AuDHD & the changing tides of ADHD medication

I want to capture something about the tide of AuDHD, particularly in the context of ADHD medication. I would say that I am on the whole medication neutral/positive. ADHD medication is used in my family and it has been useful for a number of reasons. But something I’m seeing in my private practice as a therapist is giving me pause to reflect on the double-edged sword of meds.

The Resounding Sea - Thomas Moran American, born England, 1837-1926

So you get your assessment, your diagnosis, you go through titration and for a number of people who don’t have complications, you’re ‘ready to go’. You’ve got your productivity pill. It seems like a miracle, you call it a game-changer. And so you get stuff done, you become more productive at work. People praise you, so you keep going. (At any point, have you asked your autistic part how they feel about this situation?) Looks like your ADHD part is having a great time. It loves the praise, the fact that it’s getting things done and not procrastinating. On the surface all looks shiny and happy.

But.

We live in a capitalist society. There is risk here. Every time I think about it what comes up for me is the ‘pound of flesh’ which I often bring up in therapy.

The “pound of flesh” metaphor from Shakespeare’s The Merchant of Venice takes on new resonance when considering ADHD medication in the workplace. Once an AuDHDer (or ADHDer) begins methylphenidate treatment, the sudden surge in productivity can feel almost miraculous—tasks that once seemed impossible become manageable, and the validation from employers and colleagues can be intoxicating. But this newfound capacity comes at a cost. The capitalist system extracts its pound of flesh not through cruelty but through a more insidious mechanism: the medication that enables focus and productivity doesn’t discriminate between work that serves the company and work that nourishes the self. Like Shylock demanding his precise due, employers benefit from every ounce of medicated productivity, while the ADHDer/AuDHDer—having poured their enhanced executive function into meeting deadlines and exceeding expectations—arrives home depleted. The medication has been spent, the hyperfocus exhausted on someone else’s priorities, leaving nothing for family connection, creative pursuits, or simple rest. What appears as pharmaceutical liberation becomes another form of extraction, where the same tool that promises autonomy delivers the worker more efficiently to burnout, their capacity harvested during work hours and their evening hours left barren.

I honestly do not want to throw the baby out with the bathwater or cause anyone to feel any shame in using ADHD medication. I think I just want to invite reflection on what the rhythm of your life looks like pre-medication and how it looks now with medication.

Waves - Hung Hsien (Margaret Chang, Hong Xian) 洪嫻, Chinese (Yangzhou, China born 1933) 1967

I often think about how a more fulfilled AuDHD life looks like a tide that goes in and out throughout the day. The tide comes in and the ADHD part gets on with its dopamine-fulfilling tasks, busying around and surfing waves of productivity. And then the tide goes out while the autistic part might sit and have a cup of tea, stare out of a window or do some regulating research. And after a little while, the tide can come back in again.

And so forth.

‘At Sea; - Denman Waldo Ross, American (Cincinnati, OH 1853 - 1935 London, England)

So let me ask you – how does your tidal system currently work? Does your tide come crashing in fast with tumultuous waves of productivity followed by the tide going out as your body crashes onto the short with flotsam and jetsam all around you that you cannot for the life of you pick up?

Are you all at sea?

Or can your medication journey take you towards a place where your tidal system can become managed in a much more gentle way that allows space for your autistic part to rest naturally?