At this point, I’m pretty positive I do, but I’m still not fully convinced, and I’m still not entirely sure why I’m not entirely sure yet. Maybe this essay exists solely for my own benefit of organizing my thoughts and feelings on the matter, or maybe someone else will find this enlightening as well.

I was recently diagnosed with ADHD by a psychiatrist and my primary care doctor who concurred. I’m 28 years old and was never flagged as ADHD before, but I suspect that is largely because I was in environments that were maybe not the best at recognizing or even acknowledging the existence of ADHD. Here are some myth-busting and baseline premises I’ve discovered as part of this process.

• ADHD is a real thing that affects how your brain works. It has been picked up in brain scans (though it’s not fully settled on how that works yet), and we can reliably diagnose it by looking at the repeated behaviors of those who have it.
• It is commonly diagnosed in children but can be discovered and diagnosed in adults. (There are some rumblings of adult-onset ADHD being a thing, but most people think it’s adults that never got diagnosed.)
• The concept of ADHD has been around since the early 1900s. There are some theories that our current environment of overwhelming technology has contributed to its existence (I’m currently surrounded by four computer monitors and a cell phone, all buzzing notifications at me), but there’s no definitive word on that yet, and it’s certainly not the only cause.
• About 13% of U.S. boys are diagnosed, and 6% of girls. However, there is some agreement that we’ve been a bit too trigger-happy with that diagnosis.
• It is genetic. If one of your parents has it, there’s a roughly 35% chance you do.
• There’s no established correlation between ADHD and IQ, positive or negative.
• There are a few different treatment approaches, but behavioral interventions (Pomodoro timers, GTD method) + stimulant medications (Adderall, Vyvanse, etc) seem to be by far the most effective.
• “Adderall/Vyvanse/Whatever is just giving kids meth” is… well kind of true. Though there’s a massive difference between taking a dose or two of highly controlled and regulated Adderall in the morning and shoving crystal meth up your butt for 3 days straight, they’re chemically very similar.

What Is It?

There are plenty of better resources on this; I particularly liked this Andrew Huberman podcast on the matter (his recent controversy and weird following aside, the content seems solid). But if you’d like a quick and dirty explanation from a self-professed non-expert, I best understood it as a computer metaphor.

Your thinking, conscious brain has two primary processes: observe and focus. observe is considered the default process, and it activates when you’re at rest. This process is event-driven; it’s passively observing your surroundings, and if it sees, hears, or thinks of anything of interest, it can alert you. From there, it can decide if that thing is interesting enough to start a focus process. focus then hones in on that thing until it decides its done, or it gets tired.

In a neurotypical brain, these processes only run one at a time. When observe starts a focus process, observe mostly hides in the background until focus is done so that focus isn’t sidetracked by random observations and thoughts that observe comes up with. Sometimes, like if you haven’t gotten enough sleep, this hierarchy is disrupted so that observe and focus are running at the same time. So while you try to focus on one thing, observe is constantly chattering in your ear about a million other things you should also run focus on. This is an annoying occurrence to most people, but for ADHD brains it is a way of life. So while you’re focusing on something important like driving your car, your brain won’t stop trying to get you to think about that thing at work you need to finish or that squirrel that just ran across the road and oh gee I hope the squirrel is okay, and I wonder what kind of squirrel it is, I should look it up when I get home, and also I need to switch the laundry, and I should put that appointment in my calendar so I don’t forget, and I should really focus on this squirrel thing so I don’t forget that when I get home, and…then you crash.

So while these two processes compete for attention, the problem is compounded by the fact that people with ADHD typically have less RAM to work with. So for example, a neurotypical person can hold five or six things in their mind at once, while someone with ADHD can max out at two or three. This is especially tricky because when you decide to focus on a few things, observe keeps adding things to the list, which kicks others off of the list. This is why ADHD people are especially prone to that phenomenon where you walk into a room, and realize you’ve forgotten why you ever wanted to go in that room in the first place. And why it’s hard to remember important things like where you put your keys 5 minutes ago. And why ADHD people frequently suffer Overwhelm.

Why Do I Think I Have It?

Mostly because multiple doctors, after listening to my issues and having me take this survey, said I do. Also, the more I learn about common symptoms and listen to the stories of others with ADHD, all of these things match my experience to an uncanny degree. Some that match with me particularly:

• Easily overwhelmed when faced with what most would consider a reasonable task list.
• Extreme difficulty concentrating on any one thing, even things I enjoy like TV, books, and video games. It’s easy to feel restless and reach out for the next thing, and the internet is an especially dangerous tool to have here. I’ll start something at work I’m excited about, then some other random thought will enter my mind, and in no time, the day will be done. I’ll be watching two videos in the background about system design while reading some esoteric article on poisonous frogs. Even as I write this, I’ve switched my attention to a bunch of random, unconnected topics. I’ve also jumped around the essay itself, writing a couple sentences in one spot and then jumping halfway down the page to elaborate on some other point.
• Except sometimes when my brain decides something is unbelievably fascinating, so much so that I’ll forget to shower or eat because I need to know every detail about how dogs’ noses work. Most people refer to this as hyperfocus.
• Hearing the phrase “wasted potential” a lot as a kid.
• I’m constantly forgetting appointments, where I put my keys, how to get home, and the names of people I’ve known for weeks.
• I can never seem to finish anything. My task history is littered with assignments, hobbies, and projects that all are close to the finish line, but never made it.
• I have a hard time getting to sleep because I’m always thinking of random bullshit that I need to know about NOW.
• I’m highly susceptible to the “Doorway” effect.
• I’m constantly fidgeting with something, getting up to pace, or generally being restless.
• I was recently prescribed Adderall, and it was such an emotional experience I cried with joy at the end of the day, a reaction that is nearly ubiquitous among ADHD people and not all that common among others.

When listing these symptoms, it’s common for people to say things like, “I forget my keys and get distracted sometimes too. That doesn’t mean I’m ADHD,” to which you’d be right. Human brains are all broadly similar. We all get sad, distracted, and prideful sometimes. But there’s a difference between experiencing something occasionally and experiencing something almost always. Everyone gets sad, but not everyone is depressed. Everyone gets distracted, but not everyone has ADHD. Everyone has moments of pride, but not everyone is a narcissist. But when these things happen every day, so much so that your wife is frequently mad at you because of your inability to remember plans or appointments; or you need to designate a specific place in your house where your keys and wallet go, otherwise you will lose countless time every day looking for them, you’ve established a pattern of behavior that indicates your brain works differently than others.

Why Am I Not Fully Convinced I Do?

I still hold this doubt in the back of my mind, so I will lay down my primary reasons for doubting and then try to debunk them because I’m more willing to believe multiple medical professionals on this matter than some irrational doubts.

It’s Statistically Unlikely

This is the easiest to knock down. Even if we over-diagnose ADHD in the U.S., it’s still not a tiny probability. The lowest estimate I could find for ADHD occurrence in my demographic was 6.76%, which is a slightly higher chance than rolling a one on a d20 die. If you’ve played enough Dungeons and Dragons, you know from personal experience that those odds are small, but they’re sure as shit not impossible.

I Don’t Match All of the Symptoms

ADHD is most commonly diagnosed in elementary or middle school. The stereotypical ADHD kid is always hyper-energy, can never sit still, is always getting in trouble, and has abysmal grades. A lot of adult ADHD sufferers also deal with impulsiveness and its consequences, like terrible credit scores, gambling debt, or an inordinately high amount of jobs and relationships.

I was never a troublemaker as a kid, and while my grades were never spectacular, I typically excelled in a few subjects while being below average in others. No one ever flagged me as ADHD when I was a kid¹. As an adult, I’ve made a few impulsive decisions here and there, but am relatively boring.

This is all true, but it ignores the fact that a diagnosis of something does not require the presence of every single symptom. I’ve undeniably had COVID-19 at least three times. I displayed a lot of symptoms, but I never felt one of the most common COVID symptoms: a shortage of breath. That doesn’t mean I never had COVID; I have multiple tests to disprove that assumption. And even if I don’t match every symptom, the list of ones I do match with is very long.

I Could Be Fooling Myself

There is a psychological phenomenon called the Forer Effect that I’m afraid of falling into. It’s a tendency for people to interpret very general statements about the human experience as having deep personal insight into themselves. Statements like “You have a tendency to be critical of yourself” and “You have a great need for other people to like and admire you” are general enough they apply to everyone, but when you hear them it’s common to think it describes you in particular and feel a deep emotional reaction. It’s how psychics and mind readers make so much money tricking you into thinking they have a particularly deep insight into your pysche.

But ADHD symptoms don’t seem to have that quality. There are some that are pretty general like, “You often feel overwhelmed when a lot is expected of you at once”, but others that are much more specific like, “You find it incredibly difficult to finish a task, even if the hardest parts are already done” or “You often feel overly active and compelled to do things, like you were driven by a motor.”

Why Is It a Problem?

Alright, I have it. Why is it something worth fixing?

This Ken Robinson talk about education and ADHD makes a good point about how we see ADHD as a problem not because our brains are built wrong, but because the education system is. Society has been designed in overt and subtle ways to move all of humanity into some narrow pathways, pathways that don’t play to the strengths of ADHD people. While I can’t reform society, I can try finding a different niche within it.

The problem is that I’m already in a niche considered nearly optimal for ADHD people. Being a software developer plays to many of ADHD’s strengths, where we can bounce around the walls learning 15 different things a day and then spend a week holed up doing nothing but hyper-focusing on a program. But it’s still an issue for me. My focus is scattered and unpredictable. It’s preventing me from where I want to go in my life and career, and it’s been something both my teammates and I have been frustrated with.

It also makes me anxious and depressed consistently. I always end the day tired because I was “working” all day, but I get very little done. So I’m exhausted, disappointed with myself, depressed at how little progress I’m making, and anxious for the next day. It’s been an unpleasant way of existing, and I thought it was normal for so long. To find out that it’s not has been a revelation.

How Do I Fix It?

My main complaint is lack of focus, specifically lacking consistent and controlled focus. I’m blessed with a flexible schedule, but it’s not flexible enough to let me sit around all day and wait for inspiration. So I need to focus (hehe) on solving that aspect. Other parts I’ve already recognized and solved (e.g. important objects like my keys have designated places so I can never forget, and I make ample use of Google Calendar, TODOist, and my wife’s impeccable memory to never forget appointments), but now that I know the full extent of what’s going on, I can be much more holistic in my approach.

The Usuals

A good diet, consistent exercise, lots of sleep, and cutting out things like alcohol are table stakes when dealing with pretty much any human issue. No matter who you are, if you don’t have these things together, you’re sabotaging any other solutions you come up with.

Pharmaceuticals

Aside from the basics, good old-fashioned American drugs are the most effective way to treat ADHD. In children, they can even help change the structure of your brain over time so that ADHD doesn’t really bother you in adulthood anymore, which is badass. But for those of us who missed that boat, drugs are pretty much unavoidable for the rest of our lives.

There are some non-stimulant medications you can take to help improve ADHD symptoms. Wellbutrin is a depression medication that’s handy for this. It can also help with anxiety, which tends to come packaged with ADHD. It didn’t do much for me personally, though there have been a lot of success stories.

The obvious gotos after that are amphetamines like Adderall and Vyvanse. There’s a litany of different kinds, but they all do the same thing and force observe to be quiet and let focus take over for a bit. For me, my first time on Adderall was a revelation. For the first time in my life, my brain was quiet. I didn’t get distracted all day by random bullshit, and at the end of the day, I was pleased. I finished a task from start to end, multiple tasks even! A feat that on a typical day seems impossible.

There are some risks to using Adderall. Dependency is the one I’m most concerned with. I’m still confused about what “addiction” means in this context. From Scott Alexander:

The data on this are really poor because it’s hard to define addiction. If a prescription stimulant user uses their stimulants every day, and feels really good on them, and feels really upset if they can’t get them…well, that’s basically the expected outcome.

I’ve heard anecdotally about people who become so dependent on Adderall that they become depressed zombies for long periods when they lose access to it. Given that amphetamine shortages aren’t exactly rare events, this is a real issue to consider. However, these stories tend to involve individuals with severe cases of ADHD, or who have been systemically abusing it for a long time. Others can function fine if they miss a dose and regularly skip doses on weekends and vacations. I’m still new to this game but have found this strategy to be the best approach for me so far.

Behavioral Interventions

It’s important to note that drugs aren’t a panacea. They unlock your ability to concentrate, but if you let yourself you can easily lock into learning about freshwater sharks all day instead of that program you need to write. Drugs can also stop working or being viable for all kinds of reasons. Thankfully I’ve been working on these for a while² and have a pretty good stable of mental and tech tools that work for me.

• Using TODOist to keep track of my work and personal life tasks. Its reminders and scheduling are crucial for me to be able to remember to do anything. It also lets me break down tasks into smaller bites to fight of the dreaded overwhelm.
• Using Pomofocus for my Pomodoro timers.
• Using Blocksite to stop myself from going into unproductive rabbit holes.
• Meditation and mindfulness are helpful for ADHD people. It’s been very effective for me to recognize when my attention is drifting and guiding it back to the thing I need to focus on. It is also surprisingly difficult to do consistently, even for neurotypical people.
• Aggressively silencing notifications. During a Pomodoro session, I’ll make sure to put my phone on DND and stash it somewhere I can’t see it. Then on Slack, I’ll set my status to “Focusing” and pause notifications.
• The How to ADHD YouTube channel has a lot of strategies and tips for handling common ADHD hurdles, and its short-format, engaging videos that are ideal for, well, people with ADHD.

Supplements

These vary wildly in effectiveness and have all sorts of issues as they’re unregulated, and frequently a favorite of fraudsters to separate fools and cash from each other. That said, there are some that have minor but demonstrated helpful effects:

• Caffeine can almost function like a micro doses of Adderall for some people.
• Creatine can help working memory. I mostly take it for muscle growth, but it has some small benefits to cognitive tasks.
• Fish Oil, specifically Omega-3s, is particularly beneficial. There are a lot of claims about its benefits for heart health, and can apparently help a lot in focus and hyperactivity.
• Ashwagandha is a bit niche but apparently effective at improving attention, though I personally haven’t seen much benefit.
• L-theanine is usually combined with a stimulant like caffeine or Adderall to help attention. There’s some anecdotal evidence out there and a few studies with small sample sizes. I haven’t tried it myself, but it might be next on the list.

What I Take Away from Writing This

Well, I have ADHD. I think I’m ready to accept that. This was informative mostly for my own psyche, but on the miniscule chance that someone actually finds this, perhaps it can help them figure it out like I did. If you’re in that position, I will say I wish I had tried the scarier sounding interventions like Adderall sooner. It was akin to wearing glasses for the first time, and not at all how I expected it to be. It’s also tempting to think that discovering and treating something like this will ultimately “fix” you. It won’t, but it will help a whole lot.