So an internet phenomenon I've encountered is the person who thinks that ADHD is being diagnosed willy-nilly, and that everyone is "seeking labels these days", and that "doctors hand out meds if you go in and say that you can't concentrate"

Let's just examine this for a moment.

I've said it often enough but I didn't realise before I got diagnosed and medicated what ADHD meds actually are.

We all love to joke that they're speed, and when I first saw diagnosed ADHDers talking about their "legal speed", I assumed they were being hyperbolic.

They/we are not. Speed, for most of the world, is amphetamine: Wizz. Billy. Poor man's cocaine. Dexys. Call it what you will.

The current state of the art in ADHD treatment is Elvanse (Vyvanse in the US). This is the only custom designed second generation ADHD drug on the market. It is lisdexamphetamine dimesylate.

"Ah, so it's not speed! It's some weird derivative!"

Well no.

I mean, fair enough, a LOT of medicine is substituted amphetamines. Sudafed contains pseudoephedrine which is Beta Hydroxy N-methyl amphetamine, for example, and you don't get Jarvis Cocker writing songs about being sorted for lemsip.

But no. Lisdex, as we like to call it, is a prodrug. It converts in the blood to dexamphetamine, which is the most potent of the two amphetamine stereo isomers. It's delayed release speed, basically.

And then after mine runs out (I start the say on 70mg lisdex), I then take, usually, 10mg of dexampetamine and then 10mg more a few hours later. Dexamphetamine is pure, pharmaceutical grade, speed.

In the United States, they have a drug you have probably heard of called "Adderall". This is a 3 parts to 1 part mix of dexamphetamine and levoamphetamine. Levo is the other isomer. It's not as effective, has more side effects, but I believe it had a longer half life. Ostensibly they added it for that. In reality, it was for patent reasons.

Adderall is much closer to street speed (which is 50/50, typically). The US also has an ADHD drug of "last resort" called Desoxyn.

Desoxyn is methamphetamine. Straight up meth. As in Breaking Bad. That one. They prescribe it. To people with ADHD.

The other main drug used is methylphenidate, which was discovered by a Swiss chemist in the 19th century who promptly named it after his wife, who everyone called Rita. Methylphenidate is Ritalin. Like amphetamine, it is a central nervous system stimulant but possibly not as potent (this point is complicated). Call it a speed tribute act.

So that's point one. The FIRST LINE treatment for ADHD in much of the world is speed. Literal speed. I have taken in every day for nearly 13 months now. I am on speed writing this right now. It's making me feel a bit sleepy.

So the second point: ADHD is one of THE most objectively testable mental health conditions. Quite possibly the most testable.

You can do a thing called a "continuous performance task" (I did one as part of my diagnosis), and what's really cool is that you can do these on a computer, in a web browser. Mine took 21 minutes, and the webcam watched my eyes while I did it.

People without ADHD describe these as "a bit zen" or "quite relaxing really".

After 10 minutes I was sobbing.

After 15 I was trying to claw my face off.

After it finished, I was basically shaking from trauma and drank an entire bottle of wine. That was the last time I was drunk. 14 months ago.

In my subsequent diagnosis appointment it turns out I redlined it. They are designed to torture ADHD brains and we tend to utterly suck at them. They are not perfect. They produce false negatives, bur rarely false positives.

And after that there is the diagnostic interview, which is called DIVA V. You are interviewed by a clinician who not only listens to your answers but evaluates HOW you give them and your manner while doing so. You can train a nurse practitioner to administer DIVA V in a weekend. It's not hard. It's a standardised questionnaire to diagnose adult ADHD and you have to hit a certain number of categories out of 18 in adulthood, and the same 18 in childhood, to be diagnosed. 9 are for inattention, 9 are for hyperactivity. I think you need like, 6 in each for childhood and maybe 5 for adulthood? Can't remember. So like, 12:10

I was 18:18

What's the point of all this? Well, standardised and pretty reliable testing regime (be nice if people actually used it rather than telling people they can't have ADHD because they have one of "A-Levels" or "Tits"), and the treatment is speed. Wizz, as in sorted for.

And yet these eejits live in a world where you can apparently just waltz into a GP office, tell them you're easily distracted, and walk out with a script for "some profoundly good shit".

And I'm like ... how is it that they think drug dealers still exist?

(Oh, and if you're interested in the CPT test thing, and we know each other decently, HMU in DMs)

More thoughts on ADHD medication, specifically amphetamine, after a year.

Like lots of people, I started them and BANG! Neo waking in his pod in The Matrix. Life changing. The scales fell from my eyes. I suddenly understood. It all made sense. The stuff I found so incredibly difficult for half a century and other people could just ... do it?

I wept.

"Don't chase the high", they all warn. What does that mean?

About 4-6 weeks later I had an argument with Zoe. I felt some of the old behaviours creeping back in. What? Why is that happening?

Then I started to go to bed late again, and procrastinate, and some of the other stuff. Not all though, I kept the place clean. The piles of clothes never came back. I was still getting relief from sensory issues.

And each new titration dose brought it all back.

Until titration stopped, and I was on my final dose.

And it slipped, slowly, it slipped.

Why did it slip? "Tolerance! You have become tolerant to amphetamine! Take a meds holiday!", they all chant.

I tried. I got as far as 3pm before I couldn't stand the bullshit.

Thing is, the evidence that drugs tolerance to therapeutic doses of amphetamine in ADHD even develops is ... dubious. There's a great video by Russell Barkly on this, here: youtu.be/RbZjL7czIy0?si=6xHaoY…

It's not though. I worked out what has happened, and it's fine.

Unmedicated, undiagnosed ADHD is marked by horrible disregulated emotions (more severe in the combined (me) and hyperactive forms I believe), non existent executive functioning, difficulty focusing, and yada yada.

It is, in a nutshell, "really bloody awful".

If you think you have ADHD but are undiagnosed, you possibly just read that and felt like a fraud, didn't you? "But I don't feel that awful!"

How do you KNOW? You have never known any different.

Because here's the thing. You grow up with this crap and you start to mask it, because you HAVE to.

But masking and coping strategies are profoundly psychologically expensive. They destroy us with burnout run the long run.

So we mask to the point where we can more or less make it through the day, and no more.

And it's a pretty sodding miserable existence (Yes, it really is, yes, for you, person reading this wth "some traits". Lots of stuff you accept as a normal part of being human simply is not. I know you don't believe me, even if you think you do. I wouldn't have believed me either).

And then we get diagnosed.

And medicated.

It. Goes. Away.

It all goes away.

Annnnnnnnd breathe!

You are suddenly Mr Spock. You are impervious to your emotions. You can just DO STUFF! You CAN clean the house and you DO and you ENJOY IT! What witchcraft is this?

"I'm cured! Why did nobody tell me about this?" (We did. You ignored us)

You also aren't cured. You still have ADHD.

Your emotions are still there.

You still have executive dysfunction,.

You still struggle to focus.

All of it. It didn't go away.

You just can't hear it.

Why? Because ... well, you are outside and it's stupid sodding bright, and loud. Insanely loud.

And you've been out there for hours.

Then you come into a dim room which is quiet. You can't see anything, you can't hear anything. It's all there though, just below your level of sensitivity.

A few month later when stuff starts coming back and you conclude the meds are failing? They aren't. Your eyes are adjusting to the dark.

Here's another metaphor: A shelled of water has been dumped on a landscape, continually, over thousands of years. It carves out a basin. It finds its level. Water always finds its level.

Move it to the side and it will flow back into the basin it carved. And so it is with us. We start meds and the level of effort we have always applied to make it through the day, which was borderline killing us, suddenly makes it STUPIDLY EASY.

Borderline killing us. Still is.

So you start to dismantle your big expensive coping strategies, because they were hurting you.

You dismantle them until ... well, you start to approach the level of functionality, or rather disfunctionality that you are used to. And then you stop.

Because water finds its level.

You conclude they aren't working, so you take a meds break and OH MY GOD IT'S HORRIBLE.

What the hell is going on? You turned the bloody difficulty knob up to max again. That's what the hell is going on.

After a week you start meds again, and they magically work! IT WAS TOLERANCE ALL ALONG!

No it wasn't, you muppet. You just started to match your effort to the difficulty level again.

You can get trapped in this cycle.

Or you can realise that you deserve a rest, you've had a rest, and that's nice. Now get up and do your goddam laundry, which is a thing you can do, and is still far easier than it ever was.

That is all.

Having one of those “oh god, the meds don’t work any more. I’m still time blind and distractible and have executive dysfunction. Everything is fucked” drops.

And then I go into my room to get ready for bed past the washing machine that’s running and the dishwasher that has run twice today, been emptied twice, and refilled, under the clean and clutter-free work surface.

The sink does not have a three week old pile of teabags in it.

The bedroom floor when I get there has no clothes on it. My chair has no clothes on it. I know where all my meds are. I have cleaned my teeth twice in the last 24 hours. I take my clothes off and put them away; laundry basket or hung up for reuse.

I stopped doomscrolling to do all that. Consciously. Wilfully.

Also I don’t hate myself. Better even; I like who I am. I’m a good person. And I’m funny, even if my sense of humour is somewhat niche. That just makes it a delicacy.

I haven’t impulse bought stupid shit on Amazon in ages.

And I ate vegetables today. Lots of them.

My total alcohol consumption for 2026 is: 2 units. At no point in the last 12 months have I ever been illegal to drive.

And when someone gets upset, I don’t assume it’s about me.

So yeah. Don’t forget where you came from. Sometimes it’s too easy to do that.

They still work.

OK, gonna preface this by asking you to read to th end before judging.

It's been more than a year now and initially my experience of diagnosis was very much, "I hate this thing and would love it to go away".

And to be fair, I still hate this thing and would love it to go away. But it isn't going to.

However, this did colour my views of the terms "neurodivergent" and "neurodiverse", because while I saw the former as simply descriptive, and largely value neutral: my neurology is an outlier, the latter seemed to normalise what I very definitely experience as pathology and sometimes even want to celebrate it.

And I don't want to celebrate the way my own nervous system torments me constantly, nor do I seek to regard that as "just another equally valid way of being that's no worse than any other", because it is objectively worse.

My nervous system torments me. That's not a good thing.

BUT:

I find my position evolving quite a lot more nuance. One of the things I've been doing for the last year is therapy. I had loads of therapy before but this time I had specific requirements.

I wanted a therapist who was: female, late diagnosed ADHD, LGBT positive, and on stimulant medication.

And there are reasons for all of these, but the ones that may not be immediately obvious are why she needed to be late diagnosed and on stimulants.

It's because I didn't want to have a recurring expense while I talked to someone weekly for an hour a time during which I spent large fractions of that hour having stuff pushed at me that I KNOW DOES NOT WORK, and having to argue the toss.

I needed commonality of reference.

Let me give you an example: mindfulness meditation. I can't. Don't reply to this saying that I just have to practice, or I haven't found my thing. I can't do it. Any form of metacognition while I'm in the unmedicated state results in setting off an ADHD thought chain that starts ruminating on metacognition, which ruminates on rumination on metacognition, which ruminates on ruminates on STACK OVERFLOW! CORE DUMPED!

Or in common parlance, "it gives me a right fucker of a migraine".

That's the unmedicated state (in case it's not clear, stimulant meds aren't like, say, antidepressants where you aim for a constant effect. What you get instead is two modes: medicated and unmedicated, and you will switch from one to the other sometimes as abruptly as under a minute. You can seem to be two different people). I can do mindfulness meditation in the medicated state.

There's just no point that I've discovered to doing that. Useless activity. "Find inner calm!" Um, got it. That's why I am able to count my breaths or some shit. So what?

"Well it's like exercising a muscle, and eventually you'll be able to do it unmedicated"

No I won't, because that MAKES MY SYNAPSES CRASH MY BRAIN, and if it didn't I wouldn't be in the unmedicated state, knobhead.

My therapist asked me, "can you meditate?"

"No"

"Ok, cool. Me neither. Let's do something else"

Easy. "Something else" was reparenting my inner child and it's been crazy effective.

And yesterday I watched this video: youtube.com/watch?v=zL_s6dKitH…

And it helped crystallise something I've been thinking more and more because YouTube has been increasingly pushing pop psychology videos at me and something most of them have in common is this: They present common neurodivergent behaviours as "trauma response", and never once mention neurodivergence.

And yeah, that's exactly why I'm starting to feel that "neurodiversity" is something that I can identify with. Yes, my neurology results in things that are objectively pathological and they never won't be.

But the fact that I'm playing with a Whacky Tracks fidget stim whilst typing this is not one of them. That's harmless, and it doesn't mean "I'm stressed", or that "mummy didn't love me". It just means that I enjoy having something in my hand to fiddle with.

The Fediverse to Bluesky crossposter is gonna have a field day with this one. I wish it the best of luck. If you want to see it unadulterated, try here: thegoatery.dyndns.org/profile/…