Loved this. Your point about clinicians never asking "what are you already using to cope?" before reaching for the prescription pad – that's the gap I see constantly. You're naming the real tension: ADHD shows up as a mismatch as much as a "deficit", and meds can either buy breathing space to fix the context… or prop up a bad one.
What tends to work best in my experience as a doctor (and patient) working in ADHD is a both/and plan framed as a time-boxed experiment, not a forever decision. A simple scaffold I use:
CARE — Context, Aims, Risks, Experiments
Context. Map the current coping stack (caffeine, overwork, crisis-deadlines, exercise) plus friction points at work/home. Name one environment change you can make this week: written agendas, 3-box task list (Must/Should/If time), 10-minute walk after lunch, phone charging in another room after 9pm.
Aims. Pick 3 outcomes that matter in real life – reply to emails within 24h, start tasks within 2 minutes, lights-out by 11pm. Baseline them for a week.
Risks. Sleep, appetite, pulse/BP, mood rebound, anxiety spikes, dependency patterns (including "productive" ones like workaholism). Decide upfront what would make you stop or dial down.
Experiments. Stack one change at a time. If medication is used, treat it as a scaffold: lowest effective dose, daytime cut-off, weekly check-ins, one "med-light" day to test whether skills generalise. Review at week 6 and week 12 with the original aims in hand.
Medication isn't a moral failure. Nor is declining it. The red line I try to hold: never widen the mismatch (longer hours, impossible workloads) just because the brain feels smoother today.
I'd be curious to know, if you had 12 weeks and three metrics, which ones would you choose to track?
I love this post because you try to be as unbiased as possible, without demonizing medication and also offering to consider environment as a parameter. Keep these posts coming. You are brave for sharing your own journey.
"Safety questions remain about decades-long effects on brain development and cardiovascular health." I am interested in understanding that better as my son and I both take stimulants regularly for ADHD.
We’ve gotten to the place where “first do no medicine”should be our first consideration. The medical industry isn’t structured to encourage people to investigate the upstream roots, causes and possible treatments of many of our ailments. We have to be curious, like you say, and take our own body and health into our own hands more and more.
Many thanks for another great post! Much of what you say resonates with me, when I went for an ADHD diagnosis in the uk about 20 years ago, they did not really ask me anything about how I cope with life, much of which is similar to your experience, issues with alcohol, becoming self employed/entrepreneur, some good tools and some not so good - a process of learning. I have often thought if only somebody had pointed these things out to me when I was younger, I have had to learn myself, that I am very sensitive, I am like my own little permaculture system, so even a tiny bit of alcohol will throw me off, similar with the food i eat, and yes exercise helps enormously. I have never taken medication. I also think another theme to explore in a post is just how much the covid pandemic hit people with ADHD - my i spent much of that period on my own - i found ways to cope, but i am still feeling my brain has not really recovered and it has made me realise how much i do need to be around people.
Thank You . . The article has been informative and reassuring . . My adopted daughter (8years) has been diagnosed with Smith Magennis Syndrome. I believe a lot of the condition overlaps with ADHD. This article just gives me the right questions to look at while I figure my way on her upbringing.
such an important journey to share with so many navigating the same. I believe some clinics in the netherlands do sleep tests when a diagnosis of adhd is considered or after, not sure anymore
This is exactly what I was looking for.there is so much uncertainty and confusion in the diagnosis of adhd.One psychiatrists says that I have adhd and the other says i don't.and these medications too,iam very sceptical about it.iam afraid of the side-effects and the long implications that it might have.
But iam very happy that someone spoke about this.waiting for more on this.
This! A thousand times this! "how many people are being medicated to function in environments fundamentally incompatible with their neurobiology, when restructuring those environments might address the root cause?"
Anne thank you for shearing. We are doing all of the above to avoid medicine to for our 8 year old. Neurofeedback is one of them and we like it. He does lots of sports and a structure diet. We are strolling on the academic side. Is incredible that he knows what to do but the anxiety overtakes him. When he has a burst of control, he knows what to do. It’s amazing and frustrating at the same time.
This is such a a wonderful exploration of your lived experience and current research (and past!). Thank you for writing and sharing it.
hear hear! thank you for the article Anne-Laure !
Loved this. Your point about clinicians never asking "what are you already using to cope?" before reaching for the prescription pad – that's the gap I see constantly. You're naming the real tension: ADHD shows up as a mismatch as much as a "deficit", and meds can either buy breathing space to fix the context… or prop up a bad one.
What tends to work best in my experience as a doctor (and patient) working in ADHD is a both/and plan framed as a time-boxed experiment, not a forever decision. A simple scaffold I use:
CARE — Context, Aims, Risks, Experiments
Context. Map the current coping stack (caffeine, overwork, crisis-deadlines, exercise) plus friction points at work/home. Name one environment change you can make this week: written agendas, 3-box task list (Must/Should/If time), 10-minute walk after lunch, phone charging in another room after 9pm.
Aims. Pick 3 outcomes that matter in real life – reply to emails within 24h, start tasks within 2 minutes, lights-out by 11pm. Baseline them for a week.
Risks. Sleep, appetite, pulse/BP, mood rebound, anxiety spikes, dependency patterns (including "productive" ones like workaholism). Decide upfront what would make you stop or dial down.
Experiments. Stack one change at a time. If medication is used, treat it as a scaffold: lowest effective dose, daytime cut-off, weekly check-ins, one "med-light" day to test whether skills generalise. Review at week 6 and week 12 with the original aims in hand.
Medication isn't a moral failure. Nor is declining it. The red line I try to hold: never widen the mismatch (longer hours, impossible workloads) just because the brain feels smoother today.
I'd be curious to know, if you had 12 weeks and three metrics, which ones would you choose to track?
I love this post because you try to be as unbiased as possible, without demonizing medication and also offering to consider environment as a parameter. Keep these posts coming. You are brave for sharing your own journey.
"Safety questions remain about decades-long effects on brain development and cardiovascular health." I am interested in understanding that better as my son and I both take stimulants regularly for ADHD.
We’ve gotten to the place where “first do no medicine”should be our first consideration. The medical industry isn’t structured to encourage people to investigate the upstream roots, causes and possible treatments of many of our ailments. We have to be curious, like you say, and take our own body and health into our own hands more and more.
Many thanks for another great post! Much of what you say resonates with me, when I went for an ADHD diagnosis in the uk about 20 years ago, they did not really ask me anything about how I cope with life, much of which is similar to your experience, issues with alcohol, becoming self employed/entrepreneur, some good tools and some not so good - a process of learning. I have often thought if only somebody had pointed these things out to me when I was younger, I have had to learn myself, that I am very sensitive, I am like my own little permaculture system, so even a tiny bit of alcohol will throw me off, similar with the food i eat, and yes exercise helps enormously. I have never taken medication. I also think another theme to explore in a post is just how much the covid pandemic hit people with ADHD - my i spent much of that period on my own - i found ways to cope, but i am still feeling my brain has not really recovered and it has made me realise how much i do need to be around people.
Thank You . . The article has been informative and reassuring . . My adopted daughter (8years) has been diagnosed with Smith Magennis Syndrome. I believe a lot of the condition overlaps with ADHD. This article just gives me the right questions to look at while I figure my way on her upbringing.
such an important journey to share with so many navigating the same. I believe some clinics in the netherlands do sleep tests when a diagnosis of adhd is considered or after, not sure anymore
This is exactly what I was looking for.there is so much uncertainty and confusion in the diagnosis of adhd.One psychiatrists says that I have adhd and the other says i don't.and these medications too,iam very sceptical about it.iam afraid of the side-effects and the long implications that it might have.
But iam very happy that someone spoke about this.waiting for more on this.
This! A thousand times this! "how many people are being medicated to function in environments fundamentally incompatible with their neurobiology, when restructuring those environments might address the root cause?"
Anne thank you for shearing. We are doing all of the above to avoid medicine to for our 8 year old. Neurofeedback is one of them and we like it. He does lots of sports and a structure diet. We are strolling on the academic side. Is incredible that he knows what to do but the anxiety overtakes him. When he has a burst of control, he knows what to do. It’s amazing and frustrating at the same time.