I was diagnosed with ADHD in my late 40s (November 2021). My diagnosis has helped understand my life, particularly why I haven’t yet lived up to my potential. Armed with knowledge and effective medication (as of August 2023), I feel more confident about the rest of my life.
ADHD is real and harmful. It’s also the most treatable mental disorder – 80% of people with ADHD find a medication which gives them real benefit. If you suspect you have ADHD, it’s worth getting a diagnosis and treatment.
This is the reason that I’ve written down what I’ve learnt about ADHD on this page – perhaps it will help you or someone you care about.
I am not, of course, a medical professional and what I’ve written here is not medical advice. Please seek the help and advice that you need from a qualified person.
Table of Contents
ADHD isn’t what you think
Attention Deficit Hyperactivity Disorder is a terrible name for ADHD.
Firstly, you don’t need to be inattentive and hyperactive to have ADHD – you can be either or both.
Secondly, no one with ADHD has a deficit of attention – we’re able to focus very deeply and intently on whatever interests us. Our problem is regulating our attention. That is, we have difficulty:
- paying attention to uninteresting tasks, even if they’re important,
- not paying attention to interesting tasks, even if they’re unimportant, and
- filtering out (not paying attention to) distracting stimuli.
This is caused by a lack of dopamine in our pre-frontal cortex – our brains are looking for dopamine wherever it can find it (in interesting tasks and new stimuli).
As for hyperactivity, there are much subtler forms which teachers and parents can easily miss (such as talking excessively and blurting out answers). In adults, hyperactivity usually becomes a restless mind and/or impulsivity.
Lastly, the harm caused by ADHD isn’t limited to attention or hyperactivity at all – we have problems with our executive functions (planning, tracking time, emotional regulation, self-perception, self-talk, attention regulation and other functions which allow us to control and understand ourselves). ADHD is a much bigger problem than you think.
Ignore the stereotypes, then, and keep reading.
What ADHD feels like
This 28 minute video clearly explains what it feels like to have ADHD:
In addition to the experiences / symptoms mentioned in the above video, a person with ADHD might also experience some or all of the following:
Potential: Having the sense of immense potential but experiencing intense frustration because your results don’t back up your self-belief. Working hard with have little to show for it. Frequently having ideas to fix your work / business / life but most of them haven’t worked. This is very confusing – why you can’t catch a break?
Career: Not having a career but several of them. Making sudden, unplanned career moves. Quitting jobs in sheer frustration without another job to go to. Possibly giving up on employment altogether. Not knowing what your career goals are – all you know is that your next job must to be interesting for your brain.
Hyperfocus: Thinking about an interesting problem all of the time, even when you should be thinking about an important task. Feeling stressed by the need to do the important task and the desire to do the interesting task (and switching constantly between these tasks).
Timeliness: Being routinely late because you can’t stop interesting tasks or are too optimistic about fitting more tasks in needing to go (and never learning that this doesn’t work). Uninteresting tasks take much longer than they should or get put on the later (= never) pile.
Dating: Dating impulsively. Being romantic and spontaneous but unreliable. Pursuing your partner until you have ‘won’ them and then struggling to give them attention. Feeling that your partner is tired, difficult and nagging (from dealing with you and your unreliability).
Parenting: Loving your kids deeply but not being consistent in giving them your time and attention. Not planning activities or disciplinary actions. Giving inconsistent discipline, sometimes with instant and inappropriate anger.
Self-Disclosure: Happily disclosing personal information to others. Asking for advice and support from others until you become embarrassed by your lack of progress. .
Friendships: Forgetting friends and family you haven’t seen for a while. Being an excellent listener when having interesting and unusual conversations but struggling to pay attention to everyday, mundane conversations.
Impulsivity: Giving advice to people who weren’t seeking it. Snapping at people. Dropping whatever you’re doing when something interesting comes up. Buying things emotionally. Spending, not saving.
Planning: Wanting to plan but failing to. Doing things right now or not at all. Not knowing what’s on your calendar. Difficulty breaking down complex problems and planning how to tackle them (unless the complex problem is very interesting). Needing to be spontaneous to overcome a lack of planning.
Goals: Not knowing what you want from life. Living mostly by responding to the needs and opportunities which present themselves to you.
Personality: Having an extreme Big 5 Personality profile – high volatility, low orderliness and (unfairly) low industriousness (because you can work very hard on interesting things but industriousness is about getting important things done).
What is ADHD?
ADHD is mental disorder which affects the prefrontal cortex of the brain. Here is Wikipedia’s explanation of what the prefrontal cortex does:
This brain region has been implicated in executive functions, such as planning, decision making, short-term memory, personality expression, moderating social behavior and controlling certain aspects of speech and language. Executive function relates to abilities to differentiate among conflicting thoughts, determine good and bad, better and best, same and different, future consequences of current activities, working toward a defined goal, prediction of outcomes, expectation based on actions, and social “control” (the ability to suppress urges that, if not suppressed, could lead to socially unacceptable outcomes).
The prefrontal cortex, then, is one of the features which separate human brains from animal brains. Animals do not make plans, make decisions, set goals or moderate their behaviour – they merely respond automatically to the stimuli in their environment. Humans, however, use their prefrontal cortex to decide how they will respond to environmental stimuli. Unless, in the case of ADHD, their prefrontal cortex lacks the neurotransmitters (dopamine and norepinephrine) required to perform its function. We have trouble with executive functions and, therefore, live mostly in the present (and fail to attend to their future).
Here’s a 3 minute video which explains the problem with neurotransmitters and what stimulants do. (Note that it contains an error – according to another video, amphetamines may have a stronger effect than methylphenidate because amphetamines release more neurotransmitters and inhibit uptake and they have a longer half-life in short-acting forms):
30 things parents should know (Dr Russell Barkley). At 2 hours and 51 minutes long, this epic presentation covers everything you need to understand as you start your ADHD journey. It’s aimed primarily at parents of children with ADHD, but the knowledge applies to adult ADHD as well. Don’t miss it.
Adult ADHD: Patient Perspectives and Best Practice Strategies. In a presentation aimed at doctors, two ADHD experts who have been involved in the development of new ADHD medications (Dr C. Brendan Montano and Dr Rakesh Jain) explain what ADHD is, how to diagnose it and how to treat it. The presentation pays attention to the risk of doctors missing an ADHD diagnosis (from being seduced by anxiety, depression and other symptoms) and ends with an interview with a patient whose ADHD was overlooked and mistreated medically for several years.
The international consensus statement describes the set of ADHD knowledge which is broadly accepted by the medical community. It contains many useful links to ADHD research.
r/ADHD is a good subreddit for learning about other people’s experiences with symptoms, medication, diagnosis, etc. and for asking questions.
Reaching for a new potential by Oren Mason is an excellent and easy read for understanding ADHD, its diagnosis, medications and the impact that treatment will have on your life. The site for purchasing the ebook is a pain but you’ll receive a PDF and the book is worth the hassle. Because the book was written in 2009, some of the ‘future medications’ have are now available.
This podcast episode – Don’t Eat the Frog with Jesse J. Anderson – was instrumental in working out that I had ADHD (and I’m indebted to a close friend for sending it to me).
The ADHD Rewired podcast has many helpful interviews with ADHD people, particularly about their life and diagnosis experience.
Overcoming Distractions is ADHD-centric advice on using your attention well (but will be helpful to anyone).
There are currently no tests for ADHD which use brain scans, DNA or other physically-observable phenomena. ADHD is diagnosed by interview, aided by standard question-based tests:
Because obtaining a diagnosis is not cheap, it’s worth doing some self-testing first, using some of the same tests that medical professionals use in their diagnostic interview. Please, however, note the following:
You cannot diagnose yourself. Seek the advice of a medical professional. There’s little benefit in merely testing yourself and suspecting that you have ADHD. The enormous benefit of being diagnosed is having access to medication, support, other therapies and workplace / educational accommodations.
If you’re struggling, get help. Whatever results you receive from doing these tests yourself, consult a qualified medical professional and get the help you need. It’s possible that you have ADHD even if your test results are borderline or negative. It’s also possible that you have an entirely different condition which will benefit from diagnosis and treatment. Err on the side of caution and seek help.
If there’s no harm, it’s not ADHD: The DSM-5 criteria for ADHD says that “there [must be] clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning”. If you’re coping very well in every sphere of your life, you don’t need to worry about ADHD. That said …
Harm might be hidden by coping mechanisms: It may be that you are suffering harm but have identified coping mechanisms which hold things together for you (more or less) until you reach a crisis and things fall apart. This is why intelligent people are often diagnosed later in life – they are better able to identify coping mechanisms (e.g. turning school into a game) and delay their crises (and diagnosis) until make later in life.
Attention-Only ADHD (a.k.a. ADD) can test differently. Some tests include hyperactivity-related information and, therefore, it’s possible to have attention-only ADHD even though you fail a test. I presume that the same applies to hyperactive-only ADHD but I have no information on this, sorry.
If might not be ADHD: Some of the symptoms of ADHD are also symptoms of other disorders and conditions. Only a medical professional can perform this differential diagnosis (and may use tools such as this differential diagnoses chart for DSM-5 to help them do that). For instance, here’s the story of someone with Bipolar Disorder who was falsely diagnosed with ADHD.
It might be ADHD and something else: A positive test result does not indicate that ADHD is your one and only condition. It is very common for people with ADHD to have one or more other conditions at the same time. When you seek a diagnosis, tell your doctor all of your symptoms and concerns (especially those which are not common to ADHD).
You don’t know yourself as well as you think: People with ADHD and many other conditions have poor self-perception (they cannot see themselves as they truly are). It’s quite likely, then, that you’re not aware of all of your symptoms and behaviours. You’re also likely to underestimate the severity of your symptoms and behaviours (and may blame others or circumstances for problems which are driven by your ADHD). Your intimate partner, family and friends will be able to help you have perspective (and bringing a trusted person to your diagnosis, with the permission of the medical professional, will help).
Please read the caveats in the previous section before doing any self-testing.
Start with ADHD Self-Report Scale Symptom Checklist (ASRS111). This is a simple screening test and contains instructions for scoring it.
Then go to the ADHD RS IV with Adult Prompts. You will see 18 main questions, each with their own sub-questions. Circle the sub-questions and then identify the highest sub-question score to obtain your main question score (for each of the 18 main questions). The first 9 questions relate to inattention, the second 9 questions relate to hyperactivity. Add up the scores for the first 9 and second 9 independently. If your score in either is high (I’m not sure how high is the threshold for ADHD, but the maximum score for each half is 27) then it’s likely you have a subtype of ADHD (inattentive or hyperactive respectively). If both sections score highly, it’s quite likely that you have combined (both inattentive and hyperactive) ADHD.
Then do the Jasper Goldberg test – a score of 70 or higher indicates a likelihood of ADHD.
Consider also the list of Differential Diagnoses, showing other conditions which share symptoms with ADHD. Note that it’s very common for people with ADHD to also have another condition. It’s also common for ADHD to be mistaken for anxiety and depression – the frustrations of ADHD can lead someone to be anxious and depressed and doctors often miss the ADHD as the underlying cause and attempt to treat the anxiety and depression directly.
How to Obtain a Diagnosis
Obtaining a diagnosis is vital for gaining access to medication (which is needed and effective for most people with ADHD). It also gives you clarity about who you are, what you’re facing and what to do next. If you think you might have ADHD, I strongly recommend obtaining a diagnosis.
Here in Australia, adults and teenagers should see a psychiatrist for diagnosis. Each psychiatrist will have a minimum age for the teenagers that they will see. Children will need to see a paediatrician.
You will need to:
- Identify one or more psychiatrists / paediatricians who have experience dealing with ADHD (this is important),
- Contact their office to find out when they’re available for an initial ADHD assessment (a one or two month wait is common and sought-after people might not be available for several months),
- Visit your GP to obtain a referral to them,
- Send the referral to the psychiatrist / paediatrician’s office,
- Book your initial appointment with them, and
- Wait (which is the hard part).
The cost of your diagnosis will depend on your doctor’s fees. My GP charged their normal visitation fee of $55 for their referral and my psychiatrist charged $430 for the initial diagnosis (you will get money back from Medicare). Because the medication is a Schedule 8 controlled substance, psychiatrists cannot issue prescriptions for more than 3 months. This means visiting your psychiatrist for a short appointment four times a year. My psychiatrist offers 15 minute appointments for this at $115 (again, you will get money back from medicare).
My medication costs are as follows:
- Dexamphetamine: $10 for 100 x 5mg tablets (which lasts me 16 days),
- Clonidine for emotional regulation (and reducing the side effects of increased blood pressure due to dexamphetamine),
- Zyban SR is not on the Australian PBS for ADHD and costs almost $2 per tablet (one per day),
- Vyvanse (which I tried but no longer use) was $40 for a bottle of 30 capsules (lasting one month). In other countries Vyvanse can cost significantly more,
- Fish Oil
- Vitamin C
If any or all of this sounds too expensive, let me assure you that it’s worth it – the financial burden of untreated ADHD is immense. Without treatment you (or your ADHD child) may not complete your education, lose income (from being fired or quitting jobs), limit your income (by chopping and changing careers), have failed businesses, waste money, pay too much interest (e.g. unpaid credit cards), have more car accidents, get more fines, have health complications (from poor decisions, bad dental hygiene, poor eating, etc.), have unplanned pregnancies, marry the wrong person, have a higher likelihood of divorce (even after marrying the right person) and fail to plan and save for your retirement. The ADHD tax is real.
Once you understand the cost of undiagnosed ADHD, diagnosis and medication are ridiculously cheap.
Avoiding an incorrect diagnosis
Do tell the diagnosing professional that you suspect ADHD. 15 years before my diagnosis I went to a psychologist to understand why I couldn’t concentrate in my well-paid job that I wanted to keep. I never considered that I had ADHD (because I didn’t have an attention ‘deficit’) and he didn’t think to test me for it. He tested me for bipolar, said I didn’t have it, agreed that I couldn’t concentrate on my work and shrugged his shoulders. I walked out without a diagnosis, walked out my job, walked out of the next job, quit employment and struggled to make money in business. That missed diagnosis cost my family millions of dollars in lost wages and made it much harder for me to be effective as a husband and father.
Do not steer the professional toward an ADHD diagnosis. Do not withhold information from them. Be completely honest with and give your full history to the medical professional who is diagnosing you. You might be wrong because it might not be ADHD or it could be ADHD and something else (as explained above).
Note that medical professionals can be seduced by symptoms of anxiety and depression and therefore fail to diagnose the ADHD which causes those symptoms (of anxiety and depression). I recommend listening to an interview with someone who was wrongly diagnosed.
Leading up to my diagnosis, I was primarily concerned about a false negative (having ADHD but not being diagnosed with it). I did not, however, want to distort the diagnostic process.
What I decided to do was to create a document which listed my evidence for having ADHD, grouped by different symptoms of ADHD. These were symptoms I had gleaned from my research and wrote down in no particular order.
Aware that the DSM-5 criteria for ADHD (which are used in Australia) requires that symptoms are present before the age of 12, I also asked my family for any stories which might suggest ADHD. In that also listed evidence from my childhood having ADHD (because the DSM-5 indicates that the symptoms must be present before the age of 12).
In the end, my document was ten pages long. I printed out two copies – one for the psychiatrist and another I could refer to. When he started asking questions about my history I gave him the document. He scanned it for a couple of minutes, nodded and went on with the interview.
I invited my wife to attend my appointment with me and she was happy to come. I was keen to have her support and the benefit of her memory during the diagnosis. More than that, however, I wanted her to understand the diagnosis and learn more about my disorder.
My psychiatrist asked me various questions about my symptoms both in adulthood and childhood and ran through a number of tests. My answers and test scores convinced him that I had ADHD and he started explaining and discussing medication options.
ADHD is the most treatable mental disorder, with medications which can provide temporary relief from symptoms. This video provides an overview of available ADHD medications, how they work, their common side effects and more:
Different medications have different levels of effectiveness. Note, however, that the best treatment is whatever is most effective for you, not what is most effective for the average person. Your doctor will find the medication which is most effective for you.
Medication is only the starting point – here Russell Barkley speaks about the non-medical interventions needed for ADHD people to succeed:
My Treatment Experience
Disclaimer: What works for me may not work for you – different people respond to different meds.
- I wish that I had started on dexamphetamine (not Vyvanse),
- Dexamphetamine was not enough for me – the big game changer was Zyban SR (as well as dexamphetamine),
- 3000mg of fish oil taken in the morning improves the reliability of dexamphetamine for me,
- High-dose Vitamin C (1000mg) kills the effect of dexamphetamine for me before I sleep, and
- Medication alone wasn’t enough for me – I also needed clear goals and daily structures.
My psychiatrist recommended dexamphetamine as the best medication to try first because it’s the most effective for most people. He then asked me whether I wanted to the short-acting (dexamphetamine) or long-acting (lisdexamphetamine, brand name ‘Vyvanse’). What I should have done was ask his opinion as to which was best to start on. What I did instead (impulsivity!) was ask for Vyvanse, because my research had indicated that this was the gold standard – longer lasting (12-14 hours) and smoother in its on/off characteristics. My psychiatrist give me scripts for 20mg and 30mg of Vyvanse and started me on a titration phase – I was to take 20mg daily for one week and then go up 10mg each day (combining tablets as needed) until I reached 50mg (which would be a week before my next appointment).
The next day I took 20mg of Vyvanse and was astonished by its effect. I was less compulsive (my hyperfocus disappeared), less impulsive, I could regulate my emotions and I could direct my attention (I could read my Bible without constantly re-reading what I just read, and I could keep reading for an hour). I was absolutely overjoyed – my ADHD problems are fixed! My life will be better forever!
The next day, however, I got absolutely no effect from my 20mg of Vyvanse. My body had clearly started tolerating this low dose, so I emailed my psychiatrist’s office asking if I could go up a dose without waiting a week (impulsivity!). That night, however, I had a cripplingly low mood and anxiety which prevented me from going to dinner with friends. I emailed my psychiatrist’s office a second time, saying ‘Ignore my last email’.
It then took me 142 days to optimise my stimulants (which was only the start of my meds journey). I know this because I have kept a detailed log of what medication I took, when I took it, whether it worked, how long it worked, the side effects and so on.
The only major side effects I had were a loss of appetite during the day (which suited me fine – I had kilos to lose), and occasional bouts of an incredibly low mood (including one day where I forced myself to avoid cliffs on my daily bushwalk …). Most of the time, however, the Vyvanse simply didn’t work for me. After my first day of incredible effect, it was day 27 (when I went up to 50mg) before I had a strong effect again and it lasted only 2 days. In my next appointment I was allowed to go up to 60mg and I had a good effect for 4 days in a row (My ADHD problems are fixed! My life will be better forever!).
Then, however, the rollercoaster kept going – I had 5 bad days, 5 good days, 1 bad day, 1 good day and then 4 bad days. Clearly I needing to go up in dose again to receive a reliable effect. At the point, however, I had a significant problem.
The maximum dose for Vyvanse in Australia (without special permission requiring a diagnosis from a second psychiatrist) is 70mg. And if I went up to 70mg, I wasn’t allowed to have any short-acting dexamphetamine to extend the effect of the Vyvanse each day. The effect from Vyvanse lasted only 11 hours (kicking in one hour after I took the tablet) and this was nowhere near enough. If I took the tablet early in the morning (6am) to get work done during the day, it would run out before I spent time with my family (and I would be emotionally dysregulated and snappy with them). And if I took the tablet later to give coverage for my family, I couldn’t start my work day well (and I’d waste the day). I felt completely stuck – I needed to increase my Vyvanse dose to make it more reliable, but I needed to stay on my current dose so that I could have longer coverage (whenever my psychiatrist would finally let me have dexamphetamine as well).
Vyvanse + Fish Oil
What I did, then, was try dietary supplements (one at a time) so that I could stay on 60mg of Vyvanse but make it more reliable. I started with 3000mg of fish oil and this had a noticeable effect – I had 15 good days in a row (My ADHD problems are fixed! My life will be better forever!). But then I had 3 bad days. And 1 good day. Then 2 bad days, and so on. I also tried magnesium (which seemed to destroy the effect of Vyvanse and give me a bad mood), and zinc (no conclusive results).
So I was stuck. 60mg of Vyvanse was giving me only 11 hours and worked only 65% of the time, but I couldn’t go up in dose or I’d have no dexamphetamines to extend my day. On top of that, I very much doubted that 5mg of dexamphetamine (the maximum I was allowed to have with 60mg of Vyvanse) would do anything for me, given I needed such a high dose of Vyvanse.
Dexamphetamine + Fish Oil
On my next appointment I was given a script for 5mg of dexamphetamine and I tried it at 7pm. I was surprised to see that it had an effect on mood and compulsion / hyperfocus (which was good) but it felt ‘sharp’ in my brain at 10pm which was not desirable. The next day I took 5mg of dexamphetamine in the morning (7am) and then Vyvanse at 11:30am but then I was wide awake until 1:30am. I started taking 1000mg of Vitamin C an hour before going to bed and that helped with the sleep (Vitamin C raises the acidity of your blood (or urine), which reduces the half-life of the dexamphetamine). I also started taking the dexamphetamine at 6am so that I could take Vyvanse earlier. This was a reasonably good outcome, but it required getting up at 6am every day (even on the weekend, which was not ideal).
One morning I had a happy accident – I turned off my 6am alarm and went back to sleep without taking my dexamphetamine. When I woke up, it was too late to take dexamphetamine + Vyvanse, so I decided to take 5mg of dexamphetamine three times that day instead (as I was allowed to have up to 30mg of dexamphetamine per day if I had no Vyvanse). And that worked reasonably well, so I kept trying it. A few days later, I decided to that I wasn’t going back to Vyvanse. I continued taking 5mg of dexamphetamine 3 times per day – the first dose when I woke up, the last dose at 6pm and a dose in half-way between (which went back and forth each day, depending on the time I woke up). I found I could be quite flexible with the gaps between doses (anywhere between 4-6 hours per dose was fine), which gave me much more flexibility in my day.
This was great (and I loved the flexibility of not needing to wake up at 6am) but 5mg wasn’t enough. That dose dealt with my hyperfocus and compulsion (which was good) but didn’t give me enough support to be proactive – I felt lost and aimless (without hyperfocus to drive me or any initiative to drive myself).
I took myself up to 7.5mg and it was a step in the right direction, but not enough. A few days later I took myself up to 10mg 3 times per day and that’s the dose I’m on now. This seems to work well. It gives me coverage for every waking hour (from ten minutes after I wake up to the time I go to bed) and is reliable (it’s worked 25 days in a row at the time I’m writing this). I then believed that my medication was optimised. Except that it wasn’t.
Clonidine + Dexamphetamine + Fish Oil
After about a year on dexamphetamine, I still wasn’t making progress in my business endeavours, and I was becoming quite despondent about that, and was still emotionally volatile. I mentioned this to my psychiatrist and he suggested Clonidine (one 100mg tablet, twice daily) which can help limit your responses to negative stimuli (because it’s an alpha agonist which helps reduce the sensitivity of the alpha-2 adrenergic receptor. After taking it I felt no difference with respect to emotional regulation, but it did help with a side-effect of dexamphetamine (discomfort in [ahem] intimate moments due to increased blood pressure) so I’ve kept taking it.
By February 2023 (16 months after my diagnosis) I was feeling quite despondent again – I felt that my medication, while helpful, was never going to give me the level of benefit that I needed to make a business or job work. At the same time a friend asked me to do some photography for them and, long story short, I fell back in love with photography. It occurred to me that if I did something I could be consistently passionate about (photography) I could succeed in business doing that, even if it wasn’t a great field to be in (photography suffers the curse of economic abundance).
Photography was lots of fun, at times, but I still wasn’t doing all of the things I needed to do. I was doing lots of street photography and loving it, but I wasn’t doing sales or marketing. I would take photos for free for people but not get their photos to them in a timely manner (because editing is a lot of effort). I was trying to do several types of photography at once and making progress with none of them.
Queue more despondency, deep frustration and utter helplessness. Until I took Zyban SR.
Zyban SR + Clonidine + Dexamphetamine + Fish Oil
Sometime in 2023, I visited my psychiatrist and mentioned that I wasn’t going as well as I hoped. He suggested Zyban SR in addition to my stimulants, saying that it wasn’t on the Australian PBS for ADHD so it was quite expensive (almost $2 per tablet) and that it would take 4-6 weeks to kick in.
Money felt quite tight at the time, and I was reluctant to spend an additional $2 a day on something that might not work. Worse, because I thought it would take 4-6 weeks to kick in, I felt that I wouldn’t know whether it helped and then I’d be stuck taking it for the rest of my life (at $2 per day). So I put it off.
By August 2023, however, I was so low (photography – my last resort business – wasn’t working) that I felt I should at least try it.
I took it (along with my Dex) and – oh my goodness – within 10 minutes I was clear, calm, focused and collected. I could direct my attention and switch tasks wherever I wanted (no hyperfocusing). I could also sit and do nothing, without feeling compelled to do something (e.g. be stimulated by a podcast or video). My craving for sugar (which I was constantly craving) or caffeine (which I regularly needed to wake my brain up in the morning).
I knew – instantly – that this is what my brain should feel like. Even better, I had absolutely confidence that I could now hold down a job (do whatever my employer wanted me to do) or run any business (do all of the things that need to be done, not just the interesting things).
I had three perfect, awesome days on Zyban SR (plus dex, etc.). Then a wobbly few days (uh-oh) but since then (23 days and counting at the time of writing this) it’s been awesome. This is consistent with the advisory information for Zyban SR, which is that it takes 1 week (not 4-6 weeks as my psychiatrist told me) for the levels of the drug to stabilise in your body.
One downside of being content (not being driven to do things at all times) is that I have to push myself now to do things (with structures and habits). This is deeply weird because all of my life I’ve been highly driven, but it’s much better than the alternative.
My Daily Routine
For clarity, this is what I’m doing each day (and set multiple alarms to remind me):
- On waking up (5:40am weekdays, 7am weekends): 1 tablet of Zyban SR, 100mg clonidine, 10mg dexamphetamine and 3000mg of fish oil,
- Lunchtime (12pm weekdays, 12:30pm weekends): 10mg dexamphetamine, and
- Evening (5:30pm weekdays, 6pm weekends): 10mg dexamphetamine,
- Bedtime (11:00pm weekdays, later on weekends): 100mg clonidine, 1000mg Vitamin C (acidic type, not non-acidic), one zinc tablet (because I started taking for brain function with Vyvanse and haven’t stopped).
The only drug which is truly time sensitive is the dexamphetamine. I find that I can be reasonably flexible in when I take them – anywhere from 4 hours to 6.5 hours apart. Less than 4 hours and the effect is too strong, more than 6 hours and I crash quite hard (6.5 is really pushing it).
Before I go to bed I take my night meds and, at the same time, put my meds for the next morning and in a metal tin on my bedside table. This has two benefits:
- I don’t miss my morning meds (because they’re ready to go when I wake up), and
- I can check whether I’ve taken my morning meds (when I was half-awake or otherwise not paying attention) by shaking the tin (and there have been a few times when I realised I hadn’t taken them).
I no longer need Vitamin C to sleep (I can wake up in the morning, take my dex and go back to sleep) but I’m still taking it ‘just in case’ and to ward off colds and flu (but remember not to take it during the day to avoid affecting your dexamphetamine).
In a moment I’ll explain that medication alone was not enough for me (see below). Before leaving the topic of medication, however, I want to make some important points:
- The right medication regime for me is not necessarily the right medication regime for you.
- My difficulty with Vyvanse was not the drug itself – it was coming up against legal dose limits which seem to be set for teenagers rather than someone like me (being an adult male who is well over 6′ tall with a large frame). Vyvanse might, however, be the best medication for you, and it seems particularly helpful for children (who might forget to take a dose of dexamphetamine in the middle of the day).
- I know two people who have attention-type ADHD / ADD (i.e. who are not hyperactive as I am) and we’ve noticed that the effect of dexamphetamine (and Ritalin) for them is more subtle than it is for me. This is possibly because hyperactivity symptoms are more ‘in your face’ than the attention symptoms are. If you have attention-type ADHD, talk to your psychiatrist about what to expect. Either way, don’t rely on my personal experience as a guide for determining whether your medication is effective or optimised.
- My psychiatrist told me that many people are on too low a dose of their ADHD meds (assuming that they titrated correctly by started on a low dose and working up). He said that the way to find the right dose was start low and keep going up in dose until you go too far (receive more side effects than you want to deal with) and then go back to the last dose. You need to do this, obviously, under your doctor’s supervision (and I can’t do this because I’m already taking the maximum legal dose).
Medication was not enough
I have found that I also need to set clear goals and maintain a good daily structure (particularly on work days) or I can still waste hours or whole days. This, in turn, can create a negative cycle which guarantees that I achieve nothing for days:
No Goal and No Structure -> Aimless and Unproductive -> Upset and Wanting Comfort -> Staying Up Late -> Sleeping Poorly -> Tired -> More Upset, Aimless and Unproductive the Next Day -> etc.
The good news is that a clear goal can drive a good structure and then this can create a positive cycle:
Clear Goal and Good Structure -> Being Effective -> Feeling Positive and Successful -> A Strong Desire to Pursue My Goal and Maintain a Good Structure -> etc.
Part of my structure is to organise things the night before, to ensure I have a good start on my next day. I pack my laptop bag at night, put my morning meds next to my bed, getting lunch ready in advance and so on. The biggest thing for me, however, is going to bed on time which is very difficult when you’ve had a bad day (and feel terrible), but surprisingly easy when you have a good day (and want another good day tomorrow).
I have also found the motivation to organise and clean up things which have always got in my way – my clothes cupboard is now organised and pristine (no pile of washed clothes on my bed!), my desk is (mostly) much clearer and I’ve got rid of a lot of clutter around the house (which always got me down). This is all a work in progress but already it’s making it easier to get things done (and stay in a positive feedback loop).
Setting goals is, of course, quite difficult for people with ADHD. We have so many ideas and so many options. We’ve tried so many things that we’re generalists and often lack deep expertise that our peers have (in my late 40s I’m competing with workers and contractors who have deep expertise from climbing the same ladder for 25 years!).
With no clear and obvious path to take, we also know that any path we do take will require a lot of work to pay off. This can be overwhelming, particularly when we know that our attention may not last long enough for any (or every) given path to pay off. Sometimes it feels easier to not set goals but this leaves us feeling lost. One answer is to set goals but hold them loosely, giving us the flexibility to change. Another is to reduce the scope of our goals, giving us motivation for a day, week or month so that we can get into a positive feedback loop and set large goals in the future.
Another issue for me (and people with ADHD) was a lack of boundaries – if someone else needed help that I was able to provide, I was usually unable to say ‘no’. I would end up taking responsibility for other people’s problems and get stuck helping them (sometimes with major issues and sometimes, unfortunately, for High Conflict People). This was for three reasons:
- the other person’s problem was often urgent, important and challenging to solve (and became a source of dopamine which captured my brain),
- unlike everyone else (who had a full time job or successful business) I wasn’t doing something more important for me and my family so I felt I couldn’t say no (creating a vicious cycle in I was always helping others and could not, therefore, build something more important for me and my family), and
- as a Christian I felt that if I could help I should help (but I had not factored in my responsibility to meet my own needs and serve my family’s needs and, therefore, had discounted that in the equation.
I am grateful that someone suggested Boundaries by Cloud and Townsend, which helped me to understand the above and much more.
I also found the podcast Let’s Talk Boundaries helpful (start with episodes 1-4 and then pick and choose).
Right now I have effective medication, a clear goal and a good structure and I think I’m getting enough help and advice from friends and ADHD podcasts (particularly the ADHD Rewired podcast and especially their mastermind episodes). If I find I need more assistance, however, I’ll seek help from a psychologist or ADHD coach.
What’s the difference between ADD and ADHD?
They’re the same thing (ADHD used to be called ADD). Sometimes people still use ADD to refer to inattentive ADHD (without hyperactivity).
Is ADHD real (doesn’t everyone has trouble with attention)?
Yes, ADHD is real.
Yes, everyone has trouble with attention from time to time. Everyone procrastinates in some situations.
A person with ADHD, however, has persistent difficulty with controlling their attention and performing other executive functions because of a disorder in their brain. They are not lazy, morally deficient or uniformed – they know what to do and they want to do it. What they lack are the neurotransmitters required to make it happen.
Telling people that ADHD does not exist heaps more guilt on top of people with ADHD and makes it harder for them to understand their problem, seek diagnosis and treatment.
Is ADHD is overdiagnosed?
No, ADHD is underdiagnosed, particularly in adults. Only a third of the adults who have ADHD have a diagnosis (and the personal and interpersonal cost of undiagnosed ADHD is immense).
Are stimulant medications dangerous?
No, they’re very low doses and not addictive at these low doses.
Contrary to the media scare campaigns, Dr Russell Barkley says that 32 studies have shown that stimulant medications protect the brain and promote brain development. Put simply, he says that kids who were given stimulants have more developed (less ‘ADHD’) brains than kids who were not:
Note also that it’s significantly more dangerous for ADHD people to not be medicated through car accidents, thrill-seeking behaviours, recreational drug use (as self-medication), loss of income, broken relationships, unplanned pregnancy (a 7x higher risk) and much more.
If the abuse of ADHD medications is a concern, however, note that they are also available as a prodrug. These meds are a biologically inactive compound that is converted into the active chemical when the body metabolises it. They cannot, therefore, be snorted or injected to obtain a ‘high’. One example is Vyvanse, which has lysine bound to the active compound dexamphetamine (which is released slowly as it’s processed in the gut).
How does ADHD affect intimate relationships?
ADHD has a significant and negative affect on intimate relationships, particularly because ADHD symptoms (disorganisation, lateness, not paying attention, not following through on promises, etc.) appear to be a lack of love. They are, however, are a lack of neurotransmitters in the ADHD person’s pre-frontal cortex, combined with any negative behaviours (poor coping mechanisms, low self-esteem, learnt helplessness, etc.) that one or both partners have learnt.
On top of this, people with ADHD can have significant problems with emotion and rejection. The ADHD partner can snap, overreact and be unable to soothe their emotions (and may seek comfort in unhelpful ways). They may self-medicate with arguments. Any couple can fall into negative emotional patterns but ADHD puts this on steroids.
Medication can make a significant difference but may not address symptoms completely. One or both partners might need to unlearn negative coping mechanisms and may need professional help to accomplish this.
Are ADHD people narcissistic?
ADHD can have the appearance of Narcissistic Personality Disorder (NPD) but they’re two very different things (noting that it’s possible to have both at the same time).
The short version is that narcissists suffer a personality disorder, are manipulative and difficult to treat. People with ADHD suffer a mental disorder, are confused and straightforward to treat.
|Situation||Narcissist||Person with ADHD|
|Response to diagnosis (or suggestion of problem)||Anger / Denial of NPD||Relief & Acceptance of ADHD|
|Reason for lateness||Self Importance / Control||Time Blindness / Disorganisation|
|Reason for highly romantic gestures||To start a cycle of control||Because it feels great (dopamine!)|
|Reason for blaming others||Inability to accept blame because of low self-worth||Difficulty perceiving self as cause of relational difficulties|
|Level of Self-Confidence||Little or no self-confidence (but this will be hidden to project self-confidence)||High levels of self-confidence (until bruised and frustrated by not living up to potential)|
|Concerned that they’re a narcissist?||No (they refuse to accept blame or don’t care)||Yes / Possibly (they may recognise symptoms which look like narcissism and be concerned)|
|Wonders whether they are at fault in relationships||No (projects all blame on partner)||Yes (but cannot see the cost of their ADHD in their relationship)|
|Cares about letting people down||No (other people let me down!)||Yes (and feels guilty for it)|
|Overreacts to problems||Yes (to avoid blame and take control)||Yes (from emotional dysregulation – having the right emotion but displaying too much of it)|
|Calms down and accepts blame||No (continues to use anger to take control)||Yes (and wonders why they were so upset)|
|Tolerance to frustration||Low (people are always letting me down!)||Low (no matter how hard I work, I see no results!)|
|Treatment||Psychotherapy||Medication plus other non-medical treatment as needed (CBT, creating routines / structures, coaching, etc.)|
Narcissistic Personality Disorder (NPD) is a personality disorder in which a person has elevated self-importance and manipulates other people to preserve this self-perception. There are two main types of narcissism – overt and covert – and a person with ADHD may appear to be a covert narcissist to others. A covert narcissist has little or no self worth and cannot accept themselves as they are. They cannot face their lack of self-worth and, therefore, create an alternate reality in which they are important, successful and absolved from the consequences of their actions. This includes blaming others for every problem (narcissistic projection), denying their actions (gaslighting), downplaying the effects of their actions (the absence of empathy) and responding to problems with power plays (brinkmanship and withdrawal). The narcissist’s world revolves around themselves and their goal of obtaining emotional validation (narcissistic supply). They use a cycle of manipulation in which they give excessive gifts, praise and other forms of validation to others, and then withhold these to destabilise the other person and make them dependent. NPD treatment is psychotherapy (talking therapy) to help the person accept themselves and take responsibility for their actions.
ADHD is a mental disorder which can appear to have narcissistic traits but does not. People with ADHD appear to neglect other people but this is a lack of planning and execution, not a lack of love (and they hate letting people down repeatedly). They can be incredibly romantic but they are unknowingly seeking dopamine (not validation of their self-worth). They are confident of their potential until their lack of success wears them down (unlike narcissists who have little self-worth). They want emotional support to soothe their negative emotions (but this is not a narcissistic wound, it’s a lack of neurotransmitters for soothing emotions themselves). They have low tolerance for frustration and can over-react to emotional triggers because they cannot control their emotional displays (but this is an automatic response caused by a lack of dopamine, not an attempt to manipulate you). They can blame others unfairly for relationship difficulties (but this is an inability to perceive themselves and not necessarily an attempt to shift blame).
ADHD behaviours cause significant damage in relationships but those ADHD is treatable with medication (and NPD is not). When the right type and dose of medication is found, the ADHD person can stop exhibiting many of these behaviours and the negative feedback loops in your relationship can be broken. If you’re the partner of someone with ADHD, help them to seek treatment and hang in there. Life can get better.
Are people with ADHD morally responsible for their actions?
C. S. Lewis explained the difference between mental health and morality in this way:
“The bad psychological material is not a sin but a disease. It does not need to be repented of, but to be cured. And by the way, that is very important. Human beings judge one another by their external actions. God judges them by their moral choices. When a neurotic who has a pathological horror of cats forces himself to pick up a cat for some good reason, it is quite possible that in God’s eyes he has shown more courage than a healthy man may have shown in winning the V.C. When a man who has been perverted from his youth and taught that cruelty is the right thing does dome tiny little kindness, or refrains from some cruelty he might have committed, and thereby, perhaps, risks being sneered at by his companions, he may, in God’s eyes, be doing more than you and I would do if we gave up life itself for a friend.
It is as well to put this the other way round. Some of us who seem quite nice people may, in fact, have made so little use of a good heredity and good upbringing that we are really worse than those whom we regard as fiends. Can we be quite certain how we should have behaved if we had been saddled with the psychological outfit, and then with the bad upbringing, and then with the power, say, of Himmler? That is why Christians are told not to judge. We see only the results which a man’s choices make out of his raw material. But God does not judge him on the raw material at all, but on what he has done with it. Most of the man’s psychological makeup is probably due to his body: when his body dies all that will fall off him, and the real central man, the thing that chose, that made the best or worst out of this material, will stand naked. All sorts of nice things which we thought our own, but which were really due to a good digestion, will fall off some of us: all sorts of nasty things which were due to complexes or bad health will fall off others. We shall then, for the first time, see every one as he really was. There will be surprises.”
Should people with ADHD be excused from consequences?
No. Dr Russell Barkley says that people with ADHD need more consequences in their lives, not fewer. The problem is that most consequences are in the distant future where the person with ADHD cannot respond to them. He suggests breaking big projects with distant consequences into much smaller projects with near-term consequences. See the video on non-medical interventions (above).
Can people with ADHD be successful in their work?
Unmedicated ADHD people can hold down a job long as:
- the job holds their attention (i.e. it remains interesting to their brain), and
- they’re able to maintain good relationships with management and fellow employees (in spite of their emotional dysregulation).
Even in this case, however, they’re likely to neglect:
- important aspects of their work which are not interesting, and
- relationships and their other responsibilities outside of their interesting work (as they will hyperfocus on work at the expense of everything else).
Medicated ADHD people have significantly more capacity for directing their attention and keeping their emotions in check and can probably, therefore, do any kind of work they want (while also giving appropriate attention to relationships and other important things).
Do ADHD people just do fun things (whatever they want)?
No. People with unmedicated ADHD are compelled to do whatever interests their brain (which may not be what they want to do).
Consider a parent with ADHD who is hyperfocusing about their work. They might want to play with their kids right now, but their brain will be focusing on work. With limited working memory, the parent will feel pressure to write down their thoughts, only to find more thoughts coming (which also need to be written down). This means that the parent will either not play with their kids (even though they want to) or be forced to switch between the kids and work (which is disappointing for the kids and stressful for the parent).
As for the work and projects they choose to take on, it’s true that an unmedicated person with ADHD will choose interesting and fun things to take on, but that’s not out of selfishness – it’s because they can’t do anything else. A person with ADHD has learnt though painful experience that they can’t deliver on uninteresting work and, therefore, they no longer attempt to do it..
With medication, however, a person with ADHD can be less compelled to hyperfocus, can resist distractions, be more patient, think more clearly, control their emotions and more. This enables them to do important tasks, not just the interesting ones and cope with work and projects with uninteresting aspects (as a person without ADHD can).
Is ADHD just a social / societal problem?
No. ADHD is a very real medical problem in which the person with ADHD cannot control themselves to accomplish what they want (even tasks which are individual and do not involve society at large).
There is no way to reorganise society such that humans no longer require executive functions. ADHD people would do well to accept their diagnosis, seek treatment and, where executive function gaps remain, seek accommodations from others.
Is ADHD a gift or superpower?
No, ADHD is a disability. As Russell Barkley wrote in When an adult you love has ADHD (page 125):
“Thousands of articles have been published on ADHD, and in none of them was the disorder found to convey some special advantage, talent, ability, or other trait in comparison with typical people. So, no, ADHD is no gift if by that one means that it conveys some special or unique abilities not seen in ordinary people.”
Another expert described living with ADHD as “wading through wet concrete” – it just makes everything harder.
Falsely framing ADHD as a gift or superpower harms people with ADHD because it muddies the water for everyone. It prevents non-ADHD people from understanding just how harmful ADHD is to those who have it. And it makes some ADHD people hesitant to try medications which are their best hope of overcoming their symptoms (in the false belief that the meds will make them lose their ‘gift’ or ‘superpower’).
Let’s look at each of these supposed ‘strengths’ of ADHD in turn:
- Hyperfocus is not a strength – it’s your inability to stop focusing on what is interesting and attend to what is important. That is, hyperfocus compels your brain to pay too much attention to tasks which are interesting but unimportant. Hyperfocus creates good outcomes in only one situation – when the thing your brain wants to focus on just happens to be the most important task for you right now. In every other situation it’s highly stressful because you’re caught between the most important thing (that you’re meant to be doing) and the only thing that your brain wants to do (and you’re not doing either of them well). A properly medicated ADHD person, however, is able to choose where to direct their attention (rather be compelled to focus on whatever their brain finds interesting). The ability to control your attention is the real superpower and I don’t miss hyperfocus at all.
- Omnipotential (the feeling that you can achieve anything) is not a gift – it’s a curse. It’s a lack of self-perception about the nature of hyperfocus (above) in which you fail to notice that your potential has been significantly narrowed by ADHD rather than expanded (as ‘omni’ implies). ADHD limits your potential to what you are interested in and remain interested in and believe that you’ll remain interested in such that you bother to start (which is why ADHD people can give up on employment – they doubt that they’ll find a job which remains interesting to them). Worse, even the most interesting projects and jobs will contain desperately uninteresting tasks which you’ll neglect such that you’re still likely to fail or quit (even if you’re enjoying the sensation of ‘omnipotential’ until that point). With medication, however, you can still follow your interests but you can weigh their importance and complete the associated uninteresting tasks.
- Spontaneity is not a gift – it’s a coping mechanism for your inability to plan (forcing you to come up with creative alternatives on the spot) and is related to your impulsivity (blurting things out, rapidly switching goals, etc.). With medication you’ll be able to plan (so that you’re not forced to be spontaneous) and still act spontaneously whenever you choose to.
This point about coping mechanisms is worth exploring, because they can look like superpowers. A person with no arms, for instance, will develop dexterity in their feet which will be incredible to the average person. No one could logically assert, however, that human feet or human lives are somehow enhanced whenever arms are missing.
So yes, some people with ADHD have developed coping mechanisms which can act as strengths when they receive treatment. But this is succeeding in spite of their ADHD, not because of it. Again, Russell Barkley puts it well:
“We can celebrate the success of some ADHD people without misrepresenting ADHD as somehow conferring cognitive gifts and other benefits.”
I’d love to hear from you and answer any questions you have about ADHD, provided that you’ve already read everything I’ve written here.
If you’ve read everything here, feel free to send me an email – my address is adhd at this website domain.