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If anybody has a question for a clinical psychiatrist from Norway who has worked with both adults, children, and at an inpatient unit, over many years, feel free to ask. Maybe I can contribute something compared to many of the computer-related discussions here that are beyond my expertise.

On the article I would somewhat agree but it’s too limited a view. It ignores too much of the at current assumed underlying causes that we know are relevant. For instance, it’s more correct to say that autism is associated with an increased attentions to “details”, not small things, and challenges with associations and broad concepts, maybe grounded all the way down to increased dendritic connectivity due to less aggressive pruning. of Also, the effect of motivation to focus over a period of time on unrewarding activities is not well incorporated into this theory of (monotropism). I thing there are some valid obersvation but it’s way to simplistic a model when working with real life ADHD. For instance, on interesting commonality seems to be inability to filter out information. But ADHD are unable to filter out Salient content (like a conversation) and autism are usually unable to filter out details or granular sensory stimuli.

Anyways. Ask and I can attest give my perspective


something I've always wondered about... have you ever seen anyone "recover" completely from ADHD or Autism? as opposed to finding ways of managing it. Maybe a nonsensical question but that's why I'm asking.
ADHD yes trough many avenues: change of environment, development, therapy and techniques, medication. Autism: Depends on definition of recovery. If you define it as “no large problems that hinders functioning and happiness”, then yes. If you define at all the symptoms and characteristics that are the cardinal features of the condition; as “completely gone”, then no. And more so the further into the spectrum the person is. People underestimate how noticeable true full blown autism is since it’s been conflated with Asperger’s level of presentation. Note: Many people with autism have happier, more productive lives than neurotypical people, so it’s more of personality description than a disease for them.
What kind of work accomodations have you seen that work/help for people with autism or ADHD?
There are two levels to this. The Standard Environmental Fixes This is about finding the right level of stimulation vs. distraction. Many people with ADHD work better with external stimulation, like music. Small habits help, too—like taking photos of tasks to remember them. (e.g., snap a photo of the empty printer paper so you remember to order more when you scroll through your camera roll later).

The Job Fit (The more interesting intervention). Sometimes we need to figure out if the problem is the job, not the person. Some people with ADHD simply cannot tolerate meaningless or monotonous tasks. An active person, for example, probably shouldn't work as a data entry clerk. for instance a 50-year-old builder who becomes a manager because his body is too beat up for hard labor. He is suited for leadership but can't stand the administrative work. Even if he wants the job, the boredom of the paperwork makes him miserable. These are the people who often present as depressed and benefit most from medication, as it gives them the stability to tolerate boring but necessary tasks. So basically spanning everything from small techniques, to existential and professional evaluation of best fit, to medication. Everyone is different.

Thank you for this post. It’s so obvious in hindsight, but I’ve been struggling for the last couple of years with my day job, especially the last while since I’ve been unmedicated.

In office, I listened to music almost my entire career, it’s the only way I got anything done for whatever reason, to the point I almost got fired once when a manager tried to stop me heading out briefly to pick up a replacement set of headphones when mine broke. I threw a literal tantrum almost, all I knew is I had no music, and that it was essential I did so I could continue doing what I was doing.

For some reason however, when I made a transition in the last few years to WFH, I’ve been living this bizzarely very different approach where I sit in almost complete silence all day long, and it’s the most I’ve ever struggled with my…focus for lack of a better word.

I now truly wonder how much this may have to do with this huge struggle I’ve felt to remain engaged or on task. I’m getting my job done, but 90% of my effort is me having to force myself to get it done rather than…just getting it done like I used too.

I suddenly feel very stupid.

I want to send you an e hug.

I've worked in education and helping kiddos get accomodations and fixtures for their learning has made grow a huge amount of compassion and empathy for myself in this respect.

I think the reality is that this new way of working is still relatively new for human beings. For eons we had more natural, environment based rhythms and then suddenly we're thrust into artificial air and lighting environments staring at papers and now screens.

Our eyes and minds wander to literal infinite spaces on a screen, while our body is sitting in the exact same space (often in the same posture) and we all pretend that "this is normal". But our body keeps score and you can't BS it. It takes its toll.

I too WFH and while my days are somewhat longer, it's only because I do life things while I do work things (as if reality actually has a distinction) and it's better for my mental health.

I sit on a yoga ball, I have an office chair, I do standing desk. There is a beautiful garden behind my screen that constantly beckons me to stop staring into the phony black mirror.

Sorry for the rant, but just know that you're not the weird one. Our systems and processes are the weird ones. And it's our prerogative to find, or construct, better ones for our flourishment.

You have no idea how normal your situation is. At worst, you are as stupid as the rest of us. At least you’re actually able to understand yourself and actually try to tackle your issues. Don’t feel stupid. Most people doesn’t even bother self reflect.
how often do you encounter screen addiction nowadays? (phone or pc overuse)
I personally don’t encounter it as much as I did before when I worked at a children’s psychiatric institution. I think this is explained by the relatively generous welfare system in Norway, where it’s relatively easy to just drop out of society. A lot of people actually seem to prefer it, just staying home gaming or whatever. As such, they have very little incentive to seek help, and when they do, it’s usually someone else in their family who sends them to us, not them seeking us out themselves. I encountered a relatively severe case about 25 years ago: myself. I remember going outside, thinking that the real world was boring compared to video games, and wondering why more people didn’t just game instead of going about in the real world where nothing interesting happened. I’m extremely curious to how all of this is going to play out. I thought the behavior I was watching unfold, with nobody being able to stay away from their phone for 30 seconds, would create some sort of society catastrophe, but so far it hasn’t turned out as bad as I thought it would. But there’s still time I guess. Buy 1990 standards. Everybody is addicted to screens today. But by today’s standard, the normality has shifted a lot, and at least society is hanging in there.
I was diagnosed with ADHD at several different points and saw different professionals about it at different times, most notably in kindergarden, first grade, fifth grade, the beginning and end of high school, and college. (not all were re-diagnoses but for some reason took place at different locations) I don't really know why treatment was so off and on or varied, but I suspect it is because I don't respond well to stimulants. They make me feel extremely 'up' and anxious in very, very small doses. Everything from the amphetamines they prescribe to coffee.

When I was in college, I was prescribed them again just by my primary care physician. I didn't say I was having trouble focusing, I said I was having trouble with wakefulness. I still do sometimes. It was hard to stay awake in a lecture setting for some reason, borderline impossible on days when I had several in a row. Medication definitely helped me get through college but it was a rough time.

As an adult I don't take them, but it is hard to really work the full work day. I have always performed well enough that nobody questions it (and in some cases have brought so much value to a company that nobody cares), but it is a constant source of stress. I resonate with the top commenter in that I also have hundreds of unfinished personal projects across all domains. At this time in my life (33 y/o) I am more concerned about mitigating the constant stress I feel than I am about the actual ADHD symptoms. I am ok with my many personal projects clashing with each other.

At one point a few years ago I was stressed enough about my job to seek medication. For some reason I was not able to get the information about my diagnosis from my old primary care (from 8 years ago) and the one before that was pediatric and didn't seem to count. I talked to a therapist for a bit (which was not useful), got a diagnosis, and then talked to a psych briefly via zoom, and went on medication for a month before deciding (again) that it wasn't worth it. The whole thing was kind of disheartening.

Things are very weird when it comes to ADHD treatment and diagnosis. There seems to be a tendency towards the same 'easy button' when it comes to ADHD. I also don't think it's exaggerating to say that just about every single person I know well enough to have spoken to about these things says that they have been diagnosed with ADHD, often medicated. I don't think very many of them actually do have it. Sometimes I'm not even sure if I do, or there is something else going on.

I'm not sure what to conclude after all this except that maybe there are no answers for me in this space. It's frustrating, but I've never opened up to exploring this problem without the same exact solution being thrown at me, a solution I know is not sustainable for me. I've never spoken to a doctor who's ever suggested it could be anything else. Should I just find my own way, since I seem to be able to function well enough?

This might not be relevant for you, but generally, such constellations of symptoms should at least trigger a differential diagnosis between anxiety and ADHD. Anxiety can be simplified as "energy mobilized to handle important challenges." Some people with high baseline activation are really focused on managing challenges, whether external or internal. This could resemble ADHD if the person is not avoiding their feelings but instead enduring them. This would explain both tiredness and low benefit from stimulants, scatterbrain, and high energy/activity levels. People usually think that anxiety just causes someone to sit in a corner and be anxious, but many people channel the energy into action and don’t even realize they are doing it due to an extremely high baseline activation of the nervous system. For these people, it’s almost more physiological than psychological. If the activation is always directed at managing and handling something, as opposed to reflexively focusing on the most interesting thing, I would suspect it’s more in the realm of anxiety, or perhaps better described as a really reactive, hair-trigger nervous system. Not saying that it is anxiety, but it might just be that you are the opposite of apathetic.
Interesting, I have never been diagnosed with anxiety beyond 'well ADHD and anxiety go together, ADHD medication should help' and then a kind of shrug when it made things worse. All these things are possible and are food for thought (I am not saying it definitely is that either). This is kind of US-medicine specific, but everyone I know who is being treated for anxiety is being treated via methods I'm not interested in unfortunately.

> For these people, it’s almost more physiological than psychological.

This stands out to me. I have lifted weights in the past, have not been well physically conditioned in cardio activity since I was diagnosed with type 1 diabetes at 22. Cardio tends to cause my blood sugar to become unpredictable (or at least you have to actually be really rigid in maintaining your exercise patterns to keep things predictable). Maybe a bit of biking or running would do me some good. What would you do?

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