Comment by Uptrenda
2 years ago
Oh look: another service that thinks ADHD is an inability to do scheduling or some other bullshit. ADHD is literally a neurological disorder that effects dopamine in the brain. It reduces wakefulness, concentration, the ability to filter out distractions, and the ability to motivate yourself. A software solution won't fix this. What ADHD people need isn't a normie couch to tell them to 'prioritize' differently or a bunch of shitty checkboxes to tick off. They need a licensed psychiatrist to prescribe stimulants which are effective for treating up to 85% of suffers. This service is exploitative, idiotic, uninformed, and deeming. I don't know why YC want anything to do with this. Maybe they thought people with ADHD were desperate marks and a startup could be build around exploiting them. Fuck off with that bullshit. You should be ashamed.
Thanks for your response + clearly you have a strong understanding of ADHD as a neurodevelopmental condition (and the stats around medication's efficacy!). Medication is by far the most effective treatment method for ADHD at 80%+, which is incredibly astounding given most mental health & brain disorders don't have such an effective treatment method.
We definitely understand that a software solution will by no means "fix" ADHD. It's an extremely complex condition layered on to extremely complex & individual human beings and we as a society have lots of work to do with education, awareness, stigma, medication, and other behavioral solutions (including coaching). We advocate for a mixed method that may include multiple of the above, potentially even all through experimentation, to find what works best for you uniquely.
Many of our members and community members either (1) are already on medication and use coaching to build skills & systems to further improve their lives, or (2) for whatever reason aren't able or want to be on medication [stigma, cultural barriers, can't be on because of other medications for co-occuring conditions, and many other reasons, or simply not wanting to] and use coaching either on it's own or with therapy/other modalities of care. Other benefits of coaching involve support & acceptance from someone who understands, and accountability to follow through on certain commitments in life.
We have built the service up with much care & love, alongside the ADHD community, clinicians, and ADHD experts & coaches, but are always open to more specific feedback on how we can improve. Our inbox is always open: hi@shimmer.care
I haven’t looked closely at your product but there was a similar one that launched a few months ago on HN and it was almost a joke the way they launched it.
Almost every single one of their techniques and incentives is were bound to fail exactly if someone had ADHD.
Like they had a 14 day trial where you had to remember to keep launching the app every day and things like that.
Guess what, someone with ADD would forget to launch the app, and definitely blow through a silly 14 day trial before they could even realize any value. It showed me exactly how clueless they were about their audience.
> definitely blow through a silly 14 day trial before they could even realize any value.
Even worse: the trial was probably sign up with card before you buy and many people with ADHD will still be _paying_ for the service long after the trial ran out...
> It showed me exactly how clueless they were about their audience.
It sounds like a grift that knew _exactly_ who their audience was...
[disclaimer: I didn't check which service you are talking about, so this may not be the case. This does seem to be a trope, however.]
Inflow: https://news.ycombinator.com/item?id=28877610
You are right that ADHD is a true neurological disorder that responds well to medication, but on everything else your are horrifyingly wrong. Medication alone is not a panacea for many people with ADHD and is most effective when coupled with better self understanding, self acceptance, and adoption of an ADHD-optimized lifestyle.
I have ADHD, my kids have ADHD, and most of my friends have ADHD. Was on Vyvanse for 5 years, then off for 6, and I just recently started taking it again.
During my first 5 years on Vyvance, I had my first experience of what was truly possible for me and it changed my life.
Then, triggered by unrelated health issues and unhappiness with side effects, but mainly because I wanted to run the experiment of seeing how far I could get without meds, I stopped for 6 years. I focussed on lifestyle, structure, health, exercise, nutrition, meditation, And it was pretty good, much better than before my diagnosis.
Then as my life moved forward it presented me with increasing responsibility and challenge, and this year I decided to go back on meds. Of course it was immediately obvious that meds improve my ability to focus and my general self-regulation to a level not possible through healthy lifestyle and earnest intentions. But… now I am getting a multiplier effect of an ADHD-optimized lifestyle working together with my medication, and its amazing. I'm taking a lower dose than before, but sustaining a better level of productivity and mental health.
I have seen in myself and others where meds on their own have failed because their benefits were squandered by a careless lifestyle. Now I get to see how this plays out with my kids, And guess what? Meds are essential, but they aren't enough. The hard part is changing their attitudes, habits and lifestyle.
Thank you for sharing your personal experience.
The cliche "pills don't teach skills".
A mix of (or at least experimenting with) meds, skills, routines, potentially therapy... all good starting points but the key is to figure out what works for you. And we'll take all the help we can get! Each neurodiverse person is different and will likely respond to a different mix of solutions.
Wooooaah. I don't know about this service, but I feel there would be a lot of value in having a person to bounce things off in real time / help with unblocking when things get challenging. Would that also be complete bullshit? Are prescribed stimulants the only thing that's not bullshit?
Hire a virtual assistant, not a virtual therapist. This virtual therapist costs $99 for 60 minutes of assistance. 15 minutes a week is too little time to bounce ideas off of someone. But you can buy 5-10 hours of virtual assistance with that money, or more.
A service that provides virtual assistance for ADHD ppl - without the veneer of medical treatment to raise prices - could be a lot more affordable and helpful in helping ppl complete tasks they're struggling with, bounce ideas and plans back and forth, and help with other executive tasks.
This is an assistance vs treatment approach. ADHD doesn't have to be seen as a disease you treat medically - it can be seen as a perfectly natural way of being that requires some assistance, but also provides special abilities.
Have you tried the VA strategy yourself? I don't think it's that simple to get a VA to help. I have used a lot of VAs over the years and there is a significant time cost for me in training them up to help. It's not necessarily a quick win and I have found it very frustrating when they don't understand my needs. Delegating boring work to specialists absolutely works well and I do this a lot.
It would be cool if there were VAs that were trained in how best to help people with ADHD. I would see that as being supplementary to Shimmer. I use Shimmer myself and find it useful in coming up with strategies that work for me.
Do you have any recommendations on VA services? Thank you
Even IF - even IF this service is effective for people with ADHD - how does this service deal with the problem of people believing they have ADHD when they actually have another problem which presents similarly?
Literally read their post, it's for if:
>If you have ADHD (or think you do)
Wow that's great and not exploitative at all. A service to treat a medical condition that people merely THINK they have. Don't suppose anybody is going to get a refund if they don't actually have ADHD.
Thanks for your comment.
This definitely is not treatment nor therapy/medication, just to clarify. We view ourselves as 1 potential piece of your greater solution to ADHD (or wanting better executive function skills in general). Same as a to-do list is helpful for ADHD, as is a body doubling tool. These services don't treat ADHD, simply may be of help!
Stop scamming people with your predatory bullshit. You should be ashamed of yourself. We are not your cash cow, fuck off.
This is what I would've thought not even a year ago.
Having tried pretty much all the stimulants (oh DNMs how I love you) and currently taking one, I almost can't believe I have to say medication alone is not enough.
Yup. You will also need to externalise your executive function and working memory. Get a fitbit to buzz for all alarms so that you don't miss meetings, etc because you silenced your phone and turned off buzz.
I wanted to say you need to create new habits and a schedule. With medication you can (finally) do it, but you simply don't know how. You can self-help, but external help would work much better.
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Exactly my thoughts too. This reads as yet another scam product targeting ADHD folks, just like Inflow and similar.
I would very much like such 'entrepreneurs' to stop trying to profit from my disability. If they had something actually useful to sell, they'd engage with health service providers. Instead they try to fool the individual with promises of success and happiness.
It's disgusting and predatory, and sours me even more towards the VC types that think this is a worthwhile type of business to invest in.
Thank you for your comment.
I am the 'entrepreneur' in question here (who also uses our ADHD coaching), and definitely do not want to profit from anyone's disability. I hope that comes through at some level! We are definitely in the process of engaging with health service providers but the unfortunate nature here is to get something innovative and tech-enabled out there, we first need to prove that it is helpful to folks (which is our mission anyway! By providing at-cost services while compensating our coaches, our main goal right now is to prove that we can help people with ADHD, like me!)
The also unfortunate reality is that there aren't enough therapists out there with ADHD specialization, especially once you filter for an individual's state/insurance. We know we're not the be all end all, but hopefully a useful stop to help gain some skills and routines for people with ADHD.
I work with a psych and take the stimulants, and still struggle. Medication is only half the battle. I would recommend checking out Andrew Huberman's podcast episode on ADHD. Basically, as I understand, the medication "smooths out" the pathways that are "blocked" in the dopamine system. Once medicated, I think a treatment plan like this would be very helpful for me and for others.
Have you watched Dr. Russell Barkleys series? https://youtu.be/sPFmKu2S5XY. I have actually done professional research into executive function and working memory--not a PhD but have one masters and nearly through another. His explanation lines up with the physiological psychology that I have learned.
Thank you for sharing!
I've done these 2 of Russell Barkley's free courses: http://www.continuingedcourses.net/active/courses/course109.... http://www.continuingedcourses.net/active/courses/course109....
I took notes on the former (here: https://shimmercare.notion.site/ADHD-in-Adults-Diagnosis-Imp...) but didn't get around to the latter.
Thank you, will check this out!
My friend it is you who should consider being ashamed. Suggesting stimulants as the first line of treatment rather than cardiovascular exercise, good sleep, and a healthier relationship with food is at best dismissive of the body of modern research and at worst introduction of a dangerous 'just pop a pill' crutch. Stimulants are not at all the only way out of the ouroboros of adhd symptoms making today hard and tomorrow too.
I don't disagree that things like this can be exploitative and if it happens even once then I agree with the 'you should be ashamed' thesis statement. You're treating the solution as a very black and white thing in this comment of yours though and the vitriol with which you wrote it left me with the impression that pushback is warranted.
> Suggesting stimulants as the first line of treatment rather than cardiovascular exercise, good sleep, and a healthier relationship with food is at best dismissive of the body of modern research and at worst introduction of a dangerous 'just pop a pill' crutch.
Literally none of this is true. The research overwhelmingly shows that stimulant medication is the most effective treatment for ADHD, and second place isn't even close. Show me a single paper that shows that "good sleep" is a more effective treatment for ADHD than medication and I'll eat my shoe.
ADHD and stimulants are codefined. That doesn't prove anything, it's a circular definition.
The people who got exercise, slept well and kept meaning in their life avoided falling down the hole. They aren't in the study in the first place.
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ADHD meds are suggested as a first line treatment above all of those other things because they are more effective than all those things, like several times as effective, and are well tolerated and inexpensive.
It is that fact which plays into why this treatment is exploitative. You should only ever be trying something like this after exhausting a number of more effective options. This program is marketing itself as for people who AREN'T EVEN DIAGNOSED with ADHD and pretending this is somehow an "evidence-based" approach.
Definitely agree ADHD medication has been proven to be most effective. Thank you for this comment!
Most of members use coaching as a tool in conjunction with medication or other forms of treatment. Our service is not marketed as treatment, but simply another tool (for guidance, support, accountability, skill discovery) you use like to do lists, education blogs, body doubling, etc.
Our methods, on the other hand, stand on the shoulders of giants and are based on evidence-based approaches and methods. We put a lot of effort & care to conferring with the medical/clinical, coaching, and other helping professions to ensure what we're building is based on evidence-based approaches. Happy to share more over if helpful! hi@shimmer.care
I agree their phrasing could have been better. However in my country it typically takes 1-2 years to get a diagnosis and start treatment. It's even a few months to a year if you go private.
I can see this sort of thing being at least a stop-gap, and something that might help while someone's waiting to get access to the better treatment.
Listen, if you are people reading this with adhd, don't listen to me, don't listen to this guy, don't listen to OP. Find an expert in adhd. Make sure they understand what executive function disorder means. Listen to them. Please don't suffer with this. It's not your fault.
Thanks for this, you're being very evenhanded. Lifestyle changed sustained over time is the way to go, any remaining bad feelings can be taken as signals or just part of life. Pills aren't magic.
Spoken as someone who never had to deal with decades of prolonged abuse for the crime of not having enough dopamine
It's not a normie coach. I use this service and my coach has ADHD herself (plus some other traits). I've been using it for 3 weeks and have found it very useful. I think you dismiss the role of metacognition. There are strategies that work for my brain, they're just different to what works for most people. I have found it very useful and have recommended it to other people.
Stimulants don't work for everyone. Or like for me, they stop working after some time.
This is an unfortunate truth. The physiology of how methylphenidate and dextroamphetamine work in the mid brain allows the brain to "correct" for the solution, sadly. You will need to work with experts to properly manage your medicines. I have used ritalin/Concerta and tried Strattera, catapres, SSRIs, etc. Only stimulants worked. The hardest part is that the government forces you to not use drug holidays--Yay government....so helpful.
I am curious, how do you explain the chasm in ADHD diagnosis between the US and Europe (or anywhere else really)? Surely if it's a purely neurological disorder, it should be somewhat "uniformly" detected across the globe, no?
Being purely neurological would strongly suggest uniform distribution of the disorder _itself_ — but absent a purely neurobiological _test_ for those symptoms, uniform distribution wouldn’t imply uniform detection.
“ADHD is primarily a neurological disorder” and “differences in ADHD diagnosis rates are primarily cultural” are not incompatible statements.
Europe maybe doesn't hire beautiful people to push drugs on prescribing doctors? Maybe Europe has better surveillance?
My wife was diagnosed several years ago at our 3rd marriage counselor. We found a physician that 100% believes in a medication based solution, went through 4-5 different medications to find the right one for her, and she's successful with Vyvanse. Mostly.
Vyvance is time release. She takes it in the morning and it wears off by the time she gets home. The behaviors at home that don't work well are still there but her stress level is way down now that she has a good handle on work. Good for her, better but not good for the kids and I.
I wouldn't say she needs anything like counseling because there isn't a problem with perception or emotional dysfunction. A "coach" on the other hand could help her and us quite a bit, if she had someone to talk to about "life". Maybe they could point out she's gone into work for the last 3 weekends and for this upcoming one she can take Saturday completely for herself to decompress, then do something meaningful and fun with her family on Sunday. That would make her feel a lot better and the the kids and I too.
The problem is the person with ADHD being willing to have some measure of accountability. The life coach needs to do that part expertly. In our case, it really does need to be someone else because I can say the same thing as a life coach and in the exact same way, but because I am "the husband" my wife's guilt ramps up and so does negative self talk and some anger. Even when I try to help kindly and thoughtfully she can become defiant or dismissive. Because I'm "the husband". I have tried stepping and helping her have a relax day followed by a family day but its exhausting as I'm the only adult doing it. Its a bit of a trap too because it starts to change our relationship to the dreaded parent/child dynamic. Although I tend to think of it as care giver and care needer. ADHD aside, she needs to own what she does or does not do because she is an intelligent capable adult. But she has to figure out how to do it without me stepping in all the time.
So while medication ought to be the first step for help, it is also probably the right thing to supplement with some kind of coaching, even if it is infrequent or done with a light touch. Ideally self reflection could eliminate the need for coaching but it's not a task that elevates dopamine levels in the executive function of the brain. Meaning, someone with ADHD is probably not drawn to or motivated to do it on their own. It's more likely involving an unbiased 3rd party is actually helpful.
ADHD is not a bad thing and I really don't want to call it a dysfunction. I'm in the neurodivergent camp. When her hyper focus kicks in whatever she is doing is done to the best degree anything like that can be done. There's another member of the family that has ADHD that is also competitive. When we do something together and there is the mere possibility of being competitive, their hyper focus kicks in and I can't keep up with them. In software development, an engineer with ADHD can out think and out code me by a noticeable distance if their hyper focus kicks in. Their problem isn't performing, it's being in control of when they perform and on what tasks. They make great pinch hitters by the way. Want a production issue fixed quickly? Grab the ADHD dev in a group meeting where they share their screen. Me though, I cave. I fold. Too much pressure and I don't mind admitting it. I'm too much of an empath. I just don't see ADHD as a dysfunction because its obvious that its a rebalancing of strengths and weaknesses. They'll get their electricity shut off by forgetting to pay the bill but they'll also decorate the best looking wedding cake when it's late and the decorator calls in sick.
I want to also mention, we have a friend that hasn't been diagnosed but swears he has ADHD. I can see that might be true but he also is an avid runner. The physical and mental exercise of running probably helps him manage well enough that he doesn't need medication. And I think that suggests that ADHD is not a switch where you have it or you don't, more that it is a spectrum. There are probably people that have a low level of ADHD and have figured out life just works better if they do certain things, like drinking coffee regularly and running.
edit: spelled Vyvanse wrong
Your correct. But some of us can’t tolerate the medication.
I hear you. I had very bad reactions to some of the medicine used for adhd. SSRIs, Strattera, catapres/clonidine. And I refuse to use amphetamines although my sister has success with them.
Totally agree on bullshit detector event alarm.