This is one of the best linked articles about ADHD i've seen on HN.
Especially because it gets quickly to the most important point which often times is still neglected:
> The first-line treatment for ADHD is stimulants. Everything else in this post works best as a complement to, rather than as an alternative to, stimulant medication. In fact most of the strategies described here, I was only able to execute after starting stimulants. For me, chemistry is the critical node in the tech tree: the todo list, the pomodoro timers, etc., all of that was unlocked by the medication.
This means: You do have to see a physician and psychologist to get diagnosed and to get a therapy plan. Just reading articles or books about managing ADHD won't do the trick.
If you finish a task that wasn't on your TODO list, don't fret. Just add it but don't check it off. Then when you come back to the list later, you check it off. This reminds you that you did it and gives you the gratification of completing it. Otherwise, the finished task will slide into oblivion and poke at your self-worth along the way.
The article mentions sleep, which is very important to us all. But something not mentioned is that the symptoms of Sleep Apnea can look a lot like ADHD, and if you have sleep apnea and ADHD then you get a double whammy. Sleep apnea can start at any age, which could be one reason why your attention suddenly got worse. If you're waking up unrested, or have any of the other signs of sleep apnea, get it checked out. In my case my doctor resisted testing "because I wasn't obese," (more or less, perhaps I'm being unkind), so you may have to work at it. But an in-lab sleep study will give you a clear diagnosis. I have seen reports of people who were able to stop ADHD medication once their apnea was treated.
>>> An example: you have to fill out some government form. You’re averse to it because you worry about making a mistake. And just the thought of opening the form fills you with dread. So, take the boxes in the form, and make a spreadsheet for them. If fonts/colours/emojis/etc. if that makes it feel more personal, or like something you designed and created. Then fill out the form in the spreadsheet. And then copy the values to the form and submit.
This maps pretty closely to the theories of Dr. Russell Barkley!
However. The article encourages a diagnostic approach—it asks the reader to introspect and identify the root cause of their inaction. But by omitting both PDA and RSD from its list of potential causes, it creates a "diagnostic trap" that can lead to misdiagnosis and self-blame. The omission is particularly damaging because PDA and RSD are two of the most powerful (and often invisible) drivers of severe, persistent avoidance.
It's heartening to read the comments in these threads and see that this might actually be the problem I have dealt with for 29 years and that there might be a solution for it.
Now the hard part is getting myself to fill out the paperwork required to get the NHS to pay someone to look at it.
I appreciate the author's notes on managing ADHD. I was glad to find I didn't learn much new, because I'm already applying many of these practices.
I've tried several to-do apps, but centralized systems didn't work for me. I now use multiple to-do lists across different media: some on paper, some on my phone, others in markdown files within project folders... sending email to myself. It may seem messy, but it works for me. One system doesn't fit everyone. And any customization and tweaks are encouraged.
Books that helped me:
Atomic Habits by James Clear emphasizes small, consistent changes. Over time, they build into significant improvement. It’s better to improve your system gradually than attempt a major overhaul.
The Now Habit by Neil Fiore offers tools to overcome procrastination and start tasks. It helped me understand my resistance and find ways to move forward.
Getting Things Done by David Allen focuses on reviews and planning. I struggle to make time for them regularly, but even occasional reviews help.
Marcus Aurelius' Meditations, especially annotated versions, provide a Stoic perspective. His reflections on virtue and responsibility inspire me. He seemed to dislike being emperor, preferring philosophy, but accepted his role out of duty. That example helps me do necessary tasks, even when I don't feel like it.
ADHD has a biological cause and drugs are the first-line treatment for good reasons.
I was diagnosed with ADHD as a child and spent several years in special classes as well as receiving a lot of private therapy/tutoring. I'm not a self-diagnosed adult (as is common). I've managed my situation in various way for a long time (50 years) and refused medication the entire time. Phone alarms really helped me when I started using them.
There may be good reasons for drugs but there are also bad reasons - especially, they're a quick "fix" allowing a care provider to do this and wash their hands of the situation.
Further, of course ADHD has a biological cause - human beings are biological beings so every human behavior has a biological cause when you come down to it. But the implication that proscriptions drugs designed based on a deep and verified understanding of the mechanisms of ADHD is completely false - ADHD drug prescription, like all behavior-altering drug prescription, is based on just "bucket chemistry", maybe-educated guess work. Which isn't implying drugs don't work for some people. But I think it's important to be clear the various drugs aren't ADHD cures in the way that antibiotics are cures for infection. But again, I support the right of people want ADHD drugs to have them. But I think drug use shouldn't be automatic.
Stimulants are still first line therapy for treating ADHD but I think mindfulness meditation is wholly underrated. People with ADHD have too much activity and overly-robust neural nets in the default-mode network in comparison to healthy controls. There is a network above this network, the salience network [0] that is responsible for the switching between the default-mode and executive control networks.
ADHD may present with many brain-network anomalies, but I believe the classic case is one where there is more default-mode activity, less executive control activity, and ineffective switching occurring from the salience network. Mindfulness meditation is honed at training the salience and attention networks towards playing closer attention, which offsets the deficits observed in ADHD.
That's my lay interpretation; but actually, I believe that people who suffer from ADHD probably have even more to gain, relatively, than those who don't from taking up the habit of mindfulness meditation. It's not an easy fix--I've read that it takes about twice as long for those with ADHD to benefit from the practice. But it seems like it's worth it; after all, your mind is really the only tool that you have.
Those interested in this topic should read about ADHD and it's relation to the salience and executive networks; and how mindfulness sharpens the function in these areas.
"Decision Paralysis Procrastination". I've been going round in circles for 3 days trying to decide where to go travelling. I can go pretty much anywhere I want to and there are lot of places I want to go. I've even found some /really/ good deals but couldn't pull the trigger.
> One thing to consider is that thinking in your head is inherently circular, because you have a limited working memory, and you will inevitably start going in circles
That REALLY resonates. It's crazy how much I will put off writing things down. Like my mind keeps telling itself "that's too simple to actually help"
> I can notice if something has not been worked on for a while, and act on it. Otherwise: out of sight, out of mind.
A visual indicator for task age works wonders for me. I use parentheses to show the age of a task. As the parentheses accumulate it's very obvious what I'm behind on. e.g. ")))))))))) respond to important email".
Works especially well for recurring tasks: the parentheses disappear when the task is marked complete.
I try to keep my lists as small and up-to-date as possible and this serves as a staleness indicator as well.
I have set up my projects in a way that whenever I work ok it, all the context I need is available from one single starting point. My goal is that zero friction is needed for to resume work on any project, no matter how long it was paused.
My habit to keep the context for each project fresh is a at-least weekly, timestamped, append-only Captain‘s Log, which - just as its namesake - is a very brief 1-2 sentence summary of what’s going on for everyone to get back into the story after the commercial break. „No updates“ is a valid update. Since its append-only, retrieving more context is just a matter of keeping on reading after having read the latest update.
adult diag ADD (prob some ASD also). Kids were diagnosed, had one of those ahah moments. At least in my generation, the quite, bored as hell kid in the back of the room. Thankfully, I think the ASD made me determined, hardheaded, and perceptive, and my parents encouraged and supported me to set good goals. That served me well, but I look back and wonder what could have been if I could have stayed awake in high school classes.
My longest friend is hyper, smartest dude in the room but could not stay out of trouble. Right now, he is literally climbing up a mountain. Even today, I get so pissed at my adult peers who don't understand that that distracted kid is just wired different, not undisciplined. You can't change your neurology anymore than you can change your eye color.
Stims helped much more that antidepressants, but I burn thru catecholamine quickly. Vyvanse lasts maybe a few hours, by example. I've had days where I could take a stim, then fall asleep waiting for it to kick in. Its burn-out, and it sucks.
One thing that helped was NALT and Phenylalanine. Initially, 700mg of NALT was miraculous. Doesn't help so much any more, but I continue to take it. I suspect there are other things causing dopamine production bottlenecks and-or low storage of dopamine.
Gene test indicates I may not convert folate to methylfolate, which is important for the stress hormone cycle. You can supplement methylfolate but so far I've not seen improvement.
The ASD makes it very difficult for me to not call a spade a spade, especially around touchy-feely people. My ASD daughter is now in college, like me, struggling greatly with social. She's as liberal as it gets in a free society, but when the college offered group therapy she refused for the same reasons I hated all that groupology crap; you can't really speak your mind without getting ostracized.
IDK if I have ADHD but I started taking Bupropion to help me quit smoking and stayed on it because I feel better on it, and naturally have picked up a lot of this organizational stuff over the past few years like lots of reminders, notes, managing inboxes, calendars, pomodoro. I don't think I've had or have any of the main symptoms of ADHD but sometimes I see a post like this and think maybe? It's also hard because the list of symptoms of ADHD in pop culture seems to be growing out into infinity and it's difficult to separate what's actually ADHD and what's not.
Some people with OCD literally starve to death, because they can't leave their house. Commonly you find those affected washing their hands repeatedly until they bleed... and then some more. It is absolute not a "what makes you feel good" kinda thing, it's a dysfunctional and irrational mental world model enforced by a crippling sense of doom, anxiety and shame, which will consume life (especially if "very OCD").
Most importantly, for those with actual OCD, you absolutely aren't advised to embrace that destructive, irrational world model by leaning in on compulsions. You cannot really exploit it for good, by definition. And by definition, it isn't benign.
I wish people would stop attributing a quirky/controlling personality, a desire for order, symmetry and tidy rooms to a serious mental disorder. You wouldn't twist major depression, schizophrenia, or cluster B disorders like that. If you feel left out on the identity game, go read Lord of the Rings, or Das Kapital, try horse riding, or golf.
Quite honestly, for me this casts serious shade on the whole article. Because "ADHD" is similarly misattributed and casually "self-diagnosed". Maybe the author just got very ADHD by browsing too much Insta and later found stimulants to be stimulating. Much easier to cure that kind of ADHD through abstinence and structure. (Although coming up with elaborate routines and revolutionary hacks, which are a total breakthrough for a whole month, is a very ADHD thing...)
Thank you for this article. I have yet to discuss with my doctor about this. But I have noticed several issues that are severely lacking for me compared to my peers:
1. My brain drifts away very easily. Even in an important work conversation, my brain just starts thinking about a completely different project or upcoming meeting.
2. I have a hard time remembering things/events that my spouse and others can easily recall (ie: which restaurants we have been to)
3. I can't seem to form an opinion on very basic things like do you like restaurant A or restaurant B better? do you like option A or option B? I can't decide or come up with any heuristics.
At first I chalk it up to I am being too critical about myself and others are having the same issue. But that doesn't seem to be the case. Can these all be rolled up in the same conversation with my doctor?
> Here’s an example: you (having undiagnosed ADHD) try to set a schedule, or use a todo list, or clean your bed every day, but it doesn’t stick. So you get on medication, and the medication lets you form your first habit: which is using a todo list app consistently, checking it every morning.
How exactly is this supposed to work?
(Even assuming a health care system that actually cares about ADHD in adults, "just get a diagnosis" seems like a much higher bar than "just clean your bed every day".)
> I often fail to finish projects simply because I forget about them. I start reading a book, but I don’t write it down anywhere (say, in Goodreads) that “I’m reading this book” is something I have committed to.
I don’t have a history of ADHD symptoms. But I’ve been happier and arguably more productive since I abandoned the idea that I must complete projects just because I committed to them at the start. Sometimes you learn, halfway through a book, that it doesn’t contain the info you thought it would; then it’s best abandoned. The same applies to many commitments, I think. We learn more about them as we undertake them. Something might stop being engaging because deep down we’ve realized that it won’t serve us as we expected.
But maybe I’m able to discern productive vs nonproductive commitments because I don’t have ADHD? I just hate to see people beating themselves up about not following through with ideas which really don’t deserve follow-through.
For those who cannot be prescribed amphetamines, I recommend seeking out Modafinil. It works really well and a regular psychiatrist should be able to prescribe it.
I'd be taking my meds if the pharmaceuticals didn't keep having many-month long shortages of the ones I'm taking...
I need the higher doses, so I'm practically screwed. Makes me so damn frustrated, cause I'm 4-5 months down without meds and I'm REALLY STRUGGLING. Depression, zero motivation, practically no executive function. Really needs to be accountability on these companies to ensure they can supply.
Preach, this is a great post. The author has approximated the same system I (and many others) independently found to be working well for themselves. The bad news is that it’s very hard, if not impossible, to teach masses with ADHD all these elaborate, often very personal systems. The good news is you can make an app which will automatically make it work for individual people. Which is what I’m working on right now (not out yet).
Has anyone used the Todoist app? What are the apps that you find the most helpful in supporting ADHD - I am thinking to get this app, but also have never used Obsidian before, would love to hear what others are using.
Edit: Oh also want to mention that I generally prefer privacy oriented apps - so if there is something, even paid, that will keep my notes on device without sharing them with a server I'd love to hear about it.
On the chemical note, I found glycine supplementation to be actually helpful in avoiding hyperfixation (not being able to stop on a task). In contrast, stimulant meds solve the issue of not being able to start on a task (not enough motivation/dopamine). Make your own N=1 experiments though.
I read at one place regarding an ADHD drug that is non-stimulant and makes people a little drowsy, which is why it is good to take before going to bed. I don't remember what the drug is called. Does someone know?
As a life long member of the decision paralysis club, this was incredibly refreshing to read. Have been getting better, but reading this has brought it back to the forefront of good habits.
I guess I have some reading to do tomorrow! Which is also a great reminder that I should update my own posts with all my current techniques of managing with ADHD.
For reasons of personal history, stimulant medications like Adderall are a hard no for me. I am curious, though, about non-stimulant options like atomoxetine, if anyone has views.
I searched the article for "meat" and "carnivore". Zero mentions. First paragraph admits that this is a biochemistry issue and then immediately jumps to the conclusion that MEDICATION is needed.
Insane.
Eat a proper human diet, and your ADHD symptoms will mostly go away.
Notes on Managing ADHD
(borretti.me)632 points by amrrs 31 August 2025 | 329 comments
Comments
> The first-line treatment for ADHD is stimulants. Everything else in this post works best as a complement to, rather than as an alternative to, stimulant medication. In fact most of the strategies described here, I was only able to execute after starting stimulants. For me, chemistry is the critical node in the tech tree: the todo list, the pomodoro timers, etc., all of that was unlocked by the medication.
This means: You do have to see a physician and psychologist to get diagnosed and to get a therapy plan. Just reading articles or books about managing ADHD won't do the trick.
If you finish a task that wasn't on your TODO list, don't fret. Just add it but don't check it off. Then when you come back to the list later, you check it off. This reminds you that you did it and gives you the gratification of completing it. Otherwise, the finished task will slide into oblivion and poke at your self-worth along the way.
Oh wow this spoke to me - do it a lot …
However. The article encourages a diagnostic approach—it asks the reader to introspect and identify the root cause of their inaction. But by omitting both PDA and RSD from its list of potential causes, it creates a "diagnostic trap" that can lead to misdiagnosis and self-blame. The omission is particularly damaging because PDA and RSD are two of the most powerful (and often invisible) drivers of severe, persistent avoidance.
Now the hard part is getting myself to fill out the paperwork required to get the NHS to pay someone to look at it.
I've tried several to-do apps, but centralized systems didn't work for me. I now use multiple to-do lists across different media: some on paper, some on my phone, others in markdown files within project folders... sending email to myself. It may seem messy, but it works for me. One system doesn't fit everyone. And any customization and tweaks are encouraged.
Books that helped me:
Atomic Habits by James Clear emphasizes small, consistent changes. Over time, they build into significant improvement. It’s better to improve your system gradually than attempt a major overhaul.
The Now Habit by Neil Fiore offers tools to overcome procrastination and start tasks. It helped me understand my resistance and find ways to move forward.
Getting Things Done by David Allen focuses on reviews and planning. I struggle to make time for them regularly, but even occasional reviews help.
Marcus Aurelius' Meditations, especially annotated versions, provide a Stoic perspective. His reflections on virtue and responsibility inspire me. He seemed to dislike being emperor, preferring philosophy, but accepted his role out of duty. That example helps me do necessary tasks, even when I don't feel like it.
I was diagnosed with ADHD as a child and spent several years in special classes as well as receiving a lot of private therapy/tutoring. I'm not a self-diagnosed adult (as is common). I've managed my situation in various way for a long time (50 years) and refused medication the entire time. Phone alarms really helped me when I started using them.
There may be good reasons for drugs but there are also bad reasons - especially, they're a quick "fix" allowing a care provider to do this and wash their hands of the situation.
Further, of course ADHD has a biological cause - human beings are biological beings so every human behavior has a biological cause when you come down to it. But the implication that proscriptions drugs designed based on a deep and verified understanding of the mechanisms of ADHD is completely false - ADHD drug prescription, like all behavior-altering drug prescription, is based on just "bucket chemistry", maybe-educated guess work. Which isn't implying drugs don't work for some people. But I think it's important to be clear the various drugs aren't ADHD cures in the way that antibiotics are cures for infection. But again, I support the right of people want ADHD drugs to have them. But I think drug use shouldn't be automatic.
ADHD may present with many brain-network anomalies, but I believe the classic case is one where there is more default-mode activity, less executive control activity, and ineffective switching occurring from the salience network. Mindfulness meditation is honed at training the salience and attention networks towards playing closer attention, which offsets the deficits observed in ADHD.
That's my lay interpretation; but actually, I believe that people who suffer from ADHD probably have even more to gain, relatively, than those who don't from taking up the habit of mindfulness meditation. It's not an easy fix--I've read that it takes about twice as long for those with ADHD to benefit from the practice. But it seems like it's worth it; after all, your mind is really the only tool that you have.
Those interested in this topic should read about ADHD and it's relation to the salience and executive networks; and how mindfulness sharpens the function in these areas.
[0]: https://en.wikipedia.org/wiki/Salience_network
"Decision Paralysis Procrastination". I've been going round in circles for 3 days trying to decide where to go travelling. I can go pretty much anywhere I want to and there are lot of places I want to go. I've even found some /really/ good deals but couldn't pull the trigger.
> One thing to consider is that thinking in your head is inherently circular, because you have a limited working memory, and you will inevitably start going in circles
That REALLY resonates. It's crazy how much I will put off writing things down. Like my mind keeps telling itself "that's too simple to actually help"
A visual indicator for task age works wonders for me. I use parentheses to show the age of a task. As the parentheses accumulate it's very obvious what I'm behind on. e.g. ")))))))))) respond to important email".
Works especially well for recurring tasks: the parentheses disappear when the task is marked complete.
I try to keep my lists as small and up-to-date as possible and this serves as a staleness indicator as well.
I use Todoist and have a script to manage the parentheses. https://github.com/leroux/todoscript
Credit to intend.do. I shamelessly stole the concept from NotDone Propagator. https://intend.do/features#notdones
My longest friend is hyper, smartest dude in the room but could not stay out of trouble. Right now, he is literally climbing up a mountain. Even today, I get so pissed at my adult peers who don't understand that that distracted kid is just wired different, not undisciplined. You can't change your neurology anymore than you can change your eye color.
Stims helped much more that antidepressants, but I burn thru catecholamine quickly. Vyvanse lasts maybe a few hours, by example. I've had days where I could take a stim, then fall asleep waiting for it to kick in. Its burn-out, and it sucks.
One thing that helped was NALT and Phenylalanine. Initially, 700mg of NALT was miraculous. Doesn't help so much any more, but I continue to take it. I suspect there are other things causing dopamine production bottlenecks and-or low storage of dopamine.
Gene test indicates I may not convert folate to methylfolate, which is important for the stress hormone cycle. You can supplement methylfolate but so far I've not seen improvement.
The ASD makes it very difficult for me to not call a spade a spade, especially around touchy-feely people. My ASD daughter is now in college, like me, struggling greatly with social. She's as liberal as it gets in a free society, but when the college offered group therapy she refused for the same reasons I hated all that groupology crap; you can't really speak your mind without getting ostracized.
> If you are very OCD
Please educate yourself, OCD is serious shit: https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_d...
Some people with OCD literally starve to death, because they can't leave their house. Commonly you find those affected washing their hands repeatedly until they bleed... and then some more. It is absolute not a "what makes you feel good" kinda thing, it's a dysfunctional and irrational mental world model enforced by a crippling sense of doom, anxiety and shame, which will consume life (especially if "very OCD").
Most importantly, for those with actual OCD, you absolutely aren't advised to embrace that destructive, irrational world model by leaning in on compulsions. You cannot really exploit it for good, by definition. And by definition, it isn't benign.
I wish people would stop attributing a quirky/controlling personality, a desire for order, symmetry and tidy rooms to a serious mental disorder. You wouldn't twist major depression, schizophrenia, or cluster B disorders like that. If you feel left out on the identity game, go read Lord of the Rings, or Das Kapital, try horse riding, or golf.
Quite honestly, for me this casts serious shade on the whole article. Because "ADHD" is similarly misattributed and casually "self-diagnosed". Maybe the author just got very ADHD by browsing too much Insta and later found stimulants to be stimulating. Much easier to cure that kind of ADHD through abstinence and structure. (Although coming up with elaborate routines and revolutionary hacks, which are a total breakthrough for a whole month, is a very ADHD thing...)
For me, most of the time, the challenge is lack of energ and motivation to do anything outright. Even on 50mg Lisdex.
1. My brain drifts away very easily. Even in an important work conversation, my brain just starts thinking about a completely different project or upcoming meeting. 2. I have a hard time remembering things/events that my spouse and others can easily recall (ie: which restaurants we have been to) 3. I can't seem to form an opinion on very basic things like do you like restaurant A or restaurant B better? do you like option A or option B? I can't decide or come up with any heuristics.
At first I chalk it up to I am being too critical about myself and others are having the same issue. But that doesn't seem to be the case. Can these all be rolled up in the same conversation with my doctor?
How exactly is this supposed to work?
(Even assuming a health care system that actually cares about ADHD in adults, "just get a diagnosis" seems like a much higher bar than "just clean your bed every day".)
I don’t have a history of ADHD symptoms. But I’ve been happier and arguably more productive since I abandoned the idea that I must complete projects just because I committed to them at the start. Sometimes you learn, halfway through a book, that it doesn’t contain the info you thought it would; then it’s best abandoned. The same applies to many commitments, I think. We learn more about them as we undertake them. Something might stop being engaging because deep down we’ve realized that it won’t serve us as we expected.
But maybe I’m able to discern productive vs nonproductive commitments because I don’t have ADHD? I just hate to see people beating themselves up about not following through with ideas which really don’t deserve follow-through.
>> The symptoms of ADHD and thyroid disorder are similar.
Ask your doctor to check that first before ADHD.
I need the higher doses, so I'm practically screwed. Makes me so damn frustrated, cause I'm 4-5 months down without meds and I'm REALLY STRUGGLING. Depression, zero motivation, practically no executive function. Really needs to be accountability on these companies to ensure they can supply.
Edit: Oh also want to mention that I generally prefer privacy oriented apps - so if there is something, even paid, that will keep my notes on device without sharing them with a server I'd love to hear about it.
anyone from India willing to share some pointers on how to get an evaluation
signed - someone who has been procrastinating on it for a few years now
Google Tasks has the advantage of allowing you to manage your Todo list through its web interface, while Samsung Reminder is a mobile app only.
Does this also work in the opposite direction?
Insane.
Eat a proper human diet, and your ADHD symptoms will mostly go away.