. Sometimes without even realizing it
It was even called "minimal brain damage" at one point early on!
I'm also reminded that "Obsessive-Compulsive Disorder" and "Obsessive-Compulsive Personality Disorder" are different in kind but necessarily in magnitude.
The former comcerns more localized obsessions and the latter is more of a global "default state of perfectionism".
It’s that I try and then can’t. When stuck in bed I can feel this momentum building in my head to push for movement and the a surge of will and then nothing. I didn’t reach the threshold of exerting my will and now I’m waiting for the next wave.
to me it is definitely "attention deficit", and it is a deficit in attention in two distinct ways:
1) it's a deficit in that i can't put my attention where i want to put it when i want to put it there. this is definitely "attention deficit" to me.
2) when my attention wants to focus on something on its own somehow, i can't prevent it from putting its attention on that; that thing becomes my main focus for some amount of time that I can't really control. that's also definitely "attention deficit" to me, but in another way than the first way.
Your comment's parent might know very little about ADHD, but your critique shows an antiquated view as well. It's not only the ADHD person that needs to change by any means available so that they fit the expectation of the system. The system, too, is in need of change, so that we accommodate more diverse people. Improving the environment that you operate in goes a very long way and might enable exactly the kind of change that makes children and adults with ADHD thrive. Medication is just one option. CBT and more flexible environments are as important, probably even more so.
It's not an either/or thing. At least for my kid, it's been a combination of the 3 that have helped, but if you dropped a component (including the medication), she wouldn't be doing nearly as well.
I agree with the label being a huge problem. It's basically compressing a multitude of individual characters with huge differences on multiple dimensions of behavior into a binary label, which people confronted with someone bearing that label then decompress based on their personal view on the topic, which is like an algorithm trained on caricatures of what society portraits as ADHD. Your comment sounds like you're doing the same mistake: you take your favorite solution for a complex problem, which (I agree here!) might actually be sufficient for some, a relief for many, any at least good or not harmful for everyone else, but you try to market it as the only necessary solution while invalidating everyone's needs that go beyond this solution. It creates the reactions that you can see in already a handful comments that basically call for the individual to accommodate to the system at all cost...
Hmm, I do this this is a point worth considering, but it needs nuance. ADHD is overdiagnosed in young boys, by about 3% iirc. But the thing is overdiagnosis doesn't mean that it doesn't exist at all. It's certainly underdiagnosed in middle-aged women for example, and tends to be underdiagnosed in women in general. There's also a point to be made that some ADHD meds are not without side effects, and kids aren't always listened to when they complain about them (I have a friend who was on Concerta as a kid and had a lot of side effects that really bothered her). But also, ADHD meds are a complete lifeline when they work, and they do work in most cases.
> It's certainly underdiagnosed in middle-aged women for example, and tends to be underdiagnosed in women in general.
What I'd like to see studied more is whether that root cause is underdiagnosis of inattentive type ADHD. My daughter was diagnosed because my wife is aware of this and had her evaluated, which led to me getting evaluated and eventually on medication. The common thread I've observed is that if you're reasonably intelligent such that it's not causing you to fail classes/get fired, people will just call you lazy and not entertain the idea that there's actually something else wrong. Couple that with girls/women having inattentive type w/o hyperactivity, and I think you do end up with a pretty solid bias.
> But also, ADHD meds are a complete lifeline when they work, and they do work in most cases.
For some there's a lot of trial and error, too. I wonder how many give up or insurance stops paying before they get to the right medication.
Ok, but what about when those children grow into adults that can’t sit still for 8 hours either? I am in my mid-thirties and I am still waiting for the hyperactivity to die down.
Getting the best out of yourself and your environment isn't a matter of waiting to fit in to the sit-down-and-focus shaped life. You have to learn about yourself and learn about how to shape your environment to live your best life, and a major step is not thinking about having that temperament as a disease to be overcome.
Ironically, I know myself very well. I had no choice early on life. I was not officially diagnosed until I was a young adult, FWIW.
Most of my difficulties in life are due to the intersections of my 'temperament' with others. If there was a way I could make life work for me, I would have done so by now. I did not choose to have this 'temperament', and I do not want to have this 'temperament.'
If you have been able to make your life fit for you, consider me jealous. But you need to understand that because you or others are capable of doing so does not mean everyone else is capable of the same.
> Do you think most people are made to sit still for 8 hours?
No, I was just reiterating the value in the GP comment. I do think the ability to set still has some sort of distribution like all other human attributes. I think it's more important to focus on how little someone sits still compared to how long someone sits still. I'd be lucky to make it a few minutes.
> Do you think someone who can't do that is defective?
No, I do not think of myself nor others that way. I would identify as misaligned. Honestly, ADHD does not cause me as much harm as it does for everyone else in my life. And brother, let me tell you, after all the punishment you receive for being misaligned, you really start to believe you are defective.
It’s amazing to see a disproven and frankly ancient viewpoint espoused with a straight face here. When I was a kid in the eighties your way of thinking was already defunct.
This isn't defunct in any way. To the contrary. I've been diagnosed with ADHD myself and creating an environment that is accommodating to my individual needs has absolutely been in line with what experts recommended to be, and it's been a corner stone of my success.
CBT teaches you to evaluate how to shape the environments your living in so that you can benefit the most from your resources and weaknesses and suffer the least from your weaknesses. For some people, this can include taking stimulants, and this is where I do not condone your parent comment's undertone. Nevertheless, it's been proven over and over again that the rigid system that we call schools does not welcome neuro-atypical students and that we could do a lot more to help those who do not react well to stimulants, who do not want to use them (for whatever individual reason), or simply haven't been diagnosed yet! Allowing for movement instead of forcing to suppress it is a very good example for what could be done. One shouldn't make the mistake to think that this alone would be enough for every single child with ADHD, though. But for some, it could be enough.
Exactly. It also ignores recent genetic testing that's showing how different mental illnesses and developmental disorders cluster around the same dysfunctional gene cohorts. To very little surprise ADHD and Autism appear to be closely related for example.
