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This post is crossposted from my blog. If you liked this post, subscribe to Lynette's blog to read more. (I only crosspost about half my content to the EA forum.) 

 

I was diagnosed with attention deficit hyperactivity disorder (ADHD) last winter. 

I’m a productivity coach who frequently works with people who have ADHD. I’d studied diagnostic questionnaires and read about the official symptoms of ADHD.  

I’ve also been struggling with those symptoms for decades. I was unable to consistently focus on demand, felt constantly tired, and often needed to force myself to get started on my projects. Yet I never seriously considered that I might have ADHD. 

Why not? 

Because my experiences didn’t match the picture of ADHD in my head. I thought I understood the symptoms of ADHD, but I didn’t really. (How much trouble focusing counts as “difficulty focusing” anyway?) 

I missed out on the benefits of stimulant medication for well over a decade because I didn’t understand what ADHD actually looks like. I’m guessing there’s a good number of adults (maybe including you!) who are also missing out on that benefit because of similar misconceptions. 

So I collected stories from six people who were diagnosed with ADHD as adults (including myself). These people are intelligent, high-performing individuals who nevertheless struggled for years with undiagnosed ADHD. 

I’ve structured the first half of this post around my interviewees’ responses to a typical ADHD questionnaire, so you can see what kinds of experiences you might expect if you have ADHD. The second half covers their stories prediagnosis and with medication. If these responses feel familiar to your experience, I encourage you to consider whether you might benefit from ADHD medication. 

So, what does adult ADHD actually look like? 

Hint: Adult ADHD is dominated by what I’m calling the Terrible Trifecta: trouble getting started, keeping focused, and finishing up projects. Every one of my interviewees struggled with these three areas, while most said that the other symptoms had less of a detrimental impact on them. 

Note, I mainly focus on the ‘inattentive’ presentation of ADHD, since it’s easiest to miss. If you’d like to learn more about the other types of ADHD, I recommend the youtube channel How to ADHD

When you have a task that requires a lot of thought, how often do you avoid or delay getting started?

Every person I spoke with thought this was a major problem. They described procrastinating, trying to get started but being unable to focus, or spirals of feeling motivated and wanting to make progress but then…just not doing the task. 

This isn’t just for tasks that people dislike. People would bounce off even tasks that they enjoyed once they got into them.

For me, this is especially likely when a project is distant in my mind. Resuming drafting a post after a weekend feels aversive. I can’t remember exactly what I was planning or why I wanted to write the post. If I don’t sit down and mentally “boot up” the project, it’s tempting to start something easier instead, which means that I don’t tackle the planned task until hours later. 

For some respondents, procrastination was particularly likely when they were trying to meet really high standards. If they didn’t feel that they were able to do a great job right then, they would instead go do something else until a deadline forced their hand. (I definitely resonated with this!) 

It felt like I would have such a high standard for each sentence that it felt like any word choice was totally wrong. I would try and make myself start, and then it wouldn't feel on fire enough to actually start doing it. Then I very easily get sucked into some other internet distraction. This would keep going until it was like midnight or 1 AM and then it would be like, “Okay, If I'm going to get any sleep tonight, I need to start this.” ~Richard 

Other people describe making a plan, but then just not feeling able to start doing it. It might take multiple attempts to do something very basic. 

I'm trying to read one page of a report. First of all, it's incredibly difficult to just get started on this task. Instead of doing the next step, even though I know what I want to do, I will read news. I’ll continue to follow the links…and links and links and links…and not do the thing I really wanted to do. 

It both feels like just following my curiosity and learning new things (that's exciting!), and it also feels like a part of me is slowly dying because I'm like, “Oh no, this is not what I'm supposed to do, but I can't stop”. I feel very frustrated with myself.  

Sometimes procrastination would drag on indefinitely, especially for tasks that didn’t have an external deadline. One interviewee described trying – and failing -- to work on a project for nine months. Her manager (understandably) assumed that she didn't think of the project as something she was working on, because she had, in fact, not worked on it…at all…ever.

How often do you have difficulty keeping your attention when you are doing boring or repetitive work?

Again, every single person described difficulty staying focused while working. 

Difficulty getting started would blend right into trouble staying focused while working. In the stories, I found it difficult to separate “getting started” and “staying focused,” because they generally overlapped. People would try to get started, make a plan or do a little bit of work, get distracted or want to do something else, try again… You can see the pattern here. 

I started today with one task. I know that basically I just need to open my document and read the notebook. But I just don't look at my notebook. Instead, I go on the internet…and then the Pomodoro ends. 

The next Pom, I open the notebook, but then I need to close all the windows that were open from the previous day. They are all very tempting and I sort of need them later on, so it's super difficult. Then I finally look at the notebook. I realize I can just copy down what’s in the notebook…and it’s the end of the Pom and time to take a break. 

So, I take a break, and then the whole cycle starts again. I could just write down literally what's in the notebook and put it in the document, but instead I check slack because something could have happened.  

Difficulty staying focused didn’t just apply to boring or repetitive work either. Work that required a lot of thought and concentration seemed to be the most common challenge, even if people enjoyed the task once they were able to focus on it. 

For me, difficulty focusing feels like my brain is mush. I’m trying to force my mushy brain to do something, but my working memory is shot and every minute is effortful. 

Other people describe similar experiences of feeling unable to force their attention, no matter how hard they try. 

“When it comes to, like, reading something I find boring, it's like my mind just won't Stay. On. The. Page.” 

Several people were easily distracted by things around them, such as noises or people. I find it easiest to work alone so I’m not distracted. Another interviewee only realized they were extremely distractible when they suddenly became more productive after they happened to move to a new desk with a privacy barrier. In contrast, other people with ADHD have told me that e.g. working in a café or library with other people around makes it easier for them to focus. I suspect that these people feel more accountable and stimulated with background noise or other people around. 

Most people also found it super tempting to just start doing something easier. 

I would just reflexively reach for my phone or go to some other tab. ~Richard 

I’ve seen arguments that ADHD is really just people reacting badly to addictive phones or superstimuli on the internet. I don’t entirely buy this: why would ADHD meds make our phones no longer superstimuli? However, there is something here. Some people with ADHD say it helps to be in an environment where there is no internet or other distractions. As I understand it, ADHD brains have low dopamine, so people with ADHD are unusually tempted by things that quickly release dopamine (like videogames or interesting videos). Being distractible AND having so many things that will quickly give you dopamine makes focusing harder. (Though removing distractions doesn’t always solve the problem – several of my interviewees mentioned that daydreaming or mental restlessness was their worst distraction.) 

[My experience of ADHD] would be starting the day ready, feeling pretty good about what I'm going to do, having a plan, and then being interrupted and distracted. Feeling more and more despair accumulate over time. And then finally by the end of the day, focusing for a little bit. After like 75% of the day being a bit crushed, finally at the end of the day, being able to really work for 25% and having a somewhat decent outcome.  But I feel shame that I've worked so inefficiently. 

Similar to starting work, my respondents said that open-ended, deadline-less tasks without accountability were the biggest challenge. 

Compared to school, my work had fewer deadlines. This was a lot harder because I never got to the point of like, “Oh no, my big essay is due and I've got to write the whole essay tonight.” Instead I just kept being like, “Okay, I guess I'll make more progress next week.” ~Richard 

Many people with ADHD have found workarounds by setting up deadlines and accountability, such as telling their supervisor that they’ll get a particular doc to them by a certain date or coworking with people who will hold them accountable. 

I can’t overexaggerate how important deadlines and accountability were to people with ADHD. Almost all of my respondents told me (unprompted) some version of “I can’t do open-ended tasks until the deadline is close or there’s accountability.” 

How often do you have trouble wrapping up the final details of a project, once the challenging or interesting parts have been done?

All my interviewees said they struggled to finish the projects they started – if there wasn’t a clear deadline. Most of the people I spoke with found things like planning an event easy, because there was a clear deadline that other people counted on. They had to do the work. 

Some projects are easier for me. Some projects are just like, “Oh, this needs to get done” Like a hiring round or any event organizing. But then afterwards, there's some things you can do that just make it a bit nicer, like having an evaluation. Those tend to not happen. 

Any task without a deadline – for example, writing a post or an independent research project – might never get done. Everyone had stories of half-finished projects left on the shelf. 

I feel like I just can't [finish projects]. So I'm delegating. Even if I don't have a super high budget, I just need to hire people to do the citations and the refining, or I need a very strong deadline. Otherwise it doesn't get done. I have an EA forum post that I'm almost done with. I just need to ask one person to add to it and…it's been two months. 

And more stories…

I do the hardest parts, like writing several murder mysteries with plots and character profiles, but haven’t finished any to where someone could play it. It just doesn’t feel enjoyable to do – the part that felt enjoyable was figuring out how the characters and plots interact with each other. Once that’s been decided, actually having it be printable for people to play it doesn’t feel exciting. 

One contributing factor is that people with ADHD seem to often start new projects impulsively. They get excited about something new and start working on it, only to find that they’re much less excited about completing the project later. 

I'll get halfway through writing something. And then I'll just be like, “I don't know where to take this,” or another idea will inspire me. ~Anisha 

A couple of people commented that “finishing the final details” of a project is rarely a small task. I’ve heard before that having a full draft of something written is more like 50% done than 80%, because “just polishing it up” is actually so much work. 

I like to say that I've never finished a project but it's not quite true. But it’s kind of true for every project that didn't need to be finished.

For example, I have a post. It's not the first draft. It's not the second draft. It's like the third or some later draft, but I thought it wasn't ready to go out. I started writing it in 2020. I haven’t touched it in a long time. I should probably just post it at this point, right? 

But then I just think that rewriting a draft to a final polished post, especially when you still want to make structural changes, is just very challenging. Like, I'm not sure I want to call this finishing up the final details. 

I loved how Anisha put this struggle for the final push that you never quite manage. 

It feels like chasing butterflies sometimes. You don't end up catching them, but it feels like you get really close.

How often do you make careless mistakes when you have to work on a boring or difficult project?

The results were split fifty-fifty here. Half of the people said they thought this was a problem for them, half said it wasn’t. 

The people who said they struggle with “careless” mistakes mostly mentioned homework. I’ve also heard people say that they frequently need to resend emails because they had typos. You might struggle with this if you have gotten feedback that you’re making typos too often and need to work on it, but find it difficult to improve when you try. 

According to one interviewee: 

It's not like sometimes I will make careless mistakes. I just assume I will have made careless mistakes. It's just a thing. When I do math, I just assume that something is wrong, because something is usually wrong. 

My most embarrassing story was from some application thing. I meant to send out a mail merge to the people that we wanted to interview before we admitted them to the next stage. But instead, I sent them all an email saying they were accepted to the program. It was like only eight people or something, but I was so embarrassed. 

How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?

All but one of the people I spoke with said they sometimes struggled here. However, for most of them, it was only with people they felt fairly comfortable with or things like lectures. 

I have enough attention control to not [space out] with people that I don’t feel comfortable doing that with. But I think it's more like I'm putting effort in. 

How often do you have difficulty getting things in order when you have to do a task that requires organization?

I think this question is poorly defined. Everyone said they struggled here, but they all gave different examples of what they struggled with! These included:

Physical space organization (like “where did I put those notes?”)

Being messy

Regular planning (le.g. making a weekly plan)

Realistic planning (these people can easily make plans, but the plans aren’t realistic)

Breaking a task down (e.g. renewing a driver’s license)

Scoping tasks (like being efficient with research and not disappearing into rabbit holes) 

A recent thing was that my old ID card expired nine months ago. In order to get a new ID, I need to make an appointment at the DMV and gather a couple of documents to prove where I live. This was a task that I started a couple times and then I stopped part way through, because I couldn’t figure out where to find some document. If I had really focused, I could have figured out like, “Oh, you can find this tax form and make it work.” Or the DMV is right by my parents’ house, and I’d want to go when I could also see them.  

It feels like everything had to be perfect, so I would wait another few weeks to make the appointment. It didn't have a deadline beyond the one that had already passed, so there was no urgent moment to do it. Just that little trivial inconvenience of gathering the right papers meant that when I started it, I didn't complete it. And then I would have to go back to square one when I restarted. ~Richard 

The most common challenge was being consistently too optimistic with deadlines.

Not plans like “I will meet you at this place at 4:00 p.m.” type of plans but like “I will hand you this report by Friday” - that sort of plans. The part of my brain that is making these promises is not actually doing the hard work of imagining buckling down and doing the work that it takes to do that. Part of my brain is taking the easy way out. So I always would schedule a fairly optimistic time frame. ~Richard 

People described making plans and fully intending to follow them, but also not being surprised that they didn’t follow the plan or that they didn’t meet the deadline they set. 

When I plan my own time, I say “I'm going to do this then” but I don't believe it in my mind. I'm already imagining I'm not going to do it. 

It’s possible that over-optimistic planning happens because people with ADHD have poor time perception.

For purposes of self-diagnosis, I think the point that I remember jumping out at me most was the extreme reliance on "the last minute", and how remember resonating I would be totally unable to actually start doing the important task until it really did feel dire. If you want the one thing that I most with past Richard, it's that. ~Richard 

Some research shows that people with ADHD are worse at estimating the passage of time. A couple of people said it feels like there is “now” and “not-now,” and planning regarding anything that’s not-now doesn’t happen. 

You either do [the thing] now, or it doesn’t happen. ~Anisha 

How often do you have problems remembering appointments or obligations?

Most of my interviewees said they didn’t struggle with this – at least, not anymore. People said that they used to struggle with forgetting things, or that they struggle if they forget to write stuff down, or that they are often a few minutes late to most things. 

If I forgot to write down a homework assignment, I might forget to do it entirely. ~Anisha 

However, by the time they’re adults, they’ve mostly developed coping strategies. One person described telling herself she needs to leave by an earlier time than she actually does, so that, when she inevitably leaves later than planned, she’ll still arrive mostly on time. 

Almost everyone mentioned using calendars and/or todo lists scrupulously. “Out of sight, out of mind” fit me to a tee. If it’s on my todo list in TickTick or if I have a physical reminder present, I’m almost guaranteed to remember it. If it’s out of sight, I won’t. I’m really, really good at writing down todos immediately so I don’t forget them. 

How often do you experience mood swings or difficulty dealing with stress? 

Mood swings aren’t one of the standard diagnostic criteria for ADHD, but they came up a lot when I was reading about it. Five out of six people said they often had mood swings. 

For me, this means going from excited to pessimistic about a project based on my mood, even if the project hasn’t changed. Another person said they had a “mood of the week.” 

From the inside, it doesn’t feel like I’ve had these mood swings forever and that’s just how I work. From the inside, it feels like, “Oh, I had this big thing that made me sad, but now I’m on the up. Oh, I have a new big thing that was exceptional, but now I’m on the up…” 

It took a while until I looked back at it to go, “Wait, that doesn't seem to be what's going on.” I think part of the story is that I immediately forget how I felt. 

At some point I had a really bad weekend, like I had a Saturday that was possibly one of the mentally worst days of my life. On Tuesday, somebody asked me how my weekend was. I was feeling good that day, so I said that I had a great weekend. Then I wanted to tell them more about what I did, so I thought about what actually happened last weekend. “Wait, I was miserable last weekend!” 

In other cases, the symptoms of ADHD frequently put people in situations where they are understandably anxious, depressed, or frustrated with themselves. If ADHDers continually feel like they’re not living up to their ideals, they might also qualify as depressed. (Both “feeling bad about yourself” and “trouble concentrating” are diagnostic questions for depression.) Or if they are continually stressed about meeting (or failing to meet) deadlines, they might get anxious about whether they’ll be able to do it this time. 

Half of the people I spoke with had experienced depression or anxiety that was probably caused by ADHD. This meta-analysis found that about 50% of people with ADHD also have anxiety, and 18% to 53% of people with ADHD have depression (and 9% to 16% of people with depression have ADHD!) 

I haven’t seen good advice on how to tell if you’re more likely anxious/depressed, ADHD, or anxious/depressed because you have ADHD. A therapist told me that you should treat both possibilities at once: “If someone is experiencing anxiety or depression (manifesting as sadness, guilt, irritability, low self-confidence, and helplessness) due to ADHD-related challenges, such as difficulty focusing, forgetfulness, disorganization, and restlessness, it's important to consider ADHD. However, it's also possible to have ADHD and depression unrelated to ADHD. Treatment plans should typically address all conditions simultaneously, rather than separately. If someone suffers from ADHD and an anxiety disorder, the treatment plan should be designed to target both issues at once.” 

My impression is that when doctors and therapists are presented with one diagnosis, they don’t always consider whether there’s a comorbid condition that better explains the situation. I would guess that if most of your symptoms are around poor concentration and feeling tired (rather than low mood), your difficulties concentrating continue even when your mood is better, or you feel bad about yourself or anxious primarily because of your work, you might want to ask directly about the possibility of ADHD.

Before you know you have ADHD

The above descriptions have one thing in common: they are from people who already have an ADHD diagnosis. Knowing you have ADHD is a lens that subtly changes how you perceive your own experiences. Before getting diagnosed with ADHD, the people I spoke with still had the same symptoms. But they often chalked them up to “just not trying hard enough” or some health issue. Sometimes, they didn’t even realize they were struggling more than other people. 

“Having ADHD without knowing you have it” is really different from “having ADHD and knowing you have it.” So, the story that is the most like me “having ADHD and not knowing,” is probably losing my job and being surprised at my incompetence in the office when I was assigned stuff I didn't find interesting.

Whereas, having ADHD and knowing that you have it, I guess just feels a lot more like, “Oh, I understand the types of things that I'm better at. I understand that if I want to do some of the things I'm not as good at naturally, I'm going to need some systems in place. I'll probably want to prepare those before I get started.” 

My respondents only realized they might have ADHD when someone else suggested it or they heard about a friend getting diagnosed and realized they’d had the same symptoms the friend was describing. Before they were diagnosed, they interpreted their experiences very differently. 

One person thought they had chronic fatigue, and that’s why they felt unmotivated and could sleep for fourteen hours a day. None of the things meant to help chronic fatigue (like iron and exercise) worked for them, but it’s common for treatment to fail to improve chronic fatigue symptoms. 

Others attributed their experiences to personality traits or personal failings. One person said they used to think they were just a night owl, which is why they wouldn’t get anything done until late at night. Another said she was always being told to focus more, and just thought she wasn’t trying hard enough.

Several people told me that before they were diagnosed, they felt like they were trying their hardest but just not getting quite as much done as other people. They usually assumed that others were just working harder. 

The hallmark experiences of undiagnosed ADHD seem to be saying “I just need to try harder” over and over for years, or kicking yourself for intending to start work and then not getting much done, or wondering “How does that person get so much done?” It feels like you should be able to do more, but you just can’t. Some people blame themselves. Others assume that something must be wrong with them, but they think it’s anxiety, depression, fatigue, or some other health problem. 

I previously attributed my troubles focusing to brain fog from POTS and headaches/migraines, and possibly depression. I also previously blamed personal failings but had mostly worked through that in therapy before I ever considered ADHD.

These were reasonable guesses. Brain fog is a symptom of POTS. Feeling unmotivated and tired are symptoms of depression. Almost everyone describes some difficulty focusing on hard work like writing. I knew I was worse than normal at focusing, but it’s hard to pin down how much worse when there are such huge variations between people already. And all of my experiences fit neatly with the theory that my health or emotional issues were just making it harder to focus than ideal. If I said I wanted to do something but couldn’t get myself to do it, maybe I didn’t care about it as much as I thought?  

The hard thing is that all of this is probably partially true. If I’m tired or don’t really care about some task, I’m going to have more difficulty focusing, ADHD or no ADHD. Working through emotional issues (e.g. perfectionism) did help me get more done.

But there’s another layer on top of all of those. My brain is deficient in the chemicals that make tasks rewarding. It’s impossible for me to feel as motivated as I “should” be relative to how much I care about the task. 

It’s not surprising that I didn’t notice I was less motivated than I should be. There’s not a good motivation meter we can check the readings on. 

And ADHD is a measure of degree; there’s not a clear line between having it and not having. Everyone struggles with focus sometimes. Everyone sometimes doesn’t want to get started on a hard task. So if you want to determine whether you have ADHD, you need to ask yourself not “Do I sometimes struggle to focus?” but “Are these symptoms negatively impacting my life?”  

Medication 

Missing that I have ADHD meant that I spent over a decade struggling when there is a simple solution. 70-90% of people with ADHD find stimulant medication highly effective. [1] 

When I actually get things done, I just feel like my heart is blossoming and it's like “Finally, I can be the person I want to be.” 

Of the people I spoke with, all six said stimulants helped them focus. Four said meds worked quite well for them. 

Of the other two, one person tried one medication, which helped her focus but had bad side effects (losing an unhealthy amount of weight and emotional blunting). She hasn’t tried another kind yet. This meta-analysis found that 10 percent of adults with ADHD discontinued stimulant medications due to side effects. It’s fairly common to need to try a couple medications before you find the one that works best for you, but it only takes few weeks to test each one.

The sixth person said that meds helped her focus, but that she still needed “to fight the rabbit hole” while on them. I think this experience isn’t unusual. ADHD stimulant medications help people focus, but they work best alongside learning prioritization and productivity strategies. 

Of the people who said that meds worked well, some take them every work day, while others find that they develop some tolerance if they take them every day. In those cases, it’s more common to take ADHD meds three or four days a week (often cycled with caffeine on the other days). I’ve heard that other people with milder symptoms only take meds when they need to focus for a big task, like writing an article. 

The research on stimulant medication for ADHD finds a large effect size (Cohen’s D of 0.73). Put simply, this means that people with ADHD who take medication report fewer, less intense symptoms on average, than those who don’t. It’s not easy to directly quantify reduction in ADHD symptoms, but for comparison, an intervention to increase IQ with a Cohen’s D of 0.73 would increase IQ by 11 points. 

Here are the stories of how meds helped the people I spoke with: 

Medications proved to me that I need them. Before I tried anything, well, I was still a little skeptical, like maybe I really am just not trying hard enough. But after trying medications and having them work, I know what it looks like to experience a day where I have normal amounts of energy and focus. I’m able to consistently jump from one task to the next, without always needing a break in between. 

I’m not getting sidetracked by things. Like, when I have meds, if another task comes up, it's just like, “Okay, write it down, go back to what I'm doing.” Because there's a sort of feeling of, I don't want to be pulled away from what I'm doing. ~Anisha 

 

It puts me in a mode where I feel more “let’s go!” It energizes me. The idea of checking things off my to-do list feels as addictive and “pulling me towards it” as random internet distractions usually feel. 

With a lot of tasks, if I can just get myself to the point of starting the task, I go, “Oh, actually, this is interesting.” But just doing that first five minutes would be a huge lift on a lot of days, and when I have taken Adderall, then it just would be a lot easier to force myself to get through the first five minutes and pick up some momentum.  ~Richard 

 

I can just feel energized to do something as soon as it's needed. I mean, obviously I have to decide to take them, but then I have energy for the next few hours. 

For me, medication has led to more than a 25% improvement in my general quality of life. I feel like I must be an outlier because the effect was so huge in so many areas of life. For one example, writing feels so much easier – the little voice that’s obsessing over each word is gone. I can just plan a post and write it out. Previously I had to be in the right frame of mind, or I would try writing and feel like I was pushing at mush in my brain. I felt scattered by possibilities at every choice - how to structure the post, what to cover, how to phrase each sentence. It was hard to narrow my focus to any one thing or feel satisfied when I did. Now I’m reliably able to imagine a structure and quickly hammer it out, without feeling like I’m forcing myself. 

This How to ADHD video beautifully captures my internal experience of taking meds vs not. 

If you’re worried about side effects or addiction or something else, I highly recommend psychiatrist Scott Alexander’s page on Adderall. I trust Scott’s analysis and feel pretty comfortable accepting risks he compared to “the risks of eating one extra strip of bacon per day.” I also checked the UpToDate page for risks of stimulants; their findings broadly seem to agree with Scott’s analysis. 

When I wondered aloud why we treat these stimulants so differently to caffeine, I was informed that just because I’m a prude who never considered taking 25 times the prescribed dose, doesn’t mean that there aren’t people that crazy. If you take 25 times the prescribed dose, ADHD meds are more dangerous than caffeine. Don’t do that, please. 

Conclusion

Medication shouldn’t stand alone. If you have ADHD, you’ll want to learn coping strategies and productivity habits, like coworking and setting external deadlines, to use alongside the meds. 

But those strategies aren’t a replacement for meds! Without stimulants, I will always be working harder to do the same task as someone with more dopamine. 

If you’re saying, “Yes, but how do I know if ADHD meds will help me?,” you could take an ADHD questionnaire, like this one. Or you could look back at the Terrible Trifecta:

Do you struggle to get started working, frequently procrastinating? 

When you’re trying to work, do you find yourself getting distracted or having a hard time producing output? 

Once you’ve made progress on a project without a deadline, do you have a hard time finishing it up? 

Have any of these symptoms made you lose a job or underperform in your job? Do you feel like you have to constantly work as hard as you can to do a “normal” amount of work? Do you get feedback that you don’t accomplish enough or don’t accomplish it fast enough? Do you feel unable to force yourself to do work, even if you think it’s important? 

None of the above are conclusive evidence you have ADHD. These experiences might also be explained by anxiety, depression, chronic health problems, poor prioritization, being inefficient, or having a bad manager. However, they are still good indicators of whether you might benefit from meds.  

Honestly though, there’s probably a simpler way to test for yourself. 

One therapist told me that they sometimes recommend a client take stimulants to see how they respond, such as trying a friend’s pill (note: this might be technically illegal, depending on where you live). I suspect that caffeine might also help with ADHD symptoms, as long as you don’t regularly consume it (e.g., no more than once a week). (Before my diagnosis, I had a super strong response to taking caffeine once a week.) 

If you have a strong response to either, there’s a good chance that ADHD stimulants will be helpful and it’s worth going through the process of getting a diagnosis. 

A weak response doesn’t rule out stimulants being helpful (you often need to try a few kinds or doses to find what works best for you), but it probably makes it less likely that you’ll have a huge positive response to ADHD meds. 

One of my respondents said: 

The first evening that I properly considered that I might have ADHD, I just started crying. Because I felt so relieved and I had just realized that I felt extremely guilty before. I think the thing that triggered this was me thinking that “Actually I'm trying really hard. It's not, in fact, the case that I'm just lazy and not putting any effort in.” 

In the end, it’s that simple. Are you struggling, and can medication help? If it can, I want you to have that help. 

 

A huge thank you to Richard, Anisha, and my other interviewees for sharing their stories. Thanks to Amber Ace for editing. 

Footnote:

  1. ^

    Papers on ADHD cite that stimulants work for 70% to 80% or 90%, often without bothering to give a citation. Ones that offer a citation link to studies like this one that found Methylphenidate reduced ADHD symptoms in 76% of patients, compared to 19% of the placebo group. Meanwhile, StuffThatWorks aggregates reviews from people with ADHD of which medication they’ve tried and which has been helpful, kind of like Yelp reviews for medical treatments. Based on more than 10,000 reviews each, the website finds that 91% and 86% of users found Adderall and Methylphenidate (Ritalin) helpful, respectively. This is consistent with psychiatrist Scott Alexander’s claim that most people slightly prefer Adderall.

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The "terrible trifecta" of: trouble getting started, keeping focused, and finishing up projects seems universally relatable. I don't know many people who would say they don't have trouble with each of these things. Drawing this line between normal and pathological human experiences is very difficult and is why the DSM-V criteria are quite specific (and not perfect).

It might be useful to also interview people without ADHD, to differentiate pathological ADHD symptoms from normal, universal human experiences.

The risks of overdiagnosis include:

  • People can develop unhealthy cognitive patterns around seeing themselves as having a "disease" when they're actually just struggling with the standard human condition
  • They might receive harmful interventions that they don't need
  • It adds unnecessary burden to health systems.

I wish we didn't need to treat ADHD like a disease, and instead people could just say "yes, I struggle more along these dimensions that the average person." Unfortunately, the medical community treats ADHD as a disease and has drawn arbitrary, frustratingly vague guidelines around it. If someone wants to access medication, they need to accept that label. 

My best understanding is that ADHD symptoms are roughly normally distributed in the population. I would be thrilled if the medical community followed an informed consent model where patients could decide for themselves if they needed medication, following proper advisement of the risks and costs. Baring that, it would be great if they established clearer thresholds for what was significant enough impairment to be worth medicating, instead of the current system. 

I find the DSM-V criteria aggravatingly vague and non-specific. Like "Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months." I.e. adults who say "often" or "very often" more than 5 times on a questionnaire get diagnosed with ADHD. How often if "often"? You know, often!  

I think it is worth mentioning that overdiagnosis/incorrect self-diagnosis can have costs in the way you describe, but at the same time, when you read the stories, I think there is a difference between that and the general human condition. Like, based on the stories here I don't think I have adhd: I have trouble getting work done sometimes but my barriers seem very different to this. 

Also seems worth saying that...as far as I can tell most ADHD interventions aren't actually super harmful if given to people without ADHD? (in contrast to other medications). Like, stimulants are a controlled substance, but from what Lynette says in this post, the risks from a non-ADHD person taking them by mistake seem quite low, and they may even get increased focus anyway. 


I think the point about the label is complicated. I've definitely been wary about whether I want to adopt psychological labels such as 'depression', 'cptsd', 'autism', because in pessimistic moods they can serve as focal points for negative thoughts like 'I'm broken', 'I have this undeserved disadvantage is life' 'people will never understand me', etc. At the same time, some of these interviewees report that when they labelled themselves as having ADHD, their self-narratives became more positive - previously they thought they were just lazy or not trying hard enough. And I think that can happen with other mental health or neurotype labels too: like better to see yourself as diseased than as morally depraved. 

Seconding that the risk of harmful interventions is low. Based on Scott's pages and the UpToDate page, the risks from taking stimulant medication as prescribed are pretty negligible - comparable to normal side effects from caffeine. 

I’d love to hear from people who don’t “have adhd”. I have a diagnosis myself but I have trouble believing I’m all that unusual. I tried medication for a while, but I didn’t find it that helpful with regard to the bottom line outcome of getting things done, and I felt uncomfortable with the idea of taking stimulants regularly for many years. I’d certainly benefit from being more able to finish projects, though!

I'm so glad you have written this piece and posted it in the EA Forum. I have been diagnosed with ADHD for almost a year now and almost everything you have expressed above resonated with me. There seem to be surprisingly few posts in the EA Forum which describe or take into account the experience of having ADHD.

My curiosity coupled with ADHD has led me to have surface-level knowledge in a wide range of topics and areas but not having much in-depth knowledge about any one particular area. I have always felt like although I really want to dedicate my life to doing as much good in the world as I can, I don't like work that is hard and not immediately rewarding and I cannot maintain medium/long-term projects to be able to contribute in a meaningful way. I often would get a sudden burst of motivation in a particular area and I'm feeling great and researching into it, but then after a while I lose that motivation and I gravitate either to mindless procrastination or to whatever my new motivation is, and I don't go back. I feel like, after a year and a half lurking on the EA Forum, I want to actually (actively) do something, but the above obstacles have prevented me from doing much more than reading some short Forum posts and bookmarking a load of ones that look interesting to me but which I never actually get down to reading.

I have also been a particularly unfortunate case when it comes to medication (I've tried 3 different drugs, 2 different dosages of each, and none have worked for me thus far).

Thanks for writing this, it was incredibly insightful. I was essentially looking for this very article a couple of weeks ago as I felt frustrated that most websites seemed to just give short bullet points about generic ADHD symptoms rather than talk about the experience of it and its impacts. 

The hallmark experiences of undiagnosed ADHD seem to be saying “I just need to try harder” over and over for years, or kicking yourself for intending to start work and then not getting much done...

Extremely relatable.

Thank you very much for writing this. I am in the process of getting a diagnosis, and this helped me overcome some of the totally made-up mental barriers regarding ADHD medication.

As someone with late-diagnosed ADHD, it's also common for people with ADHD to procrastinate the diagnosis/treatment process :P

Wait wait wait wait wait wait wait...

 

.....The things described above aren't normal ?

Then again, in insight, right now I'm doing my workday in a train station since I know that if I stay at home, I'll end up way too distracted. 

And I asked someone to check on me every day by SMS at 10am to make sure that I started working.

And I spent some time to make a pretty agressive todo list that contains columns like "URGENT AAAAAHH".

Uh.

[comment deleted]4mo1
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