I assume you will get a lot of helpful tips here, and I too have successfully managed to cope for almost 30 years, but I have to honestly admit that getting on medication was the best thing that has ever happened to me. There is only so much you can do to alleviate a chemical imbalance.

My life has never been the same since I got on it. The first few days I had to cry a lot, it was so incredibly beautiful and liberating. It was.. quiet. No more dozens of thought streams at once. Thoughts suddenly had structure. Everything had structure. I could tap into the potential that had always been there, but had been inaccessible. I felt normal. I fixed up my whole life within a few months, organized it (which now even helps when I dont take the medication), took care of things that have been unfinished for years.

And that's only work and organization. My social skills went through the roof too. I started to be able to hold normal conversations, I could listen properly, I could reply properly, and any conversations I have have become just so much more deep and meaningful. My depression and anxiety have vanished completely, for they were only a symptom of the ADD too. I eat better, I sleep better, my apartment is clean. I'm happier and healthier than I've ever been.

There is no real alternative. You can decide to keep on coping, but at some point you really have to ask yourself if you want to make everything harder on yourself than it has to be.

Hear, hear. I tried to make it work without medication - to be honest I didn't even know I had ADHD - and all that resulted was complete burnout, depression and self loathing at being unable to accomplish more. I had just enough energy to pull through the working day and not much else.

The medication has freed me. It has removed the ball and chain from my brain. It has saved my career and is pulling me out of a lifetime of coping mechanisms.

Now I just need a notepad and a TODO list, which I use religiously to keep track of everything. Previously todo lists were a fad for me that I wasn't able to keep up with for more than a week.

I am just starting to look for treatment. If you don't mind sharing, which medication works best for you?

I'm on 20mg XR Adderall daily. My insurance won't cover Vyvanse which seems to be vastly more popular and well tolerated these days (the patent expires next year though, so we'll see what happens).

I'm also on Vyvanse, 60mg in the morning and 100mg of Wellbutrin which is an anti depressant, that targets the same brain chemicals as Vyvanse.

Vyvanse, helped but my depression often cancelled out the med, and SSRIs didn't help at all just made me have erectile issues which really didn't help my depression.

I brought up Wellbutrin with my doctor after reading about others with ADHD being successful with it...

I found out I had ADHD 4 years ago when I was 38, I'm almost certain I also have autism, as 3 people with ASD have flat out told me I did, and they listed a bunch of reasons and I passed a few online tests...I also over share a lot as you can see from this post.

Before getting on stimulants, I too have taken Wellbutrin/Bupropion and found it somewhat helpful. SSRIs made it worse for me.

I am quite surprised to be honest that you are taking Wellbutrin and Vyvanse at the same time. While not dangerous in terms of possible serotonin syndrome, this combination is a little bit concerning as Wellbutrin can raise the blood levels of amphetamines and lower seizure threshold.

20mg Vyvanse at 8am + 20mg at 1pm is the bee's knees for me, lasts until 7pm, not too strong, pretty much no side effects and doesn't disrupt my sleep. In fact, the PM naps when I'm on it and sleep deprived are godly.

I have a mixture of instant-release and extended-release standard methylphenidate/Ritalin.

Adderall works well too, but I find it a little bit too "drug-like" and euphoric, so I settled on regular methylphenidate which has almost zero euphoria.

Fantastic original post Mo3, thanks!

May I ask how long it took you to find the right medication and balance of XR/IR please?

You are welcome.

For myself, it was immediate. There seems to be a certain kind of intuitive understanding that becomes obvious after the first doses of a medication.

It is quite hard to explain, but it seems like the brain knows exactly what it needs. Unless you have uncontrollable addictive tendencies, you will automatically gravitate towards the dosage necessary to restore chemical balance. You will redose when it is needed, and you will notice quickly if a medication is not the right choice for you.

I was and still am very happy with the initial methylphenidate IR and Concerta (same compound but XR). I have tried different options over time, but they did not work as well or had side effects that I was not comfortable with. For example, I noticed that contrary to MPH, Adderall is destabilizing to my emotional state and thus was definitely not suitable for productivity, and the crash mainly consists of horrible mood swings and apathy, which is not the case for me on methylphenidate. On Vyvanse this was better, but the effects themselves still somewhat comparable to those of Adderall. I have not tried Strattera yet, but I do not really see a reason to these days.

On this note, I've talked with a lot of those affected by now, and choice and benefit of medications appears highly subjective. It seems like there is no way of knowing without trying it out.

Thank you mate!

To clarify, my current dose is 20mg XR daily. I have raised with my doctor that this dose is completely spent (I have other [diagnosed] issues that lead to an overly acidic stomach) long before the end of the work day, and thus I don't have medicinal help when I turn to my personal life.

As yet she seems quite unwilling to adjust the dose or add an IR (anecdotally adding an IR seems very common), and I was wondering what the timeline was between starting medication and landing on a sufficient dose of XR+IR between you and your doctor.

Personally, I found the promise of XR's delayed-duration to be massively overstated. I like the IR's better, because you can figure out when to re-dose through experimentation (which my doc encouraged.)

I was also motivated to change to IRs, and mentioned to my doc, that the generic IRs can be had for less than half what generic XRs cost, with GoodRx. I have insurance, but GoodRx is cheaper, and insurance gives me runarounds with 'prior auth' nonsense.

My timeline was a month before switching meds/doses. Obviously, you want to give it an honest shot of a few weeks, but if something isn't working after a month, your doc should be willing to change it up. If they're giving you a hard time, I'd explore other options. There seem to be a number of providers that have a prejudiced view of stimulants. If you needed to switch/increase the dose of say, an antidepressant, no doctor would think twice.

Ah, I see. Sorry for rambling. I can understand why you would not be happy with this schedule.

Timeline-wise, when I started medication, I was given only IR. As methylphenidate is shorter acting than Adderall, this resulted in me taking 3 doses per day and active levels fluctuating a lot throughout the day, so about a week later I decided to set up another appointment and was given additional XR to be taken once per day, and the IR only when needed.

Your doctor does not sound very competent. I would not recommend increasing dosage if the problem is a too short duration, as a higher dosage will not prolong duration, but adding IR to XR is indeed a common course of action to accomplish that.

Also, I should note, try making sure to always keep your stomach full during the day. I'm not sure if the same applies to Adderall, but I've observed diminished duration and bioavailability of XR without food.

NZT?

I was diagnosed with somewhat severe ADHD, hyperactive and attention subtype. I have few tips to share:

1. Find your medication. After I found mine with the correct dosage, my life improved ten fold. Our dopamine system is wired differently and medication is the basis of treatment to cope with it.

2. Externalize everything: thoughts, events, planning, even your life’s values if you feel like it. Write it all down and build the discipline to keep those updated. Use todo-lists for everything. The poor executive functions we experience can be compensated by externalizing everything, so always organize your thoughts in a notepad. I use NotePlan mac/iOS app and highly recommend to check it out.

3. A lesser commonly known part of being ADHD is that it can also cause emotional unbalance. We can get overwhelmed, overexcited and overanxious easily. Keep awareness of your emotions. Again, write them down.

4. SLOW DOWN. Especially if you are also hyperactive. Try to think and react more slowly to the world around you. Give time for things to sink in your head before taking action.

5. Last but not least: be kind to yourself. You can’t always do everything perfectly. Mistakes are going to happen and that’s normal for everyone. Focus on improving yourself a little everyday and enjoy the present.

If you haven’t seen this video yet, it explains better and in much more detail: https://youtu.be/sPFmKu2S5XY

This could not more perfectly reflect my experience had I written it myself. I was diagnosed with (also quite severe) ADHD recently, and it seems it was a surprise to literally no one but me. A solid third of the people I've discussed it with had assumed I knew and just wasn't well treated.

Even though it's number 1, I do want to emphasize it for those who are reluctant. Finding an effective medication has been one of the most net-positive personal changes I've ever experienced. And if it isn't for you, there's no harm is simply stopping :)

Edit: I should have kept reading, Mo3 sums up my contribution here much better lol

Exactly! My doctor made an analogy of taking meds with wearing glasses for sight correction: you don’t need to use it at all times, but if you do want to see properly then you do need them.

Out of curiosity: may I ask which medication are you using?

Most days I’m taking Concerta 54mg topping up with the short release (Ritalin) as needed. I never needed to try Adderall or Vyvanse as that combo worked so nicely for me. Some days I want to have finer control and just use the short release.

I cried throughout my first weeks on meds. Finally understanding how calm most people experience their brains was life changing. :)

Sorry for the late reply mate. I'm currently on 20mg Adderall XR, but I'm very interested in exploring alternatives because the duration is very limited for me (I have acid issues in my stomach) and the side-effects are prominent.

I suffer from ADHD. I'm not sure my advice is a good fit for your specific situation, but these are some things that I think are helpful.

1. Get your health/medication on point. Find out what medication works for your and take it consistently. You can't afford to lose out on the extra executive function good medication can give you.

2. Accept your ADHD. Flagellating yourself for missed deadlines, forgotten tasks, procrastination and so on will only make things worse. I used to beat myself up about procrastination and it led to a cycle of anxiety that only made things worse. If you have a low productivity day accept it. Take each new day, each new project and each new task as completely fresh an isolated.

3. Record yourself working. Use a camera or a screen recorder. Try to notice exactly what happens. Do you start a task and then procrastinate? Do you procrastinate before the task starts? What triggers it? Is it internal? External? It can feel like you know what is triggering things but getting an actual recording can show you things you would have never noticed in the moment.

4. Inject novelty into boring tasks. Often simple boring tasks don't have enough excitement to make them interesting. Counterintuitively, making a task more difficult can add novelty and help stop you procrastinating. What adds novelty and challenge will be very individual.

5. Make peace with that fact that some techniques will stop working for you and you will need to change how you work. Just because something was working great last week doesn't mean it will work this week.

Good luck!

Point three is great! To add my own experience; I often got distracted when a task seemed “too hard”. Out of a fear of failure I didn’t start the task but due to ADD or whatever I never realised it was anxiety that was causing it.

Knowing certain ‘triggers’ can help you prevent distractions. For me simply the realisation was enough to improve it.

1. I use Adderall, cycle with Caffeine, with days on neither to prevent dependence.

2. I use Google Tasks and stick everything there obsessively. Some tasks are higher overhead to track than to execute, but not having to make the track/just-execute distinction enables more execution because of how ADHD works for me (choice making induces task avoidance)

3. I have a daily meeting at 0830 where I execute a daily tasks list. Here's the first few lines:

    Recruiting platform checks

      Greenhouse:

       Screen current candidates

       Review scorecards

       Review Application Review

     Write 3 objectives for the day

     Clear all Gmail inbox

     One off tasks

      Review task deadlines

       On Recruiting Board

       On Engineering Board

     Do all immediately due tasks

In my case, all of my behaviour got worse after I had a bad car accident so I've been forced to use all this machinery. I still get the desire to work and stuff like that but I get some sort of physiological fear-response for things that appear big but just need to be done.

This is problematic for someone in my position, so I just use the tools to deal with them and I'm able to fairly performant, though it probably sounds silly to many people who are able to task-dispatch much more easily.

I had to quit Adderall, it made me an awful dad and husband too anxious to do anything other than work and I was only able to work on specific things. I was never able to focus generally on any particular thing with it. I’m on Strattera but it’s only 10 days in and it takes several weeks to kick in.

I go to the coffee shop and do 3 15-minute Pomodoros every morning. The combination of being at a dedicated place, limiting the work I have to do, and having a stimulant works reasonably well for me.

It’s amazing what you can get done in 45 minutes if you really focus. I struggle to write much—if any—code outside of that window. The rest of my day is chat, email, docs (reading or writing), or making simple one or two line fixes.

I was diagnosed in like the second grade and have struggled throughout my life. I’m in my mid-30s now.

Thanks to the farm bill, you can look into using cbd gummies to offset the anxiety from dopamine agonists and sdris like adderol/Concerta respectively at a very small iq cost. Find a DO since they are more open to alternative medicine.

I appreciate the tip but CBD didn't do anything for my anxiety. I tried several formulations including some with THC.

It's like hens teeth now, but piracetam helped me immensely with anxiety but it doesn't mix well with adderol, I hear. I keep my GP informed about it but you can't get it prescribed unless you are outside of the US. Thanks FDA. Also tryptophan and theanine might help. The prescription anxiety meds all sucked for me because they nuked my short term memory making it impossible to do technical work, but the stimulants are the only thing that worked. Strattera almost killed me. Forebrain gummies are cool, but they don't replace methylphenidate or dextro/levo-amphetamine, unfortunately. It's the card we have been dealt.

What do you mean by 'Strattera' almost killed me? I was prescribed this and might have developed a liver issue from it although I'm not sure. Just curious if you found yourself in a similar situation.

It had really bad side effects.

I've had to work through ADHD as an engineer and echo what a few folks on here have said about slowing down and being intentional. It's easy to get overwhelmed when you have a to-do list with 25 things on it and you feel like you need to do all of them on your own or the project will fail.

People with ADHD are conditioned to expect that the projects they take on will fail if they do not put in 150% effort. I was this way in school. At work, it should not look like this. You should tend your to-do lists and deligate to your junior and mid-level devs wherever you can. Put them to work on implementation and focus on the high level stuff or fill in the gaps on things that they can't do.

On a personal level, take up meditation. This speaks to training your brain how to slow down and focus. 20 minutes a day of shutting your brain off and just sitting will make the world of difference. Lean on your medication if you need it. It really does make a difference, but it can introduce some behavioral changes that are not ideal if taken for years (for me, it induced manic depression).

The best advice I can give you is what I wish I could have told myself over the last decade: your expectations of yourself are higher than anyone can reasonably expect of you, be very cautious of burnout, counter any self doubt with the knowledge that your talent is already seen and proven, and rest.

You're already qualified to do the work or you wouldn’t be recognized for it. You don’t need to do more. Getting a promotion is a formal acknowledgment of work you already do! This is your chance to be rewarded for it and relax.

Congratulations, also, are in order. It’s really tough for us to thrive with this kind of anxiety and pressure. Reward yourself. Take a vacation if it helps. And keep doing the things you’ve found rewarding and successful.

1. I use Quiver.app to plan my week/day and to track what i'm working on right now in the moment. Any intermediate output from my work gets tracked (eg. preparing important commands, saving output of important commands) and any little task that pops up gets added to an impromptu to-do list. This keeps me focussed and stops me forgetting my place in what I'm working on in case I get distracted. At the end of the day/week I ruthlessly evaluate what must be carried over and what can spill on.

2. Learn to offload work to juniors. Create tickets and dump them in your backlog. Work with your manager to make sure that "work that is not an efficient use of my time" gets handled my someone else. Anything that drains your energy or seems tedious and can be a learning opportunity for a junior. Use your 'procrastination' as a signal that whatever you're working on should be assigned to someone else.

Do you have a link to this quiver.app?

Prob this https://yliansoft.com/ https://apps.apple.com/us/app/quiver-take-better-notes/id866...

Get a galaxy note based smartphone--you need to get notes and have something you will always have with you to get task notes to feed into your system. Star items that are action items for you. Get a smart watch. The only feature you require here is for it to buzz. You will turn your phone on silent for meetings and miss your task tracking cues so the watch will fix that. Get a private Kanban board and share that with your task lead. Use jira or the like to track your team/reports status. Get access to your project plan. You are trying to create a sense of urgency externally since your prefrontal cortex isn't maintaining task salience/has time blindness. Make sure to get buy in from your task lead. If you have issues with this, request it as a reasonable accommodation, assuming you live in a country that protects disability rights. Set frequent alarms. Set aside time cued by these alarms to a) review your task notes and cross their stars off when you complete or get them into a tracking system. b) review your tracking systems to remind yourself of all the work you/your team must complete. Get a neurologist or your family doctor to prescribe a stimulant style medicine if you can tolerate it first, then look at other options. You need dopamine going to your prefrontal cortex to maintain task salience first and foremost. Your tools and processes are externalizing your executive function. No joke, watch all of Barkley's vids. I have successfully lead teams of up to 20 and teams of teams with these accomodations. They also help with IC tasks to keep me on track for heads down, help the team time.

Also, conserve your executive function by taking life short cuts. Let go of trying to help the environment and use paper plates, plastic cups, and forks--it sucks, but you need this buffer. Prepared food are your friend.. Use melatonin to get regular scheduled sleep. Limit your pets to low maintenance like cats/fish if you can. Pay as many of your bills automatically, if you can. Set up your medicine/supplement stack at the beginning of the week with those tiny dollar store plastic tupperware containers,2x1x1 ish inches. All day brain focus has a couple of good supplements like phosphatidlserine/choline and dmae. Look into racetams if you can find them. Make sure you are getting enough b12 and d3. Look at patches, Creams. or shots if you don't absorb b12 well. Your doctor can help with everything except some nootropics unless you live in a country where racetams are prescription--in which case I envy you.

- I use ToDoist as a browser extension and a phone app, and it's very satisfying to check off items. I also maintain quick ToDo lists on Post-It notes and a white board.

- I'd recommend anyone to do this (using the same app or another one), but I use Obsidian.md for notes. I'll create a page for each Jira ticket that I'm working on, where I'll include personal notes about things I've noticed (e.g. "When passing in this object I get X result") as well as Q's that I have and any answers that I've been given.

- I use the LeechBlock extension to block certain websites between certain times of the day, including HackerNews and LinkedIn (the latter is a huge rabbit hole for me). Link: https://www.proginosko.com/leechblock/

- I've got noise-cancelling headphones. There's a lot of sirens and honking horns outside of my place and they do a great job at blocking those things.

- If I'm really distracted, I'll move my phone to the other side of the room so it's out of sight.

- I started seeing a psychiatrist in late-January and started taking Vyvanse as a result. At first (lower dosages) I didn't notice a lot of differences, but there was one day to where I didn't take Vyvanse---I was on 40mg and went to pick up my prescription the next day. I was shocked at how much harder it was for me to focus and get stuff done. I asked myself, "Is this what it was like pre-Vyvanse?" Out of all of the items on this list, starting on Vyvanse was probably the most effective thing.

- I got a standing desk a month ago and stand during meetings. Not only is it a bit easier for me to focus, but I'm also getting my money's worth :)

> most if not all software companies require work that's less research/depth in nature and more planning/organizing/breadth in nature

I wish I could say just pick the work that is more R&D in nature and avoid 'secretary' work, but you obviously don't have that choice. Personally I love anything along the lines of Lockheed's 'Skunk Works'[0] program. Pure R&D and risky too, because you don't know if it will work. F7ck around and find out is my mantra.

[0] https://en.wikipedia.org/wiki/Skunk_Works

I mean ADHD is a challenge in of itself, why not push back on the promo or go on a trial phase to figure out how stressful it is. I don't understand the need for people to keep pushing and advancing beyond their means.(goes beyond streching)

Is there a reason you put so much stress and was it all worth it? Are you doing it for money, prestige or a combination of both?

Most of the times its always better to slow down and not fight with your condition just to perform your regular duties. Taking medication and optimizing all for doing your job seems like a waste and something that will have its consequences in the long run.

I struggled with all of this and decided instead of pull back on responsibility because it was making me extremely unhappy trying to constantly equal my similarly levelled colleagues.

As a programmer I've approached these problems with programming productivity software for myself. 1) A hierarchical task list that has unlimited depth for tasks and undo history. I write every little task down and their subtask and their subtask... This way when I do get distracted (and I do a lot), one look at it and I know snap back to the context I was in. 2) Micro day/routine planner that schedules my day and reminds me to do things with text to speak while I work

I don't have anything to contribute, but the fact that you are in a senior position of an important project is good news to hear. I have been anxious for some time that my horrible working memory and executive function are going to stunt my career growth unless I start snorting lines of adderall, which I don't want to do.

Read my reply. You _can_ do it. It will be hard, especially with the politics and missed social cues, but it can be done. Talk to your doctor about Concerta which is abuse proofed if you are worried about that aspect. I have tried both ways and you simply need the extra dopamine from your medial forebrain bundle to your prefrontal cortex to maintain task salience. You will need to externalize executive function using your cellphone+smart watch and tracking tools. It is our wheelchair/crutch.

Kanban + Medication, by kanban, physical or a laptop or huge screen showing everything that needs to be done. It has to be standalone. I find that works great.

I prefer trello but it is fantastic to idealize what I need to do and sort priority and what to do down the road.

Collaborate with other people and draft off of their organizational skills. Pairing can make you way more productive + it’s a good way to get to better ideas.

> and pretty much in the same way

This is the dismissive part. It doesn’t even affect those of us with ADHD the same way, or even affect us each individually the same way every day.

At my best, I’ve been pretty consistently praised for being good at keeping track of how everything fits together and all of the details that should be considered for a given effort. At my worst, I know there’s a short list of things which will pass as functioning if I can bring myself to follow through with it.

Neither of those extremes are normal everyday experiences for most people. And that’s good, and it’s understandable you recognize the wide gamut in between.

I don’t want to dismiss your much broader more general experience either. I just want to push back on the thing that feels invisible for those of us who aren’t actually experiencing that broader more general thing.

I honestly didn't mean to come across as dismissive. Taking the OPs words exactly as they were written, I only meant to say that generally speaking, those responses are all quite expected, independent of any diagnosis. Having ADHD could of course make each of those bullet points much worse! But as the post was written, it seemed like textbook dissatisfaction that all of us experience when placed in a role that isn't quite right, and when that happens it's often easier to check out or become distracted. I don't see how ADHD stratagems could alleviate this without increasing unhappiness lower down. In the end, if you're not doing whats right for you then figuring out how to focus better is the real distraction.

I hope my response helps you understand why those things which seem universal aren’t necessarily universal for us. A lot of times we’re just disappointed with ourselves because we’re not experiencing the thing the way “everyone” does, and can’t find a way to that feeling everyone else expects.

I intentionally framed the problems I'm tackling in a way that resonates with a wide spectrum of people, so that I can get a variety of answers and work with anything that resonates well with me. In this process, I guess I didn't press hard on how debilitating executive dysfunction has been for my work (and life in general - story for another time) and I apologize for my assumption but I guess since you're neurotypical there's no way I can actually make you really understand the difference between the amount of energy and willpower required to execute on these tasks/planning/etc. I am formally diagnosed and have been on medicines in the past and the productivity difference and confidence in my abilities with and without medicines is day and night.

To provide a similar real world analogy that has potential to resonate with you: on medicines that work well with me, my core thoughts works as if a car is being driven on a freeway with properly defined rules and regulations, along with lots of other cars following the same rules. Without those medications, it's basically free for all, where there are absolutely no rules and regulations and anyone can drive anyway on that freeway. Sure, there's still a chance that every car reaches its destination safe and sound, but the amount of mental gymnastics needed at every point of time without those inbuilt rules in place is staggeringly exhausting.

This has been my life at work every day, because I have consciously kept myself away from medication for a variety of reasons. This post is an attempt to learn more of these structures and hopefully with enough practice, I'll become efficient in utilizing these structures so much so that it requires less effort and latency to maintain and execute them on a daily basis.

> This has been my life at work every day, because I have consciously kept myself away from medication for a variety of reasons.

This doesn't make any sense to me, especially in light of your traffic analogy. I have ADHD as well and getting medicated has been probably one of the most impactful things that I've ever done for myself. I'm very curious: why would you want to avoid something that's so helpful?

> This post is an attempt to learn more of these structures and hopefully with enough practice, I'll become efficient in utilizing these structures so much so that it requires less effort and latency to maintain and execute them on a daily basis.

Structure and process only go so far if your brain chemistry is fighting you. If you want to lose weight, diet AND exercise is the solution. If you want to regain executive function, IMO, medication AND processes are the way.

To answer your original question: most of the processes that I have are based on distrust of my brain. Therefore, most of my processes for getting things done rely on getting things out of my head (a la GTD, but without so much accounting). Things and Obsidian represent the bulk of my toolset. In particular: I have a pretty specific workflow for capturing stuff that I want to read later + a template that results in a lot of notes being taken from any given source material. In order for an article (or whatever) to get into my system, it has to be worth the effort to fill out the template + take lots of notes. That's been a good filter for me because my previous tendencies were to read ALL the things. I process my email and Things inboxes as often as needed, but at a minimum, once per week. Getting to Inbox Zero once per week is a necessity for me or I start having anxiety about the stuff that's in my inbox that I might have forgotten about. For email, I unsubscribe from as much as possible, delete the bulk mail stuff, archive things that I'm directly involved in, and capture any tasks in my Things inbox.

Then, Inbox Zero in Things is simply making sure that each task is actionable and has relevant context ("Fix issue #1234", "call so and so at xxx-xxx-xxxx to talk about xyz", etc) and then sorting it into the appropriate area of responsibility and/or project. I don't do anything with tags or anything like that. Once per week, I go through all of my Things lists and make sure that everything in there is still relevant (and delete what isn't), assign a "When" value for things that I'd like to do this week on some particular day, and assign a "Deadline" value for things that ABSOLUTELY MUST get done this week. If I have to reschedule the nice to haves, it's not a big deal.

> It becomes exponentially tougher for me once it goes beyond 2 work items.

Don't take on more than two work items at a time. If there are more, they go in a queue. You can't be actively working on more than one or two at a time anyway.

> it becomes overwhelmingly difficult to focus on my subproject without trying to understand everything it touches upon.

So don't do that. Embrace selective ignorance. Learn what you need to learn when you need to learn it and no sooner.

> There are new terms, new things very slightly unrelated to my smaller project at hand that I don't know no matter how much I learn.

Ask about these and write them down somewhere. If someone is using a term that you're unfamiliar with, politely interrupt them and ask for clarification so that the conversation is valuable to you. Start a wiki page or a gist or whatever that just lists the terms that are relevant in your organization.

> Once I get started on any task, it takes a while for me to get going, and even after finishing it up, it takes a while to start on another task as well.

This is executive dysfunction. Medication helps here.

> But when the project involves interacting with multiple stakeholders in an async manner, it gets split into tens of small units requiring immense willpower to start and stop.

Schedule a recurring check-in with these stakeholders and hold all business until the check-in. Recurring meetings suck, but you have to communicate, so you might as well consolidate all of the communication into a timeslot that works for you. Social pressure (in this case, to join a meeting and use the time productively) can be a great tool to use. You can do this with programming too: pair program with somebody (especially if you know of another person on your team who has ADHD -- you can help each other by creating social pressure to perform).

> This problem is easily avoidable at junior/mid level engineer, but at senior level these are prerequisite rather than a choice.

This is not necessarily true. There are many organizations where stakeholder coordination can be handled by somebody who isn't expected to be writing code.

> But at senior level and above, most if not all software companies require work that's less research/depth in nature and more planning/organizing/breadth in nature.

This is also not necessarily true. There are organizations where senior engineer != junior management.

This is a real physiological disorder with a genetic basis. You are dismissing it. You are not helping. People with CP can still walk but look at Walter Whites son to see how much it impacts his life. Adhd is like that but with your prefrontal cortex instead. Barkley is the guy to refer to for actual research.

Who cares? You're working for a CTO with a multimillion dollar exit strategy. Parlay this "title" into more money and get out asap

Medication, exercise, and building out a list making / journaling process that works for you.

Just stop working at Amazon.

In my experience perfectionism is one of the meta-stories we use to explain to ourselves why we have trouble executing. When starting things is hard, spending more time on what you are already doing is easier and feels productive. When starting things is hard, learning about all the related sub-projects feels productive and creates a powerful dopamine hit of new information.

I find what works best with the poor time horizon stuff is to spend a bit of time regularly looking at and planning the big picture on a calendar or paper, but then spend the bulk of your time chiselling away at the plan. Forget weeks and months, just worry about today and the next half hour. Break every task down until you can face the starting action. GTD was right about not knowing what to do next will stop you in your tracks. So will not being able to face what you have to do next.

During my most productive stretches I use a combo of digital and physical. There might be an intimidating list of todos in my browser, but my working hours are limited.

I break my day down into 30 minute (25 work/5 break) pomodoros. I string several together if I need a longer block. In the morning I transcribe what I want/need to work on onto enough cards to fill all the blocks for my day. Some things get split across multiple cards. Some cards get multiple items. This process gives me a good grasp of what is in store for the day, which helps minimise perseveration.

Then I arrange them to avoid boredom. Place the hard stuff first for when I'm fresh. Interleave projects because switching between projects keeps me interested. Maybe shuffle some for the surprise factor. Sometimes I also have cards for the breaks. Those I shuffle, again for the surprise factor. Hey! It's snack time! Again! Unless there's something I really don't want to do, then I'll have a doom scrolling break waiting for when it's done. Having a dual digital timer (a physical device) makes sticking to this easier.

If I can't face a card, I move onto the next one. If I reach the end and still can't face it, I try and work out why. Too hard? Too dull? Too confusing? Maybe I switch up the pomodoro and do 5 minutes on it and have a 25 minute break. ¯\_(°ペ)_/¯

The most important thing is making as much of your routine as you can a habit without allowing it to turn invisible. Making it physical helps, but isn't foolproof. Nothing is. We can learn to ignore anything except that we feel bad for ignoring things. Once you can ignore it, you have to start all over again with a new approach. You can delay the inevitable derail by making it as easy and as enjoyable as possible. You do that by making space for as many reliable dopamine hits as you can.

I haven't been able to work on ritalin or adderall. I'm on guanfacine (Intuniv), which takes the edge off the concomitant emotional issues, especially the performance-related anxiety we can accumulate over the years, while being psychically transparent. Unlike ritalin and adderall.