The good news is that you don’t need to. In fact, these articles tend to give people a false feeling of understanding, and an impression that ADHD is purely a chemical situation in the brain that can only be treated with drugs.
That’s not really true. Medication can absolutely help for severe cases, but falling into the trap of thinking that ADHD is a purely chemical problem that can only be addressed with chemical solutions can lead people to neglect the important lifestyle and self-discipline changes that will really help their situation in the long term.
Don’t get caught up in ideas that ADHD is “just dopamine”, because that’s a path to ignoring the fact that personal changes and therapy can improve ADHD immensely.
It's a massive topic to cover in the scope of HN comments. ADHD also tends to be a touchy subject on HN. For a less heated parallel, consider reading up on how the "chemical imbalance" narrative has been harmful for public perception of psychiatry: https://www.psychiatrictimes.com/view/debunking-two-chemical... . People consume a lot of medication ads (in the US) and bite-sized, reductionist narratives about neurotransmitters and walk away thinking that psychiatry is simply about manipulating neurotransmitters up or down. In reality, psychiatry has known for a long time that complex behavioral disorders like ADHD, depression, PTSD, and so on aren't as simple as neurotransmitter balance in the brain, nor do they purely arise from your genetic code.
These "chemical imbalance" narratives tend to do more harm than good by giving patients an idea that their symptoms are purely external to their own choices, and therefore completely out of their own control. Unfortunately, it's very difficult to convince suffering patients that they have some control over their situation without also implying personal blame for their problems, which doesn't go over well. The idea that the problem is faultless ("It's not you, it's just your brain!") and that the solutions are effortless ("This pill will fix your chemical imbalance") is just too tempting. The alternatives ("Read this book on study habits, leave your phone in another room while studying, use timeboxing...") are an unappealing alternative.
Don't get me wrong: Medications can and absolutely do help people, but this idea that the problem can only be treated via medication is demonstrably false. The most successful patients use a combination of medications, therapy, and healthy habit-forming. The least successful patients tend to give up on everything except the medication, reaching for ever-increasing doses or trying to play games of on-days/off-days or saving up extra medication. That's a losing battle.
Thanks for writing this out. My only comment is this: it's a touchy subject because while you are describing one end of the spectrum, the opposite end is almost always applied for those struggling with ADHD - "Just work harder! You'll get over it"
There's definitely a healthy balance of smart lifestyle choices, coupled with medication for those who truly struggle and need to just get from zero to 1.
Thank you very much for writing this! It's very well formulated and expressed. I especially liked
> Unfortunately, it's very difficult to convince suffering patients that they have some control over their situation without also implying personal blame for their problems
I also see it as a big part of the problem, that it's difficult to convince people that they do have control over their lives. In many psychotherapy books, when therapists describe various cases, this is a corner stone of a therapy success: a patient understanding that they do have control over their situation. That it's not the outer world that is so demanding that it leaves them no choice, but them choosing to cope in a particular way, and that there are other ways to react and cope.
The problem with "Read this book on study habits, leave your phone in another room while studying, use timeboxing..." isn't that it's unappealing (and a reasonably smart person should be able to figure out most of these without being told). It's that these approaches don't really work if you don't have some baseline ability to focus. And too often it comes out just as "you're stupid and lazy".
For the reference, where I live we don't have ads for prescription medication. On the other hand everything tends to be diagnosed as depression and treated with antidepressants, no matter what symptoms are.
Take a look at this new treatment(neurofeedback)[1]. It changed my life. Instead of changing brain chemically you can change the structure of your brain. It's not ADHD that's the problem, its the focus networks in the brain not being trained properly.
ADHD becomes a gift when you can focus and the brain just naturally learns, and memorizes very well. I went from being incapable of anything to being really great at anything I wanted to be (just late to the party).
[1] http://addcentre.com/
I am very interested in this but am currently located in Scandinavia.
What does the training practically entail?
Is it some kind of device on the head that you then learn to use with an on-screen app where you can get feedback on your "state" like meditation but with an interface?
I remember reading about this years ago and wondering when the tech would be available for use in-home.
There can be a lot to understand depending on how much change your actually looking for (so much I could write a book). But its just putting EEG electrodes on the skull to record frequency ranges in the brain. These frequencies(Delta, Gamma and Alpha) relate to the "focus", "relaxation"(related to meditation) and "cross-talk" functions of the brain that primarily are controlled by the Sensory-Motor Cortex.
There are many different programs all with different goals, some try to optimize the relax range, some focus and some try to minimize cross talk. Imagine looking at a screen and it shows your POV from inside a roller coaster car. On the sides you can see a bar chart going up and down and a threshold level you want to attain. Eventually you learn to control it so you bring that bar to the threshold and hold it (Holding it is key). If your really motivated you can tell the technicians to bring the threshold down so far that you are able to focus greater than the average person.
It begins by controlling muscles in your eyes effectively, once movements of the eyes have stabilized(this is the hyperactivity part that negatively effects focus) light can effectively move into the visual cortex. Then tying the other senses(sound and touch) together probably switches on the focus networks in the brain. This leads to experiencing reality at much higher "resolution".
I would advise having professionals around(like I did) they can spot problems/anomalies and can aid in training. It can be dangerous to mess with your brain without professionals around.
Yes the doctor who oversaw my treatment pioneered the treatment and is the thought leader in the field.
You can read her various papers[1]. I've read many things about ADHD and functioning mechanics of the brain. This is by far the most substantive and practical resource of info that I managed to put to go use when I trained my brain.
This is really fascinating. I just sent them an email to see if I could participate (diagnosed with ADHD 6 months ago at age 33, feeling pretty depressed that all the years of struggling/setbacks were to some degree unnecessary).
May I ask how long have you been participating in the training?
The training is about 1-2 hour sessions. You need about 20 sessions. They can completed once a week. But if your serious you would do 2-3 times the first 4-6 weeks to change things with greater momentum. After it is complete you never need to think about it again.
I don't know anything about those folks but my son (inattentive type) got a lot of value from neurofeedback about 10 years ago under a psychologist using the full EEG skull cap. He went once a week for 18 months then less often for another year or two. Wish I'd done it...
Many years ago I read the preface to the behemoth of a book that is Infinite Jest by DFW.
I don't remember the wording of the preface, but I recall it arguing that the sheer size of the book could be regarded both as a cultural experience as well as a mental exercise.
The author of the preface argued that when (or perhaps if) you finished the book you would feel like you've just run a marathon. You would be highly fit, reading wise. Nothing would phase you.
This was probably compounded in my teenage head by the fact that the only quote I've heard from the author beforehand was:
"I consume libraries. I wear out spines and ROM-drives. I do things like get in a taxi and say, 'The library, and step on it.'"
It sounded like a complete opposite of myself at the time, but I did want to learn that ability. And
I liked that preface a lot. It kept me going at it month after month on busy train rides, with the promise of some transcendent reward at the end.
There are famous footnotes in that book spanning several pages in tiny print. The amount of mental effort it took to read the thing was extraordinary for someone like me at the time. I often had to backtrack several pages to perform the context switch from a mini-novel footnote back to the main storyline.
This was many years ago now, and I have slipped far behind on my reading fitness. But I still carry with me the realization that I can't expect to be fit if I don't train hard.
Now, ADD is a whole nother beast. Sicknesses often require medical attention and this should not be smoothed over. Still, I think there's an interesting discussion to be had regarding reading fitness in the era of information. Maybe this is a widely discussed thing and I'm just not hearing it, but it seems obvious that we slip further toward obesity without training. Surely something similar happens with our ability to focus without training?
This is really insightful, thanks. Makes me want to take another swing at Infinite Jest.
With depression, we might take medication to grant us a seat at the table of recovery via a therapist. The hope is to get off of that medication eventually. Perhaps the same holds true with ADD/ADHD? I am not a psychiatrist.
I've been wondering about this attention deficit and reading comprehension issue for awhile now. I would love to know how many of us adults actually read books anymore for longer than a thirty minute period? Any kind of book reading.
I like to think that I'm a somewhat experienced meditator by now. Having observed the mindfulness hype over the years I wonder if what people are really missing is just some silent focused time in general. If all you want is quieter mind, maybe you don't need a ten day silent retreat but just an hourlong reading session?
I know the topic has been beaten to death but it is an important one. This constant context switching between systems and devices who have been engineered to sap your impulse control and short-circuit your core reward system need to be investigated on a personal level. So it isn't just that you aren't doing those hourlong reading sessions in silence but that you're actively practicing a different kind of negative behavior.
This is just one uneducated person's opinion. If we're talking about a dysfunctional reward pathway would it not stand to reason that someone's gravitation toward systems who provide thousands of small immediate rewards only reinforce this dysfunction? Think video games, porn, and instagram. Juxtapose this with reading a novel, painting a picture, or finally understanding recursion. I feel kind of gross typing that out because it feels like some sort of appeal to nature but I can't shake it.
> If we're talking about a dysfunctional reward pathway would it not stand to reason that someone's gravitation toward systems who provide thousands of small immediate rewards only reinforce this dysfunction?
This makes perfect sense to me.
But in the longest term, what actually /is/ the point? What is the reward that people are supposed to be pursuing /instead/ of video games, porn, and Instagram? We cannot pursue long-term goals if we don't have any. Where do they come from, those goals, that purpose?
> I feel kind of gross typing that out because it feels like some sort of appeal to nature but I can't shake it.
I wonder what you mean by this.
The apparent grossness of appeals to nature must stem from the fact that they have been used to justify injustice. But every form of argument is used to justify injustice -- so I don't think we should pre-emptively cut away our mind's ability to think naturalistic thoughts, just to avoid error. Maybe we have ignored Mother Nature for too long.
This brings me back to the original question, about purpose. Maybe it comes from Nature. Maybe a failure to enthusiastically perform for society means that the menu of options offered by that society contains nothing compatible with what Nature actually wants for us.
Porn is the best example. Why is it bad? What real thing is it simulating? What should you be doing instead?
Video games are similar: What real thing is being simulated?
You mention the development of competencies as an alternative. I agree that this is better. But what purpose of Nature's is served by the development of skills?
The feeling I can't shake is that addiction is the substitution of the simulated for the real, that increasingly everything is simulated, that the thing we are being distracted from is our own biological reality, and that we are, again artificially, trying to hack our own reward systems to be satisfied with goals that our not in our own Natures.
Sure, I vaguely remember seeing a bunch of studies about how instant access to information, social media, "mindless" entertainment and constant stimulation is badly hurting our ability to focus. I've personally stopped listening to music or reading social media/news on my phone when I commute or go for walks, as I find the quiet time really helps my focus and attention longer term.
