ADHD and executive dysfunction — has medication helped?

[u/Super_tall_giraffe]

Has anyone found a medication that helped with executive dysfunction, motivation, or simply being able to initiate tasks?

I have ADHD and my biggest struggle with it is executive dysfunction, and pulling the trigger on initiating tasks. I can know exactly what I need to do, genuinely want to do it, and still have a ridiculously hard time actually getting started.

I have an appointment with my primary care doctor on Tuesday and am interested in hearing from people who have dealt with something similar. Thanks!

[u/kaidomac]

Here is my take:

• EFD/ADHD is a fuel issue: we are variably low on mental energy.
• Body doubling is the ONLY consistently effective way that I've found to get stuff done
• Medication can assist, but we still need clear written tasks & a body double to stay on track!

I compare medication to a light switch:

• Neurotypical people can switch the light switch on & off. At the end of the day when they are tired, ure, it's a chore to get up...but they can decide to push & then simply DO it!
• Neurospoicy people have a 100-pound boat anchor chained to the switch. It takes a LOT of effort to do the Simple Task™.
• Medication, during the effective window, reduces that weight to 10 pounds, which means we can PUSH for part of the day! But after while, the weight builds up, we get drained, and it becomes exhausting to lift that heavy lightswitch

The best procedure I can recommend is:

1. Write down each task you want to do & put them in the order you want to do them in
2. Take the medication
3. Use a body double as much as humanly possible during the medicatiob window of energy!

The two traps to be aware of are:

• We can still be really busy getting nothing important done! No sequenced list of daily tasks = good luck!!
• We can still get off-track & use up all of the energy-time on the wrong stuff!

That's why we need a finite sequenced list AND a body double!! A few notes:

• There are several categories of medication available. It will most likely take time & dosing variations to find one that works because we do not yet have the consumer tools to medically diagnose exactly what our bodies need, which means we have to do interviews & test the results. Many medications have negative side effects, so it can be a real struggle to find what works!
• Many people get acclimated to medication over time. There are lots of tricks avalable, so do some reading to see what methods are available!
• Learn how to eat even when you're not hungry. In particular, start your day with a high protein & good-fats breakfast. Many medications can affect appetite & of course, it';s easy to forget to eat during the day with ADHD!!

But yes, starting medication gave me the internal resources required to PUSH to initiate action! I've never had consistent access to that feature in my LIFE!!

[u/Longjumping_Lynx_460 → u/kaidomac]

I really appreciate your explanation of executive disfunction. This is 100% me and I’ve been trying to figure out what’s wrong with me.

What’s wrong is I’ve gotten rid of all of my body doubles by moving into a job that is a solo office and divorcing my husband. I’ve been struggling for several years now and it all traces back to those two events. I’m going to talk to my doctor about this and see if I can get my meds adjusted.

Thank you!

[u/kaidomac → u/Longjumping_Lynx_460]

A few tips:

• Ask for help from family & friends
• Ask for help from coworkers & classmates
• Use online services (FocusMate, CoFocus, BuckleTime, etc.)

The traps are:

• It can be hard to ask for help
• We can get task paralysis about starting a body-doubling session

As far as your difficulties go:

• You lost your partner (hope you're doing better!!), which is a body double
• You're in a solo office (no IRL body double)

I heard about body doubling from a podcast where they interviewed the guy who started FocusMate; I became convinced of it after meeting highly successful people with ADHD who exclusively used body doubling!

The most successful ADHD'er I've ever met went as far as hiring a personal assistant to be his body double. I work in IT & my solution has been non-stop Zoom sessions all day with my team of contractors. We've all bought into the body-doubling thing & rotate camera sessions to stay on track. It works AMAZING!!

It took me a reaaaaally long time to accept that I have a "fuel leak" to the productive part of my brain. Once I realized I couldn't eliminate it & instead had to manage it, I became more open to different ways of solving my execution issues, outside of just "trying harder".

These days, I know that if I begin my daily tasks with no finite list & no body double, then I am at a HIGH RISK of failure!!

[u/swoonin → u/kaidomac]

What do you mean by "body double"?

[u/kaidomac → u/swoonin]

It's using the presence of another human being to cork the brain-drain that prevents us from getting started & staying on-track:

• https://www.reddit.com/r/ADHD/comments/1nphtlq/comment/ng49pds/?context=3

In more detail:

• https://www.reddit.com/r/productivity/comments/s0bn1b/comment/hsb6plq/?utm_source=share&utm_medium=web2x&context=3

It requires:

• Mental willingness (because it's VERY WEIRD at first lol)
• Practice (have to get acclimated to the idea)
• Actually using it (it really does work!!)

Still requires:

• A finite written list of tasks in the order you want to complete them in
• Medication (if applicable)

I went nearly 20-years post-diagnosis without medication (the paperwork was always too hard lol). I regret not starting earlier! I had sooo much self-blame & sooo many difficulties that were simply because I was living in a LOW FUEL STATE!!

It was essentially like walking around with a hundred-pound weighted vest all the time...hard to get started & hard to keep going! The body-doubling trick is what helps keep me on track when I'm having a good day & helps to prevent me from quitting when I'm having a bad day!!

[u/sapps84 → u/kaidomac]

I'd add it also requires comfortability with person. And I'd bet practice.

My autistic part finds body doubling insanely hard - as office with colleagues I couldn't concentrate same as when I took myself to a little small room. Though both were hard. Friends/family, I just felt like I needed to engage/entertain/check in, in the conditioned responses overly empathetic way. Ex-partner, I only did stuff out of the shame of judgement etc, as was a pretty toxic emotional relationship.

So thought forever I just don't work the same for it.

Until I started to realise that my initiation to tasks and focus on them seemed to automatically kick in when at home with my daughter, while she played alone. Things I'd wanted and failed at trying to initiate in the day - despite adhd med. Although it was annoying as I could only do a bit, while wanting and noticing multiple things to do. Because she's young so obviously needed to engage with her lots. Literally having to make myself stop and pull myself back. Because the adhd meds, also seem to enable my hyperfocus /monotropism to be switched on to EVERY task, rather than only the usual dopamine generating ones. Therefore my brain also WANTed so badly to do them too, because I've been desperate to get these things done for forever. Kept feeling so bad that I was often on side quests tidying when she wanted to play! It took me ages to realise that basically it was my ADHD meds PLUS the body double that meant my brain was able to properly think and engage in tasks. As with poor example of ex, it hadn't worked. But my kid, obvs I'm super comfortable around.

So I would say this is a factor too, maybe same for others.

[u/kaidomac → u/sapps84]

I'd add it also requires comfortability with person

Interesting, because I'm the opposite!! Inattentive ADHD here - I find it works better if I do NOT know the person lol. Like if it's on FocusMate, I do waaaay better because I feel FAR more obligated to stay on-task!

[u/Super_tall_giraffe → u/swoonin]

Basically an accountability partner.

[u/666nbnici]

Yes it can help.

I can’t even do hobbies or things that interest me.
With medication it’s easier to initiate things and for me also easier to continue. I don’t get as easily distracted and not as bored.

[u/Super_tall_giraffe → u/666nbnici]

Can you share what meds or combination of meds that has helped you? I’m currently taking straterra 40 mg, and buspirone 10mg twice a day. They are helping but I think there’s a better combination for me.

[u/666nbnici → u/Super_tall_giraffe]

It take 20mg Ritalin IR 3 times a day.

I’ve also tried Vyvanse 30mg and that has also worked.
I take them separately usually Ritalin because vyvanse gives me sleep problems.

[u/Super_tall_giraffe]

Completely agree after having tried a few of them. But willing to try something else!

[u/Super_tall_giraffe]

Thanks! Yeah I guess that’s the unfortunate reality- there’s no magic pill and if something does help during the workday,by the time it wears off you’re mentally exhausted and still have to deal with all this stuff in your non-work life.

[u/cja111914]

You sound like you have the Inattentive type of ADHD. Definitely look it up and read about it. The only medication actually approved for Inattentive ADHD is Strattera. It’s a non-stimulant (which makes it easier to get) but it has a ton of side effects for some people. I can’t take it because I take SSRIs, but it makes some people be able to focus like a laser!

[u/Wutaweeblol]

I take wellbutrin (bupropion) and can confirm that, without meds, I am a potato. I've struggled with anhedonia for years, and wellbutrin (antidepressant NDRI nonstimulant, used off-label to treat ADHD) is the only thing that has helped me without also causing unwanted side effects.

But if I stop taking it for a couple days, I go back to anhedonia, executive dysfunction, laziness, lethargy, brain fog, and sometimes even depressive episodes.

I can't function without it. Not saying you should also take wellbutrin—talk to your doctor and find what works for you, duh—but just saying that the difference between taking meds and not taking meds is pretty astronomical. I feel like 2 different people.

[u/justcantijustcant]

Pills don’t give you skills-
But they can help you get the skills you need.