nullpt.rs
Back to storiesRanked by HN
Comments
79 total · 79 loaded
> At the end, she told me she would review my exam and have the results ready in a few days.
Yeah man I can go ahead and let you know early if you want.
This comment is so funny to me, because I imagine you being distracted to make the comment before making it to the end where the psych did indeed review the new results.
Well I only know that because I skipped to the end. Then, while scrolling up I realised I missed the whole side-quest about promising to not cheat the test again, taking the test again, but then "accidentally" finding an exploit the system, and then cheating the test again, but this time cheating even more to see the results.
Then, scrolling up more I see that this whole thing started with seeing stars and then buying a telescope on amazon (probably at 3am).
And here I am commenting on HN instead of replying to an email...
Brother the test is quick, easy, and painless, and the results can be lifechanging.
The other thing is, ADHD in my mind is really a syndrome that starts with a symptom - inattention - that can be caused by so, so many things.
I have both, because of course I do, I had a medical problem that exacerbated my ADHD to a significant, significant degree (it's amazing I was able to be a software engineer for so long without treatment). So don't just tunnel vision in... as we tend to be prone to do. Get the whole workup with an experienced clinician, it's so lifechanging it's hard to describe.
I want to add that the comment is also funny to me because it and the blog post are very relatable to me. I don't mean to dismiss it at all. It's really important to get a good diagnosis for anything like this and not dismiss it or lock into the wrong diagnosis because of your own tunnel vision.
You wrote "the test is quick, easy, and painless" but I also want to note that it's not always. Depending on your country, parents, specific doctor, etc it can be very difficult to get a proper diagnosis and help. In some places a big criteria is diagnosis during childhood so if you're 30 or 40 you might have no chance. Or a chance but it depends on your parents retroactively answering a questionnaire, or finding an old report card with the right words.
As you said it's life changing to get the right help and I encourage everyone to pursue this.
The thing is, the test is super quick and easy. And then they throw 50 procedurally complex and tedious tasks at someone who can definitionally not do that, and they know that. Kafkaesque.
Btw no criticism implied on my end, I'm just now constitutionally incapable of not telling people they should get screened. Hmmm I wonder why I have difficulty resisting that urge...
I think I get your point. It's cruel to require Kafkaesque testing and that just makes it not worth it try. But too simple of a test can also misdiagnose.
The chance to be diagnosed with an appropriate gate varies greatly based on where you live and which doctor you can see and more. It can be anything from a 5 minute conversation, to 6 months of inconvenience, to no chance of even existing in your lifetime, to suck it up and don't ask because your career will end.
Right let me be very explicit: TOVA or equivalent are basically "play video games for 10 minutes as a part of your diagnosis" like the OP, the kafkaesque part is getting the appointment, and getting them administered, getting the diagnosis confirmed, going through the records and getting the prescriptions, everything around it :) they're actually pretty sophisticated tests, despite their palatability - I think if they had better ones they'd obviously use them.
I know this is a joke, but I'd be careful about assuming: I had a trained therapist diagnose me with ADHD ... incorrectly.
It turns out, there are other conditions out there that can appear to be be ADHD. If a trained therapist can confuse them, outside observers certainly can too, so it is possible that "very ADHD-acting" person you know might not have it.
(Or, especially for females, the reverse can be true, as not everyone with ADHD manifests with the same trademark hyperactivity.)
Opening up devtools during ADHD test is so ADHD, almost as if he didn't even need the psychiatrist to explain the results :D
That doesn't have to be ADHD, could be the *tism too. The tells are usually somewhat overlapping.
In general, if you are in the industry, save yourself (and your kids) some trouble and get diagnosed before it becomes a problem.
Add: I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
That’s basically how the end of my diagnosis went because aspects of my results were borderline, so she suggested that I just try meds to see. But keep in mind that only one type of ADHD involves being hyper. Some of us are inattentive types where our brain feels like an old 70s pony car engine, and if you pull up to a stoplight you need to keep the motor revving or it will stall. Taking Ritalin for us is the equivalent of keeping the revs up.
If you're borderline, talk to the doc about a trial of guanfacine. (note that some people HATE it, for exactly this reason) It's the opposite - if your engine is always redlining, it sets a rate limiter and gives you the chance to look out the window and enjoy the scenery, metaphorically.
And in the most interesting cases, you can find a lot of value in both - stimulants keeps you going, guanfacine gives you perspective and the ability to unclench.
As an ADHD person who was already planning to ask my psychiatrist if we can try different medication at my next appointment, thank you very much! That description sounds exactly like what I want to achieve.
I cannot overstate the degree to which it has been lifechanging, after years of trials of various other things. Honestly it was overwhelming - like a months-long mild psychedelic trip. I never want to go back. I am much, much less of an asshole now, and I say that advisedly. (note: lower assholery indicates nothing in absolute terms - I am probably still quite a bit of one. But less! and gratefully, joyfully so.)
Edit: And this is me trying to restrain myself so I don't look like someone starting a cult...
Great simile. That really is how it feels.
So this is the cheats with "give everyone ritalin and see how they feel" - it works for most neurotypical folks too. It's just a very small increase compared to the annoyance and side effects, so it's usually not worth it. To extend the car analogy from a sibling comment, putting race fuel in a volvo.
So they can't test by response, because everyone would be like "yeah I can focus better", you have to test with the drug on, and the drug off, to see whether the "horsepower increase" is worth the fuel price. Increasingly strained metaphors are my strength.
> Add: I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
I have been screened a few times for ADHD and each time was found to obviously have it.
Ritalin does not make me feel calmer. I have been told by those close to me that there are externally visible improvements in my behavior. At doses to reach that effect, it also impacts my sleep quality enough that I don't take it.
Adderall causes mild symptoms of psychosis and mania before it has any theraputic effect.
Dexmethylphenidate (aka Focalin) has identical theraputic effects to ritalin, but slightly reduced side-effects.
I'm still on my journey of finding meds (and dosages) that work but I would highly recommend for anyone who has a inattentive scatterbrain to try lis/dexamphetamine.
Methylphenidates can be quite numbing (zombifying) in my group of ADHD friends but dex seems to have a more consistenly helpful effect. The unfortunate caveat for me is that I personally seem predisposed to pelvic floor/urinary issues, which you'll find anecdotal evidence of being exacerbated by amphetamines (research seems yet to catch up), but aside from that the theraputic effects, particularly in emotional regulation seem so far unmatched.
It's unfortunate we have such a tentative model of how our body and, particularly, our minds work so drug treatments often require a trial and error process.
I have exactly the same problem with pelvic floor and urinary issues when I take adderall, although with continued use and PF therapy it's gotten moderately better (and my dr and I decided that the benefits outweighed the risks and issues).
I found methylphenidate-based drugs to be useless after a few days.
Have you tried pure lis or dexamphetamine? I know dex can be prescribed without the mixture, maybe lis can too. I keep meaning to ask my doctor about it.
The other issue I find is tolerance, though even with this I'm still far more focused than when I'm not taking adderall. It really is amazing how much better it makes me feel. I find no problem with addiction whatsoever -- if I forget to take it, then I just have full blown ADHD, but I'm no worse off. I also find it's more effective if I minimize coffee, but I haven't yet cut coffee entirely. (I find caffeine is vastly more addictive than amphetamines.)
I'm nearing my 40s. In my mid-twenties I was diagnosed and over the next couple of years tried all of the usual ADHD meds and none of them were short of terrible in regard to side effects. I guess I've just learned to live with it in a way that outweighs the side effects I get from the drugs.
I was diagnosed with Shiftwork Disorder at one point in time and was prescribed Modafinil and it was incredible for the most part and had zero side-effects, but my doctor wont prescribe it for ADHD. One down-side to Modafinil is that I could get stuck on an unproductive task and would realize in hindsight that I had just been hyper-attentative to this unimportant task for hours.
Studies show Modafinil isn't effective in ADHD adults. It may have benefit in children with ADHD.
I think many prescribers give ADHD adults a high dose too soon causing side-effects. In my experience, it's best to start with a low dose and slowly increase as necessary. The myth is ADHD responds quickly, but observing hundreds of patients it takes months, not days, for benefit of treatment to develop. There's wisdom in the phrase, "start low and go slow".
Yep. What you find often is that the drug is effective right away, at a 20-30-40% effectiveness level. But over time you learn to take advantage of the benefits more effectively, and get more used to the side effects, so it tends to increase significantly in effectiveness at the same dose over 6-8 weeks much like SSRIs, not because the effects last that long, but because you use the tools to improve the tools.
I had a doc that prescribed me amphetamine. It was glorious for work, being in one of those horrendous open table environments with only a screen in front of you to keep from staring at the person directly across.
I was able to laser focus and jam through things but the side effects were not worth it and I backed off. I've yet to find a magic pill that does that without the side effects.
PSA: depending on your specific needs, guanfacine can be close. Once you get used to it, it can be just... constant +1 to wisdom.
> it also impacts my sleep quality enough that I don't take it.
Yeah, it's basically why I don't bother with it. I know it works, but trading one set of problems that I know how deal with for a different set of problems that needs more meds isn't appealing at all.
> ... I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
In ADHD (and most conditions) diagnosis by medication response is not acceptable. Response to drugs is highly variable and fails criteria for acceptable tests. Also drugs can produce side-effects. According to professional standards, it's unethical to expose people to nontrivial risks without good cause.
That was my first thought. I only wish my type was to put in the work for a blog post instead of just thinking on it and getting overwhelmed with all I need to get done.
I didn't think of this until after haha
I spent a decent amount working on ADHD diagnostics and unfortunately it sucks. To my knowledge, to this day, there isn’t a single reliable biomarker that identifies autism spectrum disorders.
It’s usually correlation studies paired with questionnaires which for lack of better words can be described as “incidental” at best. Most z scored tests I know are also developed with small samples, a hundred participants with an outgroup of 20 would already be a LARGE sample. The standard ADHD questionnaire was validated on some 35 people.
There might be some hope in deep learning, particularly in observing eye movement components to deliver reliable biomarkers in the future, but I’m not so confident any time soon.
It’s dreadful and fascinating at the same time that defining and testing for ADS has been so elusive for so long…
From a molecular neuroscience perspective, for both ADHD and ASD (autism) you're unlikely to find any pure biomarkers as clean as a disease like huntingtons disease whose mechanism is clearly understood as extra CAG repeats on the HTT gene (a clean mendelian disorder). ADHD is defined by behavior/cognitive symptoms and most all behavior/cognitive diseases are multifactoral, which ADHD is. WES/WGS and GWAS has been done and for familial ADHD and unlike ASD there is mostly no clear monogenic mutation (a single gene that would explain the phenotype) [note monogenic mutations are usually a very small subset of cases but give scientists a look into what pathway/mechanism is causing a multifactoral disease]. Thus it is not for a lack of looking classically, and deficit is speculated to likely manifest as a neural circuit organization or synaptic issue (though the latter is more closely linked to ASD). This is currently impossible (basically) to measure in alive human brain as it requires nanoscopic imaging, note how challenging the fly map was (incomplete IMO as well).
ADHD is not an autism spectrum disorder, is it?
That’s my bad for conflating the two. Indeed they are not the same in ICT-11 but! diagnostics is moving towards the direction of treating them the same. ADHD and ASD have extremely high comorbidity and it has been proposed many times to classify them together because the symptoms overlap (difficulties at school, aggressive behaviour or temper, lack of social skills, etc). In fact it has become so difficult to find distinctive features of ADHD both in diagnostics AND treatment (both are usually treated with cognitive behavioural therapy and in more severe cases medication) that it has been proposed numerous times to drop their distinction in the ICT, but this hasn’t happened yet. Good paper to the point:
Autism Disorder with High Distractability?
No, however they are often comorbid.
I took a similar ADHD test. It seemed so easy and simple that I always wondered how it was actually supposed to catch me.
Good to know that neurotypical people mostly likely test differently than I did.
I found myself trying to come up with a system that used the position of my hands to “solve” the problem for me.
But then I worried if my system worked, I would be misdiagnosed.
It didn’t work. I was 98th percentile.
Thanks for sharing this!
hi! author here, please let me know if you have any questions :-)
No questions, but feedback for you from an engineer in a similar situation (late diagnosis), make sure you go back and get them to check for every other thing under the sun. You really don't want to dive into the ADHD side and find out it was something else (other things can masquerade as ADHD), so a good neuropsychologist is critical. And "body medicine", too, for example adrenal disorders. It's worth being extremely thorough at this point - you're off the standard path, embrace it.
Also, congratulations, once you figure it out your life is going to change for the better in a way you can't currently understand (literally, lacking the brain regions and/or development for it, take it from me), but the process can kinda suck a lot, so stick with it, it's worth it in the end, wherever you end up.
Would you mind sharing the test platform?
I have a question (and please take it in jest)! In between buying a telescope, seeking out an opinion on ADHD, accidentally hacking an online test, and then blogging about it, how many things on your todo list(s) did you not do?
> how many things on your todo list(s) did you not do?
Not OP, but... It's a much, much shorter list to list the things that did get achieved.
Here's my hobby list: pottery, photography, woodworking, animal husbandry, gardening, home maintenance, swimming/snorkeling, rowing, horticulture, hydroponics (and not like you think), metalworking, travel, electronic music, music theory, playing several instruments, linguistics, working out/bodybuilding, cooking, mental health advocacy, physical health advocacy, tutoring math and PE, renewable energy, movies, music, and microcode. Oh, and getting new hobbies! I could occupy the next ten lifetimes without thinking too hard about it. Total commitment to the bit is my superpower.
First you must divide the universe into "things that are my hobby", and "things that I must get done today", then disregard the hobbies and do the things that must get done today. It's a struggle.
That being said, today is a particularly frazzled day. Most days are more sedate.
I actually wanted to make a YouTube video for this as well! I also have a few more web fingerprinting blog posts in the backlog T_T
Oh, that reminds me...
Have you got some fancy scroll thing for your blog? Something in my brain is noticing that scrolling feels smoother than your average site, though maybe im crazy.
Following through on the top comment, surely you realized when you decided to forgo the back half of the test that, had the program compensated for it, you were consciously leaning into the ADHD diagnosis, right?
Sure! However, I think at that point I just felt trapped and overwhelmed that I no longer cared about the test or its results.
Which is exactly how it manifests, at least for a lot of people. ADHD isn't just "I can't focus lol", it's "trying to focus feels like dragging myself through broken glass"
He says while commenting on HN as CI runs...
> This performance pattern^H^H^H^H^H^H BLOG POST may indicate attentional difficulties, and taken together with other findings, an increased likelihood for the existence of ADHD.
There's a well-known issue of "construct validity" in neuroscience.
This is basically what I did to every online based quiz in school. Big respect lol.
Oh hilarious and well done Null ptrs.
And brilliant picture.
Great article!
ADHD is way more complex than just an attention issue, I mean just the amount of average daydreaming and "rumination" and the constant multi-threading of thoughts... is just next level, I believe it's not properly explained to outsiders that might just think that X guy just have a hard time going in the flow but in reality it's much more catastrophic than this and will create many more mental health issues if left unmanaged.
Most ADHD people that have jumped on some sort of strong treatment (stimulants in general) are discovering a new world in pretty much 1 hour, the first time the mind goes "quiet" is incredible. I advise everyone to read more on this website https://www.adxs.org/en - it's also friendly to scrape to be used with LLMs.
ADHD isn't a good thing to have imo, it's a serious dysfunction and it's sad to see that it's being romanticized lately in social media or plainly discredited by some people/media, and while treated ADHD can make you productive "all the time", you end up addicted and pretty much permanently require drugs to function well.
I agree that ADHD is a serious condition for many people, and that it's overly romanticized and that isn't good when it comes to getting help for those that do need it.
To that point, I'm going push back on this language just a bit:
> you end up addicted and pretty much permanently require drugs to function well
That is negatively framing medication, which if taken properly as prescribed is no different than any other medication someone might take to help with a chronic health condition. It slightly encourages and leans into the idea that ADHD is "fixable" without medication and so taking medication is a problem (or due to a weakness, etc).
I'm not discounting the value of other forms of non-medical treatment, but in many case medication IS appropriate as part of the overall treatment that a person requires to manage their ADHD. We should not use language that stigmatizes treatment that should be between a person and their doctor.
Agree with original commenter but +1 to reframing the language. I was very afraid to begin medication because I would always hear about how addicting this medication can be. But like you say, you wouldn't tell someone with diabetes that they're addicted to insulin.
I'm addicted to several things. Like eyeglasses, and breathing.
The difference the medication makes is similarly revelatory to putting on eyeglasses. Of course you never want to take them off.
There's no withdrawal symptoms, per se, for most people, the addiction is purely psychological from "trying to drive with only 3 tires sucks"
That's not really an "addiction" by any reasonable meaning besides "something I do often".
The actual meaning is more complex, involving inability to stop, negative effects on your life, etc. - none of which apply to wearing your glasses or breathing.
You... don't think there are negative effects to stopping breathing?
If you can be behaviorally addicted to gambling, or even more aptly eating, you can be behaviorally addicted to medication that doesn't give you any physiological dependency.
> The DSM-5 has re-classified the condition [ed: gambling addiction] as an addictive disorder, with those affected exhibiting many similarities to those with substance use disorder. They both activate a reward mechanism in the brain, causing dopamine release to reinforce repetitive behavior. Both often lead to loss of control.
Edit: to engage more substantively, imagine if your glasses gave you, say, mild skin irritation that progressively got worse with wear, but you chose to mitigate that and wear them anyway. I would rate it at that level.
fully agreed with this. it's the same stigma that I see get applied to SSRIs - that you become 'dependent' on medication, it's not 'natural', etc
in reality, if the side effects are minimal and you function better on it, it's a sip of water and a pill a day and that's largely it for health outcomes. most drug interventions are generally extremely well-studied with very large sample sizes. there's a reason why clinical research is considered gold-standard - the regulatory requirements to even get a drug to market is monumental and some of the most rigorously audited and vetted processes in the world
the ironic thing is that most of the big pharma detractors are also ingesting dozens of supplements, the vast majority of which have little to no good empirical evidence backing them (and very small effect sizes to boot) along with even less regulatory oversight for issues like contamination, formulation, or if it even contains the active ingredient. which isn't to say that 'big pharma' doesn't often pursue avenues for profitability reasons instead of the public good but that's not the typical critique that an anti-empiricist brings most times
it's not good to flame people for things they can't control. I also think it's not fair to compare insulin (life saving non synthesizable hormone) vs amphetamine (hard drug that helps people better cope with a society expressly designed to beat them down), because then we forget that dosing amphetamines daily comes with its own price of damage to the body. drugs prescribed for adhd are also very much addicting - if one lets an amphetamine script run out, symptoms of withdrawal will take place, regardless as to how the condition is verbally labelled (which while horrible is also to me not fair to compare with a diabetic dying without insulin)
I've never heard of anyone with ADHD on prescription amphetamines experiencing withdrawal when stopping. At least, not with any symptoms worse than just having ADHD and being unmedicated.
People with ADHD are often amused by referring to amphetamines as a "hard drug" since it has practically none of the typical hard drug effects on them.
I think it is also worth reframing what "functioning well" means. Society expects certain things of us and our brains function in a way that those things are more difficult. Is that our fault, or society, or some mix? Isn't it possible that society itself could adjust in such a way that people who naturally struggle to sit in a cubicle doing the same thing all day every day could be offered other options? Seems like our capitalistic system that requires "productive" work as measured by those who already control the capital is maybe also a problem here.
I'm on stimulants and I agree that the post you responded to needed reframing. But I think we do ourselves and anyone else who isn't "normal" in body or mind a huge disservice just focusing on acceptance of treatment when there are larger societal changes that could be made.
I can't fix society. I can, however, take a pill that lets me hold down a job long enough to not fall into crippling debt.
This Doctor's videos reframed the clinical work and actual research for me, very informative and helpful to me personally. https://www.youtube.com/channel/UC0tLWu7ljYVFPiZQfHjTMsA
[deleted]
> it's a serious dysfunction [...] treated ADHD can make you productive "all the time", you end up addicted and pretty much permanently require drugs to function well
On its own, its not "a serious dysfunction". Within the context of operating within the current societal setup for a paycheck that provides basic survival needs, yeah.
It allows me to sit down and do 'something' without being taken completely off task for the rest of the day because someone kept knocking on the door or reading a hostile/complaint email. What that 'something' is is not always 'productive' but now I can do it without everyday things or upcoming events throwing me in a completely different direction.
Meds helps with the alignment issue. If you are taking meds and its making you "productive all the time" and you find yourself addicted to it, I suggest talking to your doctor about that. I had to work with CBT just to form a habit of remembering to take the medication, and it took a few years before I finally started to remember regularly. I still forget on days that dont fit into that routine
> > you end up addicted and pretty much permanently require drugs to function well
No? First, even when I was taking it almost every day for three years, I kept forgetting to take it. Today, my last refill was in February this year.
I recommend against raw-dogging reality with ADHD without meds. At least so you have baseline "this is what normal feels like"
I think it's important to take it case-by-case. Many people with ADHD find stimulant medications positively life-changing. However, plenty of people with ADHD also have a substance use disorder. Sometimes medication is an effective treatment for both issues; other times it exacerbates the latter.
Consider the subreddit r/stopspeeding, a recovery community for people addicted to stimulants. Many, many users share similar stories of being prescribed a stimulant medication for ADHD, then beginning to abuse it. Many of these people really do have ADHD, but find that their lives are better without stimulant medication.
> it's a serious dysfunction and it's sad to see that it's being romanticized lately in social media or plainly discredited by some people/media
The author of the article is contributing to this by using their medical diagnosis to "outsmart" the system for writing material. Presenting a proper ADHD assessment as merely an online test just adds fuel to the fire (and if this is the only interaction they had I am skeptical of the assessment procedure).
> and while treated ADHD can make you productive "all the time", you end up addicted and pretty much permanently require drugs to function well
That's an unfair and sweeping characterization of the immediate therapeutic benefits and long-term health outcomes of individuals.
Why assume malicious intent? I am well aware that the test isn’t just some Math.random() and even includes quotes from the official site that talk more about how their scoring engine works.
I don’t think I was trying to “outsmart” anything, I’m just a naturally curious person
I don't think you had bad intentions. You may know the testing is more involved but there is a common perception that people can just do a single online test and get a diagnosis. People should be informed that it's just one indicator of many. I apologize for my "writing fodder" phrasing though, that was rude on my part.
Ahahah the end got me laughing
[deleted]