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?
Something about the term "meds-first approach" feels inaccurate to me. For someone to finally seek out medical advice and a diagnosis, they've usually tried other approaches and managing symptoms themselves already. Seeing a doctor in itself is rarely the first way people try to solve the problem, which means even when meds are the first approach suggested in that phase (which at least in my experience in the US has never been the case...I had to FIGHT to get meds) of the process, it's not actually the first approach/"solution" being tried in the process overall.
People often see going to a medical professional as a last resort, especially here in the US. And with ADHD meds especially, there's still enough of a stigma around not being able to "fix things yourself" that many people try everything they can, healthy and unhealthy alike, before talking to a provider about meds.
I'm interested in how things differ from country to country, because even once I admitted to myself I wasn't managing on my own, my doctors kept telling me to just try harder with things like meditation and exercise for over a year before they agreed with me that I needed medication. So not only were they definitely mentioned, I wasn't believed when I said they weren't enough.
"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.
I love this exploration. As someone who's only recently started with medications, I had very strong reservations about trying it.
I do think my environment contributes heavily to my inability to manage my dopaminergic system. However, I think another element to consider is that sometimes (and I know I'm also privileged to be saying this) even though the environment can inflame negative behaviors of my ADHD, I know it's the type of work I want to be doing in the long term.
In the short term, my work struggles to hold my focus, but long term, it's something I really believe in. So the medication helps me bridge that gap - to get engaged now, today, in pursuit of the long-shot goals that I would otherwise feel unable to pursue.
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.
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?"
Thank you for this very informative piece. Fifteen years ago, less than a year after retiring, I had an MI; my cardiologist put me on carvedilol to protect my heart. For nearly three months I suffered depression bouts, so my PCP referred me to a psychiatrist who put me on Wellbutrin, after several sessions asked me seven questions about my behavior preferences, named it ADHD, and put me on methylphenidate as well. Since then as snippets of my past behaviors return I recognize their ADHD tendencies and can cope. Again, thank you for sharing!
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.
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.
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.
I guess I'm far from the first to ask this, but please expand this paragraph in your forthcoming posts: "Researchers (including in my lab) have been exploring other interventions: exercise (we know physical activity has positive effects on attention and executive function), mindfulness practices (like meditation), dietary approaches (including omega-3 fatty acid supplementation), digital therapeutics (such as video game cognitive training programs), neurofeedback…"
My daughter was diagnosed with ADHD last year (it falls under her Autism diagnosis and is coupled with several other things - everything is a lot all of the time).
Environment is such a big thing. Medication saved her mainly because, as a kid, you have little to no control over your environment. With her medication now, she is able to function within the system that cannot make space for her differences.
I got the same diagnosis as an adult because of her BUT 40 odd years ago I was just unable to focus, not able to finish anything, not reaching my potential, always reading and never studying. I was never on medication and I often wonder how much of a difference it would have made for me.
She knows that when goes out into the world one day she may very well not require the medication because she'll be able to build a world according to her uniqueness, but for now, medication is her life raft.
I used to be so against medication for kids because of the abuse and the willy nilly prescriptions (I have seen it first hand) but my kid is coping and actually managing to thrive.
Thanks for this commentary! I especially appreciated the history of stimulants…today happens to be the first day I don’t have my meds (due to unexpected travel delays) and your article reminded me that I do have the tools to “compensate”. Especially with the current administration I’ve been aware for a while that I might have my meds taken away, so I have the knowledge and capacity to do the creative/movement/meditation/journaling stuff that you mention — it’s just hard to actually do it, since I’m more used to taking “breaks” that involve scrolling or YouTube or the like.
I’m wondering if this is an opportunity to do some tiny experiments to get past some poor habits (I’m about 3/4 of the way towards the right on that spectrum you drew) and move the needle. Thanks for the impetus!
This is such a a wonderful exploration of your lived experience and current research (and past!). Thank you for writing and sharing it.
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?
hear hear! thank you for the article Anne-Laure !
Something about the term "meds-first approach" feels inaccurate to me. For someone to finally seek out medical advice and a diagnosis, they've usually tried other approaches and managing symptoms themselves already. Seeing a doctor in itself is rarely the first way people try to solve the problem, which means even when meds are the first approach suggested in that phase (which at least in my experience in the US has never been the case...I had to FIGHT to get meds) of the process, it's not actually the first approach/"solution" being tried in the process overall.
People often see going to a medical professional as a last resort, especially here in the US. And with ADHD meds especially, there's still enough of a stigma around not being able to "fix things yourself" that many people try everything they can, healthy and unhealthy alike, before talking to a provider about meds.
I'm interested in how things differ from country to country, because even once I admitted to myself I wasn't managing on my own, my doctors kept telling me to just try harder with things like meditation and exercise for over a year before they agreed with me that I needed medication. So not only were they definitely mentioned, I wasn't believed when I said they weren't enough.
"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.
I love this exploration. As someone who's only recently started with medications, I had very strong reservations about trying it.
I do think my environment contributes heavily to my inability to manage my dopaminergic system. However, I think another element to consider is that sometimes (and I know I'm also privileged to be saying this) even though the environment can inflame negative behaviors of my ADHD, I know it's the type of work I want to be doing in the long term.
In the short term, my work struggles to hold my focus, but long term, it's something I really believe in. So the medication helps me bridge that gap - to get engaged now, today, in pursuit of the long-shot goals that I would otherwise feel unable to pursue.
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.
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?"
Thank you for this very informative piece. Fifteen years ago, less than a year after retiring, I had an MI; my cardiologist put me on carvedilol to protect my heart. For nearly three months I suffered depression bouts, so my PCP referred me to a psychiatrist who put me on Wellbutrin, after several sessions asked me seven questions about my behavior preferences, named it ADHD, and put me on methylphenidate as well. Since then as snippets of my past behaviors return I recognize their ADHD tendencies and can cope. Again, thank you for sharing!
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.
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.
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.
I guess I'm far from the first to ask this, but please expand this paragraph in your forthcoming posts: "Researchers (including in my lab) have been exploring other interventions: exercise (we know physical activity has positive effects on attention and executive function), mindfulness practices (like meditation), dietary approaches (including omega-3 fatty acid supplementation), digital therapeutics (such as video game cognitive training programs), neurofeedback…"
My daughter was diagnosed with ADHD last year (it falls under her Autism diagnosis and is coupled with several other things - everything is a lot all of the time).
Environment is such a big thing. Medication saved her mainly because, as a kid, you have little to no control over your environment. With her medication now, she is able to function within the system that cannot make space for her differences.
I got the same diagnosis as an adult because of her BUT 40 odd years ago I was just unable to focus, not able to finish anything, not reaching my potential, always reading and never studying. I was never on medication and I often wonder how much of a difference it would have made for me.
She knows that when goes out into the world one day she may very well not require the medication because she'll be able to build a world according to her uniqueness, but for now, medication is her life raft.
I used to be so against medication for kids because of the abuse and the willy nilly prescriptions (I have seen it first hand) but my kid is coping and actually managing to thrive.
Thanks for this commentary! I especially appreciated the history of stimulants…today happens to be the first day I don’t have my meds (due to unexpected travel delays) and your article reminded me that I do have the tools to “compensate”. Especially with the current administration I’ve been aware for a while that I might have my meds taken away, so I have the knowledge and capacity to do the creative/movement/meditation/journaling stuff that you mention — it’s just hard to actually do it, since I’m more used to taking “breaks” that involve scrolling or YouTube or the like.
I’m wondering if this is an opportunity to do some tiny experiments to get past some poor habits (I’m about 3/4 of the way towards the right on that spectrum you drew) and move the needle. Thanks for the impetus!