Launch HN: Inflow (YC S21) – Self-help app for people with ADHD
Accessing treatment for ADHD is expensive, slow, and can be difficult for ADHD people to organize due to struggles with executive functioning. Inflow makes accessing many of the benefits of in-person ADHD therapy significantly more accessible and affordable.
Based on the principles of cognitive behavioral therapy, our app enables people to better understand ADHD and how it impacts them. It also gives people practical tools and helps them to develop the skills needed to better manage ADHD. This is combined with a welcoming community to share experiences and learnings.
Half of our team is neurodiverse and our co-founder Dr George Sachs, as well as having ADHD, has over 10 years of experience treating people with ADHD through CBT. Consequently, we are aware of the impact of ADHD on day-to-day life and how underserved the ADHD community has been in terms of accessible and affordable support. Levi also previously worked for Babylon Health to develop products for chronic condition management and saw how technology could enable access to care.
The core of the app is a CBT-based program that provides short, daily exercises as well as tools to develop helpful habits and skills. The program is broken down into different modules each focusing on specific areas ADHDers may find challenging such as time management, organization and impulsivity. Our community lets people connect with and learn from a range of other diverse individuals with ADHD in a safe and stigma-free environment. We offer daily live events with specialist ADHD psychologists and coaches including topic deep dives, Q&A, coworking sessions and group meditations.
Other features include prioritization tools, which let you set daily goals to prioritize your most important tasks, and guided journaling—prompts and triggers to help you better understand yourself and your behaviors. We’re just getting started and have a range of exciting new features in the works including routine building tools, accountability check-ins with a real coach, progress tracking, group-based challenges, and more.
The average cost of an in-person ADHD CBT session in the US is $200-300 ($10k-$16k/year). This is compared to Inflow’s cost of $95.99/year. Of course, no app is a direct replacement for in-person therapy but it offers a far more accessible and cost effective solution which allows many more people to get the help that they need.
You can download our app here: https://inflow.app.link/0FXmBEAWjkb. We offer a one-week free trial followed by a monthly or yearly subscription.
If you’ve been trying to or previously had difficulty accessing treatment for ADHD we’d love to learn about your experiences. If you do try the app, please let us know any improvements or additional features you’d like to have. Thank you!
336 comments
[ 5.6 ms ] story [ 274 ms ] threadI have the opposite issue. I'm ... what do you call it? neurodiverse (at one time, I was an "aspie"), and I can actually get locked into a fugue, so strong, that hours go by like minutes.
In the aggregate, it has worked out OK. I'm a damn good programmer (but a total nerd).
I do have family that have suffered from ADHD, and hope that your app may be helpful.
For one thing, he gets along with other folks, much better than I ever did.
1. primarily hyperactive (cannot stay physically still),
2. primarily inattentive (”daydreamer”),
3. combined type, with features from both 1. and 2.
I hope getting treatment was that easy for you as well.
Can you at least see if they can start you on a non-stimulant pharmaceutical? Some people really like Strattera (I tried it and had horrible side effects that landed me in the ER, but I know other people who love it). Unfortunately I think Strattera is still patented, so it’s pretty pricey if you don’t have insurance. Make sure to look for coupons that will save you about 90% of MSRP.
They are not the only org that uses a process like this. Many have a longer, more thorough, more expensive process. I don't have a map of these services to navigate, so I'm a bit blind. I went with who was recommended to me. Hopefully having a thorough diagnosis that can travel with me wherever I go can be helpful. If this ends up helping me to address this and have some sort of success in life, $3k will be peanuts.
The hardest part is making the appointments, if you have someone who will help you, ask them to. If you don't just force yourself.
Though as I put on another comment I might delete, ADHD isn't really about mundane vs interesting, at least not always. Sometimes I find myself focussed on the mundane, or ignoring the interesting and enjoyable. The pills aren't magic, and there is no cure, but if you suspect it I recommend finding help. Also, intense cardio exercise, high protein low carb diet, lots of water, and vitamins. I don't stick with any of them for long periods of time, but whenever I do it makes life easier.
Pair programming was a massive benefit as it kept me on task all day.
Being bored was a physical pain for me. Meds took that pain away. Even after I stopped meds I was much improved as I no longer had that pain Association with boredom. Jus regular tendency to get distracted easily.
For example I am diagnosed as ADHD. But I feel I have some issues that put me on the autism spectrum. After doing a lot more in-depth reading I’m pretty convinced I am not autistic, even though many of my symptoms do intersect with autism.
Strongly encourage you read more books about ASD and autism and then seek professional advice if you believe it would make your life better.
Is this not a normal occurrence? I thought this is just how it is for everyone when they encounter a problem that captivates them.
This is the norm for ADHD as far as I can tell seeing how my kid behaves.
As I see it, ADHD is not an inability to focus, but an inability to control what you focus on.
As a rough analogy, ADHD is to focus as bipolar disorder is to mood.
Could you elaborate?
With ADHD, you swing between extremes - unfocused and hyperfocus. Your focus seems to have a mind of its own, you can’t always control it.
Though back to hyper focus, it is a curse and a blessing. Without it, I would never get anything done personally or professionally. Though I will also ignore family, friends, and work for entire days on things that are meaningless and I don't enjoy.
Which really brings me to the core of ADHD. What you focus on has nothing to do with what you want, or what you enjoy. It is, to various degrees, out of your control.
That said, I'm going to give the app a try, I have had some ideas for an app myself, but haven't found the focus to work on it.
For example, I was late to an event for my child the other day because I was trying to improve the speed of a one time copy of data from an old computer to a new one. To the point that when I finally pulled myself away, after receiving multiple phone calls, it had been hours and the original method would have been finished if I had just let it run. I felt like I was being productive, but I was not. Once I realized I was wasting my time it took me two more hours to stop.
Issues like you describe are difficult to self-diagnose and impossible for others to diagnose over the internet. You could have an ADHD-like etiology, maladaptive daydreaming, or you could have a seizure disorder. Undiagnosed seizure disorders can be particularly draining but are often easily treated.
Be wary of internet comments pushing you to a specific diagnosis, particularly ADHD. HN commenters frequently over-diagnose ADHD from comments about vague symptoms. Leave it to professionals who can evaluate you in person.
I have no interest in the app, but I agree that folks who believe they may have any type of issues like this, should start by seeking professional help.
One of the things about HFA and ADHD, is that they can go undiagnosed for a lifetime; which is not always a bad thing. We can often be extremely productive members of society; despite challenges.
A lot of times, the behaviors and habits we develop, as mitigations of the symptoms, can cause more problems that the issue, itself.
Too true. If you can learn to leverage the mental differences it can become very valuable. Unfortunately behaviors/emotions/habits to counter symptoms that in the larger picture often aren't that significant can make life much more difficult than it needs to be.
My main concern with any app is remembering to use it. I have a dozen or so alarms, and todo lists, and I still forget to check them. Beyond some push notification, what ways can your app help me remember to use it to make it a habit?
[edit] just looked it up, I thought Obsidian was open source but apparently not. Disappointing.
Obviously this is a decision I have made for myself and it’s just as likely to blow up in my face in the future as any other project, but I would encourage anyone struggling with memory or organization as a result of ADHD to investigate Obsidian.
219 notes though, sounds like you already have a good habit of capturing your thoughts! Organizing tasks into current contexts has helped me a lot (At Computer, Housework, Wife,...). Best of luck!
I just dump everything into its own note, then write some keywords to search for. Lots of small notes. Searching text is easy and fast on modern tech, so forget organizations that are inflexible and will need to change, just use text search for everything and put every thought into its own note.
Have an upcoming flight? Throw the entire email into a note ( i attach the email file, not contents), then write "trip SFO NYC november 2021 delta thanksgiving" and i can just search "SFO november" or "delta thanksgiving" and find the flight details.
I even keep a note called "addresses" so any service i give my address to i know about. Very helpful when moving (i do a lot) and tracking what accounts need to be updated.
I found the important thing was not to bother cleaning up notes, or tracking old ones or doing anything complex. Just let them exist, and when i get bored (eg. on flight) i may go through and clean old ones.
Re: reminders, one thing I've noticed with any sort of reminder system based on alerts/notifications, is that while they work for a while, eventually my brain just starts ignoring the alerts. I honestly have no great solutions for that. This applies to any sort of organizational system I've tried, actually.
I'll definitely check out airtags, thanks!
(then you get the self control issue of not going for that dopamine hit every time it pops into your head!)
Edit: added minor due to comment below in an attempt to clarify. The wierd text placement does bother me, i'm not joking. but its not that bad that i cannot get past it and read the rest of the website. thought i'd let the OP know; dont mean to poke fun at people who have been diagnosed with OCD. i'm still learning these terms via a child who was diagnosed with ADHD.
Have you looked into OCPD? (Obsessive Compulsive Personality Disorder) From my relatively uninformed knowledge on the subject, that sounds closer to OCPD. (Of course, talk to a licensed health practictoner, not a procrasting software engineer)
> CAUTION: After the free trial period (7 days), they will charge for an annual subscription ($102.95 US). This is OPT OUT, not opt in. In other reviews they say they will offer a refund (I will update when/if I get one) but for an app for people with executive function issues, an opt out format seems shady. Either way, I won't be purchasing this for my loved one with the opt out format for payment.
> They exploit the same vulnerability of the patients, they aim to cure! They take you in confidence and then charge you after the trial ends. ADHD folks forget things all the time and it's a challenge for them. An email reminder is not going to cut it. We have thousands of emails in our inbox. This is profiteering from the mental disability of others. Stay away. A pro-rata charge is a fairer policy for ADHD folks. Any ADHD book will be more useful for what is presented in this app anyway.
> Requires payment to be set up to use free trial... Seems a bit predatory on a mental health app for ADHD brains... We tend to forget things like canceling memberships. And of course they only tell you once you have wasted time making an account. SMH
> Why do you need a credit card to do a 7 day free trial? Why don't you take my card number if I want to continue after the 7 days? What if I forget to cancel, and forget to request refund? I see what you did there
Sounds like they're all making some very relevant points about the app payment model potentially exploiting the ADHD deficit in executive functioning, and the tendency of people with ADHD to unintentionally forget things like subscriptions and bill payments. How do you respond to these critiques?
I cancel all my credit cards every year just to get rid of all opt-in charges on regular basis
edit: There is also a monthly subscription option, in the Apple app store at least. It's $22 a month - so over twice as much as the annual. This does not give me to think the product here is less sketchy. And the Psy.D founder, Sachs, is a pretty blatant self-promoter of the sort endemic to the ADD/ADHD "coaching" space, if unusually well qualified by that standard: https://sachscenter.com/adult-child-psychiatrist-psychologis...
Perhaps it's less of a surprise than I initially found it that the account posting this Launch HN has thus far had nothing further to say.
also edit: Sachs is a Psy.D, not an MD. Granted, this does entitle him to "Dr." as a term of address, just as would a doctorate in physics, ancient history, or underwater basket-weaving. But, just as with any of those, it doesn't qualify him as a doctor in the generally understood sense. Again, this gives one reasonably to question, and the questions thus raised are ones for which well-prepared founders may reasonably be expected to provide compelling answers.
And on my phone at least, the monthly payment option is also hidden behind a scroll down action: https://i.imgur.com/rV0bMTH.jpg, with the yearly subscription already selected by default.
It would seem they're pushing quite strongly this annual payment option.
I'm not too proud to admit that I spent a long time not really taking ADD/ADHD all that seriously. That was before I fell in love with someone who has ADD. Seeing on a daily basis the effect it has on him, and the extent to which, even with effective treatment, it remains a serious obstacle in terms of executive function and followthrough even for things he plainly cares a lot about - to say nothing of subscription fees, which even people without these disorders find easy enough to forget that tools for managing them constitute an entire genre in their own right...
Well, I'm really looking forward to seeing what the founders have to say for themselves here, if anything, and wondering what reasons they could give me not to warn my boyfriend off their product in the strongest of terms.
it generally only gets portrayed in the media based on how other people experience people with adhd -- never the actual experience of the person with adhd.
i hope that changes in the future, so more people can have a similar exposure to it that you've had as a loved one.
As someone who's worked on pricing models, this speaks either to very little thought to pricing or a monumental churn issue.
A hefty discount for an annual subscription is generally something like 20%, and companies with good retention only offer ~10%.
Discounting over 50% if someone chooses annual either tells me (1) this company is low on funding and desperately needs the immediate cash flow, or (2) this company can't retain customers and is really lacking product-market fit.
Old YC would have absolutely helped the founders straighten this out, but it seems YC is now just a big cash grab and rolodex in the form of Bookface.
(Please dont kill me for the off-the-cuff idea:)
A per-login / frequency of use model;
You agree to a MAXIMUM of $100/year as WELL AS a max per month that may be charged (== to $100/12 max) -- but the idea is that if you skip a month or some amount of time you are not charged....
The usage is based on certain amount of time-in-app or somesuch....
you get the idea.
---
Anyway, as someone who has debilitating ADHD I really want to use this... but whilst not working, I can't pre-commit $100 to something that I may have too bad a case of ADHD to adopt on a regular.
Granted IAP isn't that flexible, or not to my knowledge, at least. But Stripe is right there, too.
Indeed, I've had better help from a LCSW than a Psy.D, and I never called the social worker "Dr."
1. https://privacy.com/
They can pry that money out of my cold dead hands. And I've yet to have anything sent to collections
It's bad all around, but it's extra bad for people with adhd -- and considering it's an adhd app, it really puts it on a different level of predatory that's worth focusing on.
I think this is sort of a broader start-up problem. Some things shouldn't be monetized (period, but for the sake of the audience, I'll add: at least not as aggressively as is required for a start-up).
Close, but a slight correction here:
Every medical device is sold with the intention of maximising profit, but they can't do nothing or people wouldn't buy them.
That more accurately portrays the priority.
Getting rid of all the time waste, all the stress of AD is worth a lot.
The need for this app is a problem. Insurance should cover the cost of treatment (and insurance should be affordable and available; for transparency: I'm pro medicare for all, here in the US).
Start ups have a bad habit of taking a systemic problem and trying to monetize a solution to it. In reality, the effort being put into this should be put, instead, toward making systemic changes that would make this app unneccessary.
On the other hand, you seem to be objecting to the very nature of money being charged for this app or any other healthcare service?
It's gross, and I do not love this aspect of capitalism. I agree with you to that extent.
But -- again, without ditching capitalism entirely -- what's the alternative? These folks are providing a service and that costs money. Aside from ditching capitalism entirely, what alternative is there to "charging $X to fix Y?" Literally anything amounts to a chronic or acute disability tax. The cost of asprin is a headache tax. And so on.
The best capitalism has been able to do is roll these sorts of healthcare costs into insurance premiums, so we can share the cost collectively to an extent. Unfortunately I doubt an app like this is covered by any plan.
The only other solution (within capitalism) I can imagine is if the creators of this app ran their company as a non-profit org. I have considered that in the past for a venture or two. But, the money would still need to come from somewhere.
"But I need to make money, too" isn't an excuse. It wants to be, but it is not. I would agree that the biggest offender is the predatory model, but I would say that the way to do this _correctly_ is to do it free/OSS with a patreon. Let folks who use it pay what they think it's worth.
The problem is that the incentive systems don't align. Someone elsewhere mentioned that this seemed to build dependency in its users (an anti-pattern in therapeutics (and elsewhere, but let's be specific to therapeutics for now)). With something like Patreon, the incentives are much closer aligned: the app _has_ to do good in order to well, because otherwise nobody will pay for it.
Again, they (the developers) could also put their time & energy into enacting systemic change.
I would say your incentives don't align. By effectively restricting the privilege of app/product creation to those people that have a strong economic cushion, you're effectively excluding most of the people on Earth, particularly those that not already wealthy and particularly those with people besides themselves to care for.
But app creators should just do it for free? Until the money maaaaybe rolls in? Most business/apps/etc fail.Yeah, and under capitalism, these are linked to some capitalist idea of productivity.
We're getting a little far from the original point of this thread, but I'd argue that food & shelter & healthcare shouldn't be linked to "productivity".
I think the way that this is applicable here is that when the private sector gets involved in an issue, it can be a lot harder for the issue to be addressed by the public sector. That's a really big topic, I'd suggest reading Winners Take All[0] for a more in-depth look at this.
I'll leave this at: some things shouldn't be monetized (and this is one of them).
> I would say your incentives don't align.
I'm not sure what you mean. What are my incentives here?
> But app creators should just do it for free?
There are plenty of consumer spaces where I don't complain (publicly) about app-creators getting involved. This, being a "mental health" app, is an area where the public sector getting involved could be detrimental (see my comment elsewhere where I ask if this could be harmful in the long run).
[0] https://www.penguinrandomhouse.com/books/539747/winners-take...
I would say, "if you can't afford to pay your developers and other employees a living wage, then you can't afford to make an app or launch a product"
I don't think you've thought any of this through, man. You have some excellent ideals and I agree with them but you need to think through the practical ramifications.
I think I addressed this in my other reply, but I'll reiterate: given the economic system we exist in, I'm not against people making money from their apps, I'm against certain areas better suited to public works being entered by the private sector (especially in a predatory way).
> I would say, "if you can't afford to pay your developers and other employees a living wage, then you can't afford to make an app or launch a product"
I totally agree with this.
> I don't think you've thought any of this through, man.
I try really hard to be internally consistent, but I'm imperfect. I'd be interested in hearing what I'm not thinking through, because I feel like this is an area where I have.
The respond to the quote at the top of your comment: I've been reading & hearing about a lot of restaurant owners complaining that they can't afford to pay their workers a living wage for $REASONS (this happens a lot in restaurants, specifically). My response is exactly what you quoted (and I'll type it again): If you can't afford to pay your workers a living wage, then you can't afford to do business. Asking anyone to work for a sub-living wage is essentially asking for them to subsidize your business, and, in an area that differs dramatically from start-ups, these restaurant workers generally aren't given equity as compensation (which would tie their wage to the success of the restaurant).
I'll admit that my thoughts in this area are complicated, because we live in a capitalist community (at least here in the US) so there are some concessions that I have to make. Do I think capitalism is viable in the long run? No. But I also think it is a fool's errand to wait for a revolution, so I think my thoughts get a little more nuanced when it comes to working ethically within an inherently unethical system (and I'm being very liberal with what I consider ethical work, by necessity).
I'd love to keep this conversation going. I know I have a lot to learn & that there's a lot that I don't know that I don't know. Conversations like this, that challenge my ideas, can only lead to a better understanding of my concerns and thoughts.
I appreciate you taking the time to respond to my comments.
But, I'm not sure I understand your practical alternative here.
Let's assume that Inflow is (a) actually effective and (b) they drop the questionable opt-out subscription model. Both big assumptions. I have not used the app and am skeptical to say the least. But lets assume it delivers legitimate value/relief/etc.
(Something I'd gladly pay for, and something the world genuinely needs. Doing CBT with a therapist is financially out of reach for many/most)
So, how should this app have been created? How would its creators be paid prior to the app earning money?
I have bootstrapped a product to market, and it really sucked. I went without health insurance for two years, living in the spare bedroom of a family member. And I was extremely privileged to even be able to do that: I was young and healthy and had a family I could rely on, and no dependents relying upon me. Even if I were living in a country where there was some kind of humane public healthcare system that would have been rough.
I'm not complaining. Ultimately it was an awesome experience. But that is just not a viable path to creating stuff for most people.
Obviously a lot of open source projects get created under less-dire situations, but of course there is also a lot of corporate sponsorship there.
> Let's assume that Inflow is (a) actually effective and (b) they drop the questionable opt-out subscription model. Both big assumptions. I have not used the app and am skeptical to say the least. But lets assume it delivers legitimate value/relief/etc.
These are big ifs, particularly because the incentive systems are misaligned. The incentive of the creators are profitability and growth while the incentive of the user is to manage their ADHD.
Ethics, especially concerning survival in the throes of capitalism, are complicated. I question private sector solutions for public sector problems largely because money speaks in politics and I think having money established in an area makes it _harder_ for the public sector to get involved in that area.
> So, how should this app have been created? How would its creators be paid prior to the app earning money?
Putting aside the fact that this app can't diagnose someone, can't provide alternative therapies (pharmaceutical, non-CBT if CBT isn't working, etc.), growth and profitability are not "helping users". I said this elsewhere: if this _is_ going to exist, it should be funded through something like Patreon, where payment is optional and generally is more tied to the app being functional and beneficial (users who love the service are more likely to pay, while those who do not, lose nothing but their time).
> And I was extremely privileged to even be able to do that...
You raise a really good point that I've been wrestling with a lot lately. The ability to not-charge up front is a position of privilege that locks out a lot of folks (e.g. if one is living paycheck-to-paycheck working 2 jobs, they might not be able to afford to take the time to create the next unicorn app that could put food on their plate forever). I'm sorry, but I'm not sure I have answers. I have a friend asking how to ethically be a landlord, and I can't answer her either.
(as an aside: I'd love to spend some of my time just making apps for folks without my privilege, sort of 'pass on' my privilege to those who might need it, but I'm honestly not sure how that would realistically work or how to get started.)
One of my friends likes to remind me that there's no ethical consumption under capitalism, in response to which I wonder: how feasible is ethical production under a system with no ethical consumption?
A poor solution imo (at least for any serious cases), but at least someone is trying something.
Right now, and in the past, "YC-backed" has consistently been a very solid selling point, both for following rounds and in recruitment. Maybe it's just a transient bobble, and I strongly hope that proves true. Still, at this rate, I'm starting to wonder a little what "YC-backed" might come to mean a few years hence, and whether it'll still be worth the same.
https://news.ycombinator.com/item?id=5092711
It got rejected by Apple. They insisted I use the native app store trial which is opt-out.
EDIT: I'm wrong, comment next to mine says Apple has rejected this. Maybe Google wouldn't though?
It’s their problem to figure out how to present their product to me in a compelling way that I am willing to pay for. I don’t open my wallet just because I feel bad for starving founders.
Cost of Install: $7.00, for something this specific Trial Start Rate: 20%, if paywalled like this app is Cost Per Trial: $35 Conversion to Trial: 40% Cost Per Subscriber: $87.50
If they charge you $10/month, they can't get into the black on a new customer for 9 months. They have to eat support costs that whole time. It just doesn't work, when you're starting out. You must charge annual.
Medical licensing cartels charge $500-800 PER MONTH. These guys are trying to charge $100 PER YEAR.
This is an order of magnitude more effective.
Said another way: if someone is too poor for this, they're fucked. They're definitely too poor for any other treatment option. On the other hand, this will open up treatment to people who can't pay the medical cartels.
That's amazing, iterative progress.
Let's give props to these guys for making epic iterative progress, not shit on them because they're not working for free.
The whole point here is to help folks who are having trouble remembering to do things. Regardless of the economics, the optics here make this seem like exploitation.
Making this opt-in avoids a dark pattern. Folks with ADHD are often impulsive and strike while the iron is hot—if this has value people will opt-in.
Generally, giving users a toggle to get reminded when a trial is about to run out will INCREASE conversion rates.
That depends on the business, and is part of a pretty standard set of experiments you run post-launch.
With your comments you're part HN is descending into a circular firing squad of virtue signaling. These guys shipped something that could help a lot of people, over time they can improve their onboarding flow, lower cost.
Is the most remarkable thing about a really cool CBT tool for ADHD really that they have a standard trial flow?
You can have a great business model, you can have a good product, but if you can’t operate without alienating the people you want to sell to you’re probably dead in the water.
Most startups aren't offering medical care. Call it "virtue signaling" if you like that those which do come in for a likewise unusual degree of scrutiny, but do you think you're likely to convince anyone that way?
I won't quibble with your analysis of the unit economics involved, but I will say that's not on point - this isn't a question of CAC/LTV but rather one of perception and image. My impression of Launch HN posts is that they are intended in part to elicit this sort of analysis, and by that metric this one has succeeded quite well. It seems like these founders didn't know they had this problem to solve, and now - if they're paying attention, which I assume they are - they do know. In what way is that other than a win?
Your comments come off as entirely unempathetic. Not everything is about bottom line capitalism.
These guys are moving the needle making improvements in a forward direction, and a big part of this thread is shitting on their launch, hyper-focusing on things they'll be able to change.
Launch HN threads used to be about asking thoughtful questions, having a back and forth where people learn about new spaces, and encouraging people launching their startups.
This whole thread is concern trolling of the worst kind, to eyes.
I'll bow out since clearly the bulk of the thread disagrees.
Also the word is "empathy" not "emphatic".
I don't know - the problem is that, as an adhd person, once I learn about their bad trial flow, I'm not continuing to learn anything else about it.
That's their problem, not mine.
The original announcement mentioned you folks have a neuro-diverse team, which I applaud and respect. I hope you really take advantage of this to dog-food your own product and on/offboarding processes to catch stuff like this going forward.
Keep at it! I'd love to see you succeed with this product.
Basically the model here is like a gym, where people buy things that they don’t use as much as the price implies or is simply ineffective.
Given that the customers are executive function impaired, seems shady.
And 7 days is really too short to notice a sustained effect.
7 days isn't enough time for the vast majority of people to know whether the app is doing anything at all for them.
"Spend a week playing with something new and interesting that you might just hyperfocus on, and then impulsively pay us for a year's access because this time you won't lose interest in two months" feels laser-targeted to prey on ADHD behaviors.
This is making the big assumption that a generalized set of self-directed exercises with no one-on-one personalized customization or checkins is an adequate substitute for real medical care.
I am skeptical that it is an adequate substitute. And if someone is hungry and you sell them a picture of a cheeseburger, that isn't epic iterative progress, it's just exploitative and immoral. I don't see any strong evidence that their app is actually going to work.
People with ADHD aren't famously great at consistently self-motivating themselves to do daily tasks. What are the odds that this isn't just another $100 charge for them that they can feel guilty about at 2:00 in the morning? If the founders want to argue that this is more (or even just comparably) effective than actual therapy and medication when it can't even be used as a diagnostic tool, then they need much stronger evidence than they're showing.
And I don't think that's a problem that can be solved by iteration. If they weren't marketing their product as a substitute for therapy I wouldn't be as critical (although I would still think their pricing model was thoughtless). To market themselves as if they're doing something extraordinary when, from everything I can tell from their product pages, they aren't -- that's predatory.
Self-directed exercises from a startup are not a substitute for real CBT; if they were then insurance would pay for them.
Might as well come right out and say that they understand ADHD and plan to use its drawbacks to make money from people. Considering how desperate a lot of people are for treatment, this sounds like a great monetary investment for people with no conscience.
This may be a bit harsh. I'm a bit salty as navigating the process to get treatment for ADHD is a continual reminder that most services are tilted towards providing services to already well-functioning people. I probably will try it, after all you did just remind me to cancel my free Prime membership, even though it was right there in bold on my day planner a week ago.
Edit: done! Thanks.
Plus my dislike of Amazon is rather motivating.
Not my favorite model, but also probably not intentionally predatory towards a specific group of people.
From a business point of view it makes some sense. It extracts maximum money from customers in a niche that is inherently flakey (dieting, self-help, etc.). People often start off strong for a few weeks/months and flake out. Forcing a longer up-front commitment helps their bottom line, and possibly helps some customers stick with it since they already spent the money.
I'm not trying to defend it, but I do think it's a bit much to say it's intentionally predatory. From my view it's just app economy capitalism at work.
That inner voice telling you what to do or what not to do? ADHD brains have... well, let's just say "something else".. in its place.
Pretty much every description I’ve heard from people diagnosed with ADHD features the same kind of internal voice as neurotypical people describe; the “something else” seems to be between that voice and action, not in place of it.
My natural, pre-treatment, and unmedicated sub-/semi-conscious behaviour is not at all like that of a typical person.
Your current model of opt-in subscriptions makes it clear you're looking for the best model for your bank account
There's no job shortage, so don't make excuses for them
I don't want them to do it for free. I want then to not make a predatory product. I want them to make their money through a more honest business
And if they can't do that, I want them to do nothing
(As for 'quoting you', it's called paraphrasing. I'd have hoped it was rather obvious I was not suggesting that you said those exact words.)
And thats why I don't want you quoting me or paraphrasing me. You're putting words into my mouth that I never said or even implied. And once again, I find it extremely insulting.
I'm going to make it clear so you don't do it again. I want then to make an honest business model and to stop this predatory one
I ... they're the same picture ...
You're clearly malicious and cannot listen to simple personal requests. I hope you can become a better person in the future.
Goodbye
Also, if you're not trolling with your absurd histrionics about people quoting you, then, well, I wish you luck in the world.
Usually the word free in "free and open source" is libre, as in freedom, not free beer.
You can do good work for "your community" without putting profits first
It's shocking that the myth of Linux being created and maintained by a bunch of dedicated outlaw nerds, typing away in their basements for free in their spare time (while presumably also working 50 hour weeks at their tech jobs, to pay the bills?) persists to any degree whatsoever in 2021.
Countless huge companies rely upon Linux in major ways, and therefore fund its development and maintenance.
Sources:
https://www.linuxfoundation.org/wp-content/uploads/2020FOSSC...
https://linux.slashdot.org/story/10/01/21/230201/75-of-linux...
Go ahead and collect the payment info before giving them access to the free trial, let them use the thing for free for X days, then when the free trial is up, block their access and ask them whether or not they'd like to pay for the subscription. It could literally just be one big button that says "accept." Then ideally, ask them again before each recurring charge.
Some people here are proposing an absurd amount of friction - one highly upvoted post suggested that the app should require users to re-enter their payment info before every charge. What if this app is great? What if I actually want to give them my money? Making me type in my credit card info repeatedly is nightmarishly bad UX.
Reducing friction is a good thing, even here. The important bit is just getting the user's clear consent by making it opt-in instead of opt-out.
Probably not, because your users are people who will forget to cancel and then forget to tell you about that.
> Some people also like having the subscription because it is a pay per use model
What does this mean? It sounds like users are complaining that if they download the app and don't use it it charges them $100.
> Would love any suggestions on how to improve this.
Howabout when the free trial ends, at that time the user has to approve a charge before continuing to use the app.
- Why have you chosen to make users opt out of a subscription when the free trial ends, rather than letting them opt in?
- Why is the annual payment option pushed so hard, in favour of the monthly payment option?
I'm reiterating this because promoting an opt-in, monthly payment model (thus giving more opportunities for any unintentional ongoing payments to be noticed by the payer) seems to me to be the kindest approach to subscriptions for users with ADHD, and a model that would be most empathetic to their condition.
We're actually working on several different sign-ups flows at the moment including opt-in post free trial, longer free trial, web sign-up and one-off purchase vs subscription. It is not our intention to push annual significantly over monthly - we wanted to give a significant discount to yearly subscribers but perhaps the difference between the two is too large. The previously mentioned issue with scrolling is due to to a bug with small screen sizes on Android which we're working to fix.
As you have a number of people with ADHD working on your app, I would be curious to know if any of them raised concerns about these specifics of your subscription model, during planning and development of the app?
Constructive criticism is useful but there are many here breaking the “take the most charitable possible interpretation” rule of HN.
So please do listen to this feedback and please do act on it, but don’t take the personal attacks and name calling in some of the comments here too seriously.
You are being polite and gracious in your responses!
We're working on extending the free trial / moving to a freemium model.
Please. You aren't spaceX "working on" your next engine, or AMD "working on" the next processor architecture. All you have to do to end the unethical behavior is flip a few bits in a database. Don't pretend it's some kind of grand technical challenge.
You're luring in people who are trying to improve their mental health and tricking them out of their money. The product isn't even technically innovative. No idea why YC is compromising its brand like this.
I would expect that it's more financially lucrative to have a happy userbase, which translates to a good reputation and thus larger user-base, rather rip-off a few who will eventually give bad reviews and create a bad reputation. To me the current pricing model sounds more like a bad decision rather than anything else. But in any case, if I didn't like it I would just not use it, rather than throwing accusations around on malicious intentions without having any evidence.
PS: I am not even remotely affiliated with the creators of that app
Deep down do you believe that they would have changed if not for this public outcry?
Make it free for 30 days THEN throw up a pay screen. You're a funded startup what's the issue here?
I'd ordinarily be willing to believe that, but I can't stop thinking: this is a service with a very specific target market - people with a condition whose defining characteristic is being vulnerable to be exploited through the exact payment model that Inflow has chosen. To accept this as a honest mistake is to believe that they never thought about their target audience at all, which is inconsistent with their claims of having people with deep understanding of the condition on board.
> But in any case, if I didn't like it I would just not use it, rather than throwing accusations around on malicious intentions without having any evidence.
Startups are getting way too much mileage from Hanlon's razor.
What I mainly question is the demand culture, that a lot of users have towards developers - even towards people voluntarily put their time to do opensource work.
First, the app stores are pretty prescriptive about how you handle introductory trials on subscriptions (especially Apple), which means you are usually stuck with "start trial + opt-out" as the only viable model if you're billing through the App Store.
Second, behavioral/commitment theory often shows that for apps or really any behavior change that requires some effort, a longer time commitment/investment gets people to actually invest the effort they need to actually get value out of the product. If you let people pay for a month, they won't actually put in any effort and then at the end of the month they'll be like "I'm not getting any value here" and they'll just cancel. They won't put in the effort to build the habits. So most wellness apps/products (from meditation/fitness apps to gym memberships) end up with some sort of free trial period, followed by an annual commitment (and if there's a monthly option, it's at a steep hike from the annual one).
Finally, when you're early on in the life of your startup, you're mostly trying to get to product-market fit and see whether people are willing to use / pay for what you've built. You just choose a pricing period/plan that makes sense, focus on the product, then when you get the product where you want, you go back and experiment with finding the ideal pricing plan for you and your users.
That said, it's clear in this case that this model may not be great for the target audience (in fact, even for neurotypicals, canceling subscriptions and such is still a challenge to manage). And obviously the app creators could have put more thought into it.
We ended up with an opt-out free trial plan as per Apple's rules on iOS, with a monthly plan where the yearly plan is a 25% discount if you choose it, and several reminders before the trial converts to paid. We also allow users to do a standard opt-in plan if they're not signing up through iOS (ie only need to put credit card after trial expires). We offer refunds where we can for people who got billed but didn't intend to, but Apple has to process those refunds too.
> A lot of other apps follow a similar model, we allow people to cancel anytime and have refunded everyone that has forgotten to cancel.
Many ADHD people also forget or are too embarrassed to do that.
Life hack that works for some: at least on iOS and in my region one can subscribe, immediately unsubscribe and continue to use a product during its free trial period without risking getting trapped.
At the very least, bill monthly and make the trial not auto-renew at full price. And, since the target market is people with executive dysfunction, I'd love to see your team go the extra mile and default to pushing notifications the week before and day before a user's subscription renews, giving them ample time to cancel if it doesn't fit their budget this month.
Now I have a bunch of automations set up that ping me and say “you’ve got this subscription… are you actually using it?”
It took me a fair bit of effort to engineer but it’s saved me a whole load of money.
I know many providers do not dare to give up on opt-out trials, since it brings them money. It is scary to trust your future clients - maybe they won't buy after all? But if you don't trust them, why would they trust you?
This is the norm right. I don't know ANY app that is OPT IN after the initial trial period is done. This is the Industry Standard.
Industry standards for media often don't included content warnings. However, if someone posts on HN that they're building a streaming service designed primarily for people with trauma, and they don't include content warnings in front of their shows, you'd probably have some questions -- because you expect them to know their audience. To me, this launch suggests that the founders either haven't spent much time thinking about how their process actually will work with their target audience or (much worse) that they did think about it and still decided that it would be OK.
It's just really tone-deaf to have a launch HN that spends all this time talking about how the intake process for people with ADHD is thoughtless or needlessly difficult, when their app's funding model is making the same mistakes and lacking the same affordances.
I suspect this is going to be the new trend for future apps, since it almost certainly delivers a higher number of paid users than other methods do.
https://www.bbb.org/file-a-complaint
Is that real? Or the average cost in a city like NYC? My partner has been looking for this in the UK, and the cost is under half this (so long as you're not looking for a big-name London clinic)
Context: I helped build and launch CareDash’s telehealth marketplace, which serves the large national players in mental health in the US.
The $200-$300 might refer to the price they bill to insurance companies, which is not the real price anyone pays. Insurance pays the higher of the billed cost or the allowed cost, so anyone billing insurance makes sure to bill much higher than the allowed cost to avoid leaving money on the table.
In practice, people with decent insurance will be paying $15-25 copays on average, not $200-300. I suspect their marketing material is being deliberately misleading in order to dissuade people from actual therapy, which is not cool. Wish they’d just market it as an adjunctive tool instead of a therapy replacement while trying to discourage people from going to therapy.
Between this and the $110 automatic charge if people forget to cancel the trial, this app feels like they let the “growth hackers” loose on the app instead of trying to be genuinely helpful.
Many lawyers offer a short consult before they start charging. When we have work done on our house most contractors will provide an estimate and a brief discussion before charging anything. When we go to a store we can look at things before we decide to buy them.
A free trial for an app is along these lines; it's not saying your product is free, it's saying people can check it out enough to make an informed decision about whether they want to pay for it.
I don't think placebo is relevant in the case of therapy because placebo itself is a psychological effect.
CBT seems to be somewhat effective but with these things people's experiences vary a lot.
CBT does perform quite well repeatedly in these sorts of experiments, particularly for depression (it is less studied in some other disorders although still promising). You're right there can be a lot of variance between people though. There can also be additional variance IRL due to therapist quality IMO.
Therapy is a lot more work for the patient - more time consuming, more costly, can be emotionally taxing in the early stages, etc. So I understand the desire for a meds only solution, and in some cases that is possible. But talking about therapy more generally I would encourage anyone who can to give it a try, just as I would encourage people to put effort into their diet, exercise, etc.
Obviously make sure it is evidence-based therapy though, something like CBT that has been well-studied. There are flavors of talk therapy that are total pseudoscience.
Therapy is actually a wonderful adjunct to medication because it helps instill lasting behavioral changes. A lot of people mistake the early motivational boost of stimulants for ADHD remission, but once the energizing effect of stimulants disappears due to tolerance, they’re left with the same bad habits they started with. Therapy can help build a better foundation for when the energizing side effect of stimulants disappears and only the attention-enhancing effects remain.
A lot of doctors start patients at crazy high doses (over 10mg) and a lot of patients do indeed benefit from 50+mg.
If medication isn't tolerated, starting therapy early seems like a great idea.
I don't know what to feel when people around me say I ought to talk to a therapist, leaving it as the only possible option for my mental salvation or outright refusing to listen to me about certain topics by saying the therapist needs to hear it, not them, only for the therapist to say they don't know how to help me. That is because I went just because someone told me to, because they did not want to listen to me, so I'm not motivated enough to get the most out of each session.
I started going with the intention of receiving CBT and I'm not sure if what we do can even be called that anymore after all this time. About the only reason I see my therapist each week is to have one person who is willing to listen to me in person instead of zero, and nothing particularly changes as a result. If seeing someone in person each week who is actually willing to listen is all that prevents me from becoming depressed, then it is a net positive result, but it is not life-changing in any real regard because of my lack of motivation or inability to properly utilize therapy.
One thing I find very off-putting, is the rose-coloured, almost "success guaranteed"-like image your website and app store page sketches.
This product is no wishing-well that your customerpatients can simply throw money at and magically feel better. For this to ever have any meaningful and lasting effect, they will have to put in some serious effort. This requirement should be very clearly communicated I feel.
Long-term dedication and commitment to a plan with uncertain results is not exactly what ADHD brains are known to excel at ;)
Edit: I also share the others' thoughts about your billing model not being very ADHD-friendly.
All-in-all, considering your listed expertise in this field, this is very concerning and not a good look at all.
I sincerely wish you all the best and hope you can make this this concept work.!
I will sign up for subscription services fully well intentioned and then proceed to not use the service and forget to cancel it in time. I know myself well enough now to stay away from any product offering a subscription. There is no real “managing” it, it’s just a fact of life for me and something I live around.
An app targeting ADHD minds and not offering alternative payment options is arguably more predatory than the average free-to-play mobile app, as the founders of this app presumably know about the difficulties that ADHD cause and are either willingly ignoring it or actively exploiting it.
Even if it’s a honest accident, it leaves a bad enough taste in my mouth to stay far away.
In addition to these we also send email and notification reminders before the free trial ends and refund everybody who requests one.
I don't know of any services that do this though. So I assume they are all dishonest.
From my understanding, the profitability of gyms is actually dependent upon some sizable percentage of people paying for a membership and not using it. If that cohort didn't exist, membership fees would have to be much higher.
Software subscriptions are different though, as the variable costs are negligible: the cost associated with providing service to each new user is next to nothing.
Personally, I'd be way more likely to sign up for a paid subscription if I knew they would automatically stop charging me if/when I stop using the service.
Depends on the service. Many boast about their large or unlimited storage for user's data, but this part of their marketing relies on the assumption that almost nobody will actually use a noticeable amount of the offer.
It's similar to the dishonest, but sadly normalized practice of ISPs, where the bandwidth offered would be impossible to provide if a significant number of customers tried to use it at once.
And of course every cloud provider works this way, but that's not a "subscription model" anymore.
even with a monthly subscription, it's really easy to completely forget about a service and move on from it entirely without cancelling it
I mean: someone signs up - regardless of whether you want to call it a subscription - and every month on renewal, they get a notice to confirm renewal (or have to re-enter payment, though I suspect that's probably _too_ much friction).
Is that a great way to retain revenue? Probably not. But it's way better for press than what I saw when I opened this thread and was immediately turned off. It's definitely the kind of consumer-first model that I'd love to see more of, certainly from a company/app whose target is helping people...
I'm not sure what you're trying to say here? An exit strategy isn't, like, a particular type of business model that some businesses use. It's just a word for the founders' strategy with respect to exiting the business.
Real therapists operate without an exit strategy. A good therapist isn't building dependence in their clients.
It seems like you're suggesting that the only way to run a company responsibly is to intend to personally be at the helm until you drop dead, like Zuckerberg. That just feels unrealistic, and like a totally bizarre and excessive criticism, when there's lots of other legitimate stuff to criticise about this company.
> but there's no reason why you can't exit a company and leave it in good hands, with a viable long-term plan. In fact, most founders will be incentivised to do exactly that.
That's not what "exit" means in startup vernacular. An "exit" is the part where you and your investors get rich. This is usually achieved through the company going public, or getting acquired by another one. Both cases are almost inevitably bad for existing users/customers. Going public usually means the company is subject to the whims of stock market players. Acquires usually means the company gets scrapped for parts (usually for people, knowhow, patents, and/or user data). Either way, the founders and investors got their reward - so they don't really have a reason to care about what happens with the business afterwards.
Now the problem is, getting to an exit isn't a sure thing - but it's something that can be optimized for. Optimizing for it eventually puts the company in a situation, where they have to diminish or even offer negative value to users - through e.g. bait&switch payment models, dropping useful features, vendor lock-in, UX dark patterns - in order to improve the main metric that increases the chance of successful exit: growth.
So when you see founders explicitly talking about and planning for an exit, what this means is that they already demonstrate they'll put making the company attractive to would-be acquirers ahead of offering actual value to the users/customers. And to be clear, it's worth reminding: marketing has a better marginal ROI than providing value, so just because customers seem to be flocking to a company, doesn't mean the company is offering a good deal. They may be just good at "growth hacking".
The worst case is obvious fraud (Theranos, uBeam), but the second worst case is what I referred to in another comment as "legal pump&dump" - companies who focus almost entirely on growth hacking while providing minimal value, in hopes they'll get acquired before everyone figures out the whole thing is bullshit.
> the only way to run a company responsibly is to intend to personally be at the helm until you drop dead
Of course not :). Another way would be to not take VC funding, focus on providing a good service for as long as you feel like, and eventually pass the business on, sell it, or shut down.
The way I see it, just taking VC funding - taking the Faustian bargain - makes you an "exit risk". One way to assuage the fears of users would be to make some legally-binding promises about the future of the company, but nobody ever does that. In time, as more non-tech people finally figure out how startups work, maybe that'll change.
> An "exit" is the part where you and your investors get rich.
This is normally a consequence of an exit, but - as is really my main point here - it's not the meaning of the word. An exit is just you as a founder freeing yourself of the company, in terms of leaving your management role and/or converting your equity to cash (in some kind of buyout or IPO).
"Having an exit strategy" may be conflated with "intending to get rich by selling all your equity, and therefore being short-termist in your management", but that's not remotely part of the meaning of the words. And, again, every founder has an exit strategy of some sort. (Either that, or they are floating blindly through their life in some kind of protracted acid trip.)
> Another way would be to not take VC funding, focus on providing a good service for as long as you feel like, and eventually pass the business on, sell it, or shut down.
To wit, the "eventually pass the business on, sell it, or shut down" part is an exit strategy.
A proper solution is to not charge in the meantime. I know its an aggressive stance, but the dissonance with the exploit and pricing model is strong. You should feel wrong exploiting people claiming you'll fix it later.
Wanna get paid? Find a way to do that without exploit. You'll find a potential solution a lot faster if the money stops rolling in until you do.
Either way, this is a terrible sign for your focus and compassion as business that toes the line with claiming to be a therapy or treatment for a medical condition. How can anyone believe you truly do the right thing and care? I don't think apps care about me, but an app like this that presents itself as an alternative to therapy I expect to be an exception.
I've never logged in.
That said, while everyone is up in arms about the payment model here, I'm more concerned with the nature of the app's content.
What I was expecting to be an interactive, attention-grabbing set of modules turned out to be a whole bunch of audio recordings and generic goal-setting form fields. I almost laughed when I was creating my first goal, because in the introduction video by the cofounder he makes a point to explain that, "Like many of you, I've invested in planners and organizers hoping that they would magically help me become more productive." Can someone from the team please explain how this app's first iteration is not simply the modern & digital version of planners and organizers? Which features will be able to help users with which ADHD side-effects?
To be frank, I had high hopes when I started this free trial, only to realize that it smells a bit like a newer version of the self-help tapes people would fall asleep to in the '80s.
In terms of our current features, we have: - Short daily learning exercises that tackle a range of ADHD topics - Challenges to support the development and tracking of habits to help manage ADHD - A community of like-minded individuals - Live weekly events with psychologists & coaches where you can get any of your questions answered, or participate in group meditation and coworking sessions.
We are also working on some new interactive features such as accountability buddies, accountability coaching, group-based challenges and routine building tools.
Hell, Brain Age for the Nintendo DS was cheaper than this stupid app. You'd think that we've come further as a society and developers, but nope: now you're paying monthly (or yearly, if you're one of the unlucky android users) for a toy with less features.
I'm frankly so done with YC at this point. I simply cannot believe that a benevolent person greenlit this.
This is a huge red flag for any self-help app.
Therapists should never try to build a dependency upon the therapist, yet it appears this app is structured to do just that: Convince users that external tools won't work for them, then capture their activity inside of an app with an expensive annual fee.
The purpose of therapy should be to give users the tools to support themselves. For example, showing users how to use traditional organizers in ways that are more compatible with their conditions and building a system of reminders and automatic habits to support that goal.
The incentive structure of this app is inherently in conflict with the traditional goal of therapy: Self-sufficiency.
Can I download this directly without signing into Google? I'm not a big Google or big tech supporter.
Also why does the front page of your app not explain precisely how it works and what it does? All it promises is an awesome black box that "helps". What does it even do exactly? Writing an increasingly complex "how it works section", like Fastmail had when I signed up or that great comic on cryptography, would be appropriate.
> "ADHD drugs, such as Adderall and Ritalin, increase levels of the brain chemical dopamine and provide mental stimulation. This, in turn, allows users to become more focused and calm because they no longer need to engage in self-stimulating behavior."
> "The number of young people abusing ADHD medication has been steadily increasing over the last five years, with almost 9 percent of high school seniors abusing and approximately 35 percent of college students in the same category. And unfortunately, this misuse does have consequences: Over 19,000 people have suffered from complications related to ADHD drugs since 2013."
It gets less attention than opiate abuse as deadly overdoses are much less common, but amphetamine addiction has major psychological effects - whether we are talking about street meth, ritalin, adderall, desoxyn, etc., the general effect is the same.
In addition, there's no clear diagnostic test for ADD/ADHD (no way to even distinguish between the two), it's just an opinion based on the subjective judgements of psychiatrists - and yes, just as with the opiate business, there are kickbacks with the pharma outfits and reckless prescription practices.
1. https://drugabuse.com/blog/spotlight-on-adhd-meds-and-their-...
Yes, ADHD drugs are abused and it leads to complications. But, to quote Alexander Scott, "drug users use a lot of drugs": https://astralcodexten.substack.com/p/drug-users-use-a-lot-o...
https://astralcodexten.substack.com/p/drug-users-use-a-lot-o...
One way to think of it is to see attention/motivation control as a spectrum. There are going to be people in the bottom X% of that spectrum, where it starts to negatively affect their lives. I'm thankful we live in a society that recongizes those people and has come up with ways to help them, since I've benefitted tremendously from ADHD treatments.
> In addition, there's no clear diagnostic test for ADD/ADHD (no way to even distinguish between the two)
they're literally the same thing. ADD got renamed to ADHD in the publication of the DSM IV.
> it's just an opinion based on the subjective judgements of psychiatrists
No, there are standardized screenings with recognized scales, as well as evaluations to measure attention span.
This can also be said for several mental illnesses: depression, anxiety, ocd...
>> > "ADHD drugs, such as Adderall and Ritalin, increase levels of the brain chemical dopamine and provide mental stimulation. This, in turn, allows users to become more focused and calm because they no longer need to engage in self-stimulating behavior."
Yes. that's the point. Give 20mg of adderall to someone without adhd and see how calm they are. That dopamine boost brings someone with adhd up to neurotypical levels.
I'd also say: consider how many people are diagnosed with adult adhd without ever having been on a CNS.
Some thoughts:
- Patient intake for ADHD is genuinely awful, you're right about that. The diagnostic/treatment process for ADHD often feels like it's designed to make people with ADHD struggle.
- CBT is generally helpful, therapy is an important part of treatment. I've seen good results from it.
- in-person sessions are expensive (although if you have good insurance you shouldn't be hitting $200-300 a session).
----
However:
- Non-personalized CBT may not be as helpful. One thing I've learned working with my therapist is that a lot of behaviors I thought were universal aren't, even among people with ADHD. We spend a lot of time breaking down what my motivators are, what things I struggle with, and we spend a lot of time brainstorming coping mechanisms and exercises that will work specifically for me. There is no single technique to deal with all of this, and you really need to have some way of narrowing in on what type of ADHD you have and what other conditions (anxiety, autism, etc) might complicate it.
- "5 minutes a day" is not really CBT to me. CBT is work, and I'm immediately skeptical of any app that tells me I'm just going to do some quick daily exercises and it'll change my life. Therapy doesn't work that way in my experience.
- I'll also note that the reason that the average cost of a CBT session is so high is because it's a personalized, one-on-one session that can last as long as an hour. So I feel even more that the comparisons being made here to traditional therapy aren't very apt.
- A self-directed routine that isn't being done with a real person kind of misses the point that people with ADHD often have trouble forming and sticking to routines. "You just need to do X every day and be mindful" isn't good advice for someone with ADHD, the whole point of CBT is to teach you how to do that stuff. But in this case, being able to stick to a consistent routine feels like a pre-condition to using the app.
- The app can't be used for diagnosis, and I really feel like diagnosis is important. Diagnosis, insurance coverage, and medication access are the reasons why the ADHD intake process is so complicated. Of course it could be better, but I don't feel like you can brag about circumventing the intake process if the way you're circumventing it is by skipping all of the hard parts that are of significant long-term value to people with ADHD.
- Medication is often used in combination with CBT, and I feel like it's irresponsible not to get into that or even mention it. The pitch makes it seem like CBT on its own is going to solve every problem, but for many people it won't. Therapy didn't work for me at all until I got on medication, and then suddenly I had the ability to start to utilize a lot of the techniques I was learning and to be more mindful throughout the day.
- Other people have brought up the pricing model, but I just want to reinforce that this feels predatory to me, it feels designed to capitalize on behaviors that people with ADHD struggle with.
----
Getting more critical. From the FAQ:
> We are not trying to replace medication or in-person therapy.
This is not how you're phrasing your post on HN. If you're building a quick helper app so that people can do daily CBT exercises, then say that. I wouldn't be so critical of an app like that, I can see a lot of use for a Duolingo-style CBT exercise/reinforcement app.
But when you compare the price of your app to traditional therapy and intake, you are creating an implication that your app is a substitute for therapy or medication. And it's not, you need to be more upfront about that and you need to stop comparing your product and your product's pricing to normal medical treatment.
----
With all of the above in mind, (to me) $100 a year feels too expensive for a 5 ...
You make a really interesting point about diagnosis that I hadn't considered. Could an app like this _do harm_ by routing folks away from the traditional (albeit shitty) route of diagnosis and the subsequent treatment (insurance doesn't cover shit without a diagnosis)?
Just wishing YC was more discriminatory in who they allow into the program. This shouldn't have passed the smell test.
Good day!
Can you explain succinctly how you help with OCD?
None of what this website claims their website does aligns with any description of CBT for ADHD I've ever seen (either from practitioners, or from good friends of mine who undergo such therapy), and also is rife with "this app helps user do things in a self-directed manner" when having an executive disfunction is at the core of ADHD(!), as if the developers behind this app have never had ADHD and didn't even bother reading Wikipedia, let alone any actual research.
The billing system seems to be incredibly predatory as well, another typical anti-pattern used by companies that try to trap people with mental disorders.
Can someone from YC actually go on record and say this is part of YC S21? I don't see it listed officially from YC anywhere.
Link :- https://www.ycombinator.com/companies/inflow
This is not true at all. If anyone is considering ADHD therapy, please do not let such misleading figures dissuade you.
For anyone with insurance, the average cost of a therapy session is often as little as a $15-25 copay. You could get 4-6 in-person, personalized therapy sessions with an experienced provider for the same price as the annual fee of this app, depending on your insurance.
Even self-pay therapists don't charge $200-300 unless you look at the most expensive cities like NYC [1]. The average self-pay cost is going to be closer to $125 in most regions, though providers often have what's called "sliding scale" charges for low-income patients that go much lower.
The $10K-$16K per year figure is also extremely misleading. In the United States, the annual out-of-pocket maximum for an insurance plan is capped at $8,700 for an individual in a given year [2]. Mental and behavioral healthcare is covered as an essential health benefit [3]. It's not possible to spend $16K per year on any services unless you attend providers that don't accept insurance, which is exceedingly rare. Don't let any apps scare you away from professional services by quoting unbelievably high numbers.
If anyone is considering therapy, please visit your health insurance website and check the cost. Don't be discouraged by anyone trying to sell you alternatives. For most people with insurance (including government health insurance in the United States), several sessions are going to be cheaper than this app and will also provide more personalized, in-person care.
[1] https://blog.zencare.co/therapy-fees-private-practice-by-cit...
[2] https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
[3] https://www.healthcare.gov/coverage/mental-health-substance-...
I went to two in-network LMFTs that listed ADHD as a field they treated and they were complete shit. It was basic talk therapy with generic organizational suggestions like "have you considered keeping a todo list"
I went for 6 weeks with each just to make sure it wasn't just them establishing a baseline (and 6 weeks of copay was cheaper than a single visit to an out-of-network provider). In retrospect, the 6 hours of lost time was not worth it even if the visits had been free.
I have paid over $10k out-of-pocket in a single calendar year ($220 per session) to a therapist that actually helped and $0 was reimbursed by my insurance. I do live in an expensive area (SoCal) but not NYC expensive.
[edit]
None of this is saying I think the App from TFA will be useful; just refuting that everyone who is insured can get ADHD CBT treatment covered by insurance.
The situation has changed significantly under the ACA now that behavioral health is covered as an essential health benefit.
But you do have to go through your insurance company's website to find the in-network providers. As you said, you can't simply pick a therapist and then try to seek reimbursement later.
Some of the cash-only therapists are great if you can afford them. Some therapists strike out on their own as cash-only after building a reputation and a loyal client base. However, it's not a guarantee of success as cash-only also attracts a lot of people who simply want to maximize profit and not deal with insurance, so YMMV.
My meds are 100% covered (though I had to have my psychiatrist file some extra paperwork to get anything that wasn't Adderall or Ritalin) , so at least there's that...
Finding therapists who accept insurance is such a large problem in so many US cities that there are entire startups working to fix that (one example: https://headway.co/). $200-300/session is a low estimate for people in those markets.
As a point of comparison I have a son with severe dyslexia and another with severe ADHD. My son with dyslexia was completely illiterate until almost the 4th grade and now he is almost making a 4.0 in high school with ease. ADHD is by far the greater challenge affecting everything from learning, functioning, and motor cognition.
I am a bit hesitant to comment here. The last ADHD related thread I saw on HN was the worst shit show I have seen on HN filled with big tears and many narcistic people injecting unrelated defenses against personal attacks that didn't exist.
This reads....shitty. "I'm interested in business ideas for large frequently disadvantaged populations"... I mean...are you interested in ways to make money off cancer patients, too?
Stuff like this app needs to be part of a diverse treatment plan, not some profit center for an exploitative corporation.
> The last ADHD related thread I saw on HN was the worst shit show I have seen on HN filled with big tears and many narcistic people injecting unrelated defenses against personal attacks that didn't exist.
There's something a bit ironic about this statement...
If it actually helps treat cancer at a reasonable expense then absolutely. Medicine comes at a cost.
I sincerely hope you never find yourself bankrupted due to some condition outside your control.